Most clinicians who responded to a survey indicated not to use antiviral prophylaxis for nonenergy-based and injectable treatments.24,25 The literature supports universal oral antiviral prophylaxis, though, in practice, many clinicians only find this necessary in patients undergoing ablative procedures or those with a history of frequent herpes simplex virus outbreaks.24,25 The literature is inconsistent on what dose to give and when to start prophylactic antiviral treatment. Some authors recommend acyclovir (400 mg orally three times daily) or valacyclovir (500 mg orally two times daily), starting one day before the procedure and continuing for 6–10 days post-procedure.24,25
Outside the algorithm's scope, the panel recommends using oral antiviral prophylaxis for patients undergoing ablative treatments. For those patients requiring antiviral prophylaxis, the oral antiviral should be used for five days, starting one day before the procedure.24,25
As a pre-treatment before nonenergy and injectable procedures topical arnica/bromelain or products to prevent hyperpigmentation, especially in darker skin types (ie, Fitzpatrick Skin Types 4 to 6), have been recommended.24,25 Products applied for prevention and treatment of hyperpigmentation include topical hydroquinone (HQ), non- HQ agents to impact melanogenesis.24,25
Section 2: Before the Procedure
Pre-screening for nonenergy and injectable treatments should include a thorough discussion with the patient, including the reason(s) for treatment, the patient's expectations of treatment outcome, and what to do after the procedure.24,25 This is followed by a detailed discussion about possible sideeffects, complications, preventive measures, and signing the consent form before the treatment (Table 2).24,25 Both clinical and photographic outcome measurements are used to evaluate the primary outcome of the treatment.24,25
The advisors agreed to take a complete medical history before the nonenergy-based, or injectable treatment is initiated, asking the patient about their history of post-inflammatory hyperpigmentation, excessive scarring, drug allergies, and medical conditions. Further, the patient should be asked about previous facial treatments/surgeries, specifically chemical peels or dermabrasion, and the use of supplements and medication that could increase the risk of complications during the procedure.24,25 These agents include acetylsalicylic acid, ibuprofen, and vitamin E and should be avoided at least ten days before the procedure, unless prescribed for specific medical conditions.24,25
The literature is inconsistent about the use of topical agents and skincare before and after the procedure.30-39
Section 3: During the Procedure
Before starting the procedure, the skin is free of makeup and should be cleansed with a gentle facial cleanser.16 Agents such as isopropyl alcohol, chlorhexidine, or hypochlorous acid (HOCl) are frequently used for skin preparation for nonenergy and injectable treatments.36-45 Isopropyl alcohol, although inexpensive, can irritate the skin and is flammable.24,25 Chlorhexidine is used extensively and provides effective antimicrobial skin cleansing.40,41 However, it has both ocularand ototoxicity, especially to the middle ear.40,41 When using chlorhexidine in peri-ocular areas, it may contact the ocular surface, and corneal damage can occur.40,41 Therefore, a suitable alternative that is safe to use in these areas should be selected.24,25,42-45
The use of stabilized HOCl for skin preparation and after nonenergy or injectable procedures may have several benefits.24,25,42-45 Stabilized HOCl is highly active against bacterial, viral, and fungal microorganisms that have significantly harmful activity against biofilm and increases oxygenation of treatment sites to improve healing.24,25,42-45
When choosing topical antiseptics, antimicrobial resistance should be taken into account, and factors such as geographic
