were reported anywhere from 0.04% to 0.2%.37 Biofilms are particularly problematic as they are challenging to treat.36 Most post-procedure infections are associated with pain, swelling, delays healing, and may lead to scarring and require an in-office evaluation.37-39,51-56
Few injectors regularly use prophylactic therapy before or after injectable treatment. When products were used to avoid or manage AEs, the heterogeneity of the measures prohibited identifying or establishing a standard.61
Given the large amount of aesthetic injectable treatments performed per year, the incidence rates of AEs, and the lack of any standard before, during, and after treatment measures, AE risk reduction must direct efforts at validating and standardizing these measures.24,25
Post-procedure, the advisors recommend avoidance of sun exposure, topical retinoids, and ascorbic acid/hydroxy acids to reduce the risk of proinflammatory pigment alteration or inflammation. They further advised to delay hair removal (eg, shaving, depilatories) between 24-hours post-procedure to two weeks post-procedure, depending on the procedure and specific patient requirements. Patients are advised to keep the treated site clean using a gentle cleanser and to keep the skin moist using a fragrance-free moisturizer (Table 4).
Various products are provided by clinicians to patients or recommended to use at home post-aesthetic nonenergy and injectable procedures. These products include white petrolatum, topical antiseptic cream or ointment, HOCl containing products, or products containing arnica or bromelain.24,25
Currently, there are no standards of practice for clinicians when using before, during, and after procedural measures for nonenergy and injectable treatments.24,25 Given the large amount of nonenergy and injectable treatments performed per year, the incidence rates of AEs, and the lack of standard before, during, and after procedural measures, AE risk reduction must direct efforts at validating and standardizing these procedural measures.
Few injectors regularly use prophylactic therapy before or after injectable treatment. When products were used to avoid or manage AEs, the heterogeneity of the measures prohibited identifying or establishing a standard.61
Given the large amount of aesthetic injectable treatments performed per year, the incidence rates of AEs, and the lack of any standard before, during, and after treatment measures, AE risk reduction must direct efforts at validating and standardizing these measures.24,25
Post-procedure, the advisors recommend avoidance of sun exposure, topical retinoids, and ascorbic acid/hydroxy acids to reduce the risk of proinflammatory pigment alteration or inflammation. They further advised to delay hair removal (eg, shaving, depilatories) between 24-hours post-procedure to two weeks post-procedure, depending on the procedure and specific patient requirements. Patients are advised to keep the treated site clean using a gentle cleanser and to keep the skin moist using a fragrance-free moisturizer (Table 4).
Various products are provided by clinicians to patients or recommended to use at home post-aesthetic nonenergy and injectable procedures. These products include white petrolatum, topical antiseptic cream or ointment, HOCl containing products, or products containing arnica or bromelain.24,25
Currently, there are no standards of practice for clinicians when using before, during, and after procedural measures for nonenergy and injectable treatments.24,25 Given the large amount of nonenergy and injectable treatments performed per year, the incidence rates of AEs, and the lack of standard before, during, and after procedural measures, AE risk reduction must direct efforts at validating and standardizing these procedural measures.
LIMITATIONS
Statements used in the algorithm were based on a mix of
data and expert opinion. While alternatives for before and
after measures for nonenergy-based-device and injectable
treatments could exist, the statements suggest best practices
developed from a panel of expert clinicians supported by peerreviewed
literature. However, there is a lack of literature that
explicitly addresses before and after measures for nonenergybased-
device and injectable treatments.
CONCLUSIONS
The algorithm designed to support optimal treatment outcomes addresses measures for prevention before, during, and after nonenergy and injectable facial treatments.
Prevention includes sun avoidance and the use of a broadspectrum sunscreen with an SPF of at least 30. Oral antiviral prophylaxis is recommended for those with a history of HSV-1. Stabilized HOCl has benefits for pre-, peri-, and postprocedure management combined with an emollient. A purpose-designed antimicrobial option for preparing the skin, as well as a topical post-treatment option, would be welcome.
Prevention includes sun avoidance and the use of a broadspectrum sunscreen with an SPF of at least 30. Oral antiviral prophylaxis is recommended for those with a history of HSV-1. Stabilized HOCl has benefits for pre-, peri-, and postprocedure management combined with an emollient. A purpose-designed antimicrobial option for preparing the skin, as well as a topical post-treatment option, would be welcome.
CONCLUSIONS
Swiss American, LLC supported the research and development of the algorithm with an unrestricted educational grant.
The pre-/post-procedure measures project group (authors) produced three published surveys: 1) Laser and energy devices, 2) Nonenergy devices, and 3) Injectables and one algorithm on laser and energy devices. The current algorithm addresses pre-/post-procedure measures for nonenergybased and injectable skin treatments.
The information obtained from the survey on nonenergy devices and injectables is used for the algorithm.
The pre-/post-procedure measures project group (authors) produced three published surveys: 1) Laser and energy devices, 2) Nonenergy devices, and 3) Injectables and one algorithm on laser and energy devices. The current algorithm addresses pre-/post-procedure measures for nonenergybased and injectable skin treatments.
The information obtained from the survey on nonenergy devices and injectables is used for the algorithm.
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10. Cosmetic Surgery National Data Bank Statistics. 2020; https://www.surge ry.org/sites /default/files /ASAPS -Stats 2020.pdf
11. American Society for Dermatologic Surgery (ASDS). Consumer Survey on Cosmetic Dermaotlogic Procedures; 2019. Accessed 11/March/2020 from: https://www.asds.net/Porta ls/0/PDF/consumer-survey-2019-infog raphic.pdf
12. Matarasso SL, Carruthers JD, Jewell ML. Restylane Consensus Group. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (restylane). Plast Reconstr Surg. 2006;117(3):3.
13. Rho NK, Chang YY, Chao YY, et al. Consensus recommendations for optimal augmentation of the asian face with hyaluronic acid and calcium hydroxylapatite fillers. Plast Reconstr Surg. 2015;136(5):940-956.
14. Kapoor KM, Chatrath V, Anand C, et al. Consensus recommendations for treatment strategies in indians using botulinum toxin and hyaluronic acid fillers. Plast Reconstr Surg. 2017;5(12):1574.
15. Fitzgerald R, Graivier M, Kane M, et al. Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations. Aesthet Surg J. 2010;30:36.
2. Panchapakesan V, Klassen AF, Cano SJ, Scott AM, Pusic AL: Development and psychometric evaluation of the FACE-Q aging appraisal scale and patientperceived age visual analog scale. Aesthet Surg. 2013;33(8):1099-1109.
3. Renton K, Keefe KY. Accurately assessing lines on the aging face. Plas Surg Nurs. 2018;38(1):31-33.
4. Karimipour DJ, Karimipour G, Orringer JS. Microdermabrasion: an evidencebased review. Plast Reconstr Surg. 2010;125(1):372-377.
5. Hou A, Cohen B, Haimovic A, Elbuluk N. Microneedling: a comprehensive review. Derm Surg. 2017;43(3):321-339.
6. Pathak A, Mohan R, Rohrich RJ. Chemical peels: role of chemical peels in facial rejuvenation today. Plast Reconstr Surg. 2020;145(1):58.
7. Rezaee Khiabanloo S, Jebreili R, Aalipour E, Eftekhari H, Saljoughi N, Shahidi A. Innovative techniques for thread lifting of face and neck. J Cosmet Dermatol. 2019;18(6):1846-1855.
8. Ablon G. Safety and effectiveness of an automated microneedling device in improving the signs of aging skin. J Cosmet Dermatol. 2018;11(8):29-34.
9. Schmitt L, Marquardt Y, Amann P, et al. Comprehensive molecular characterization of microneedling therapy in a human three-dimensional skin model. PLoS ONE. 2018;13(9):e0204318.
10. Cosmetic Surgery National Data Bank Statistics. 2020; https://www.surge ry.org/sites /default/files /ASAPS -Stats 2020.pdf
11. American Society for Dermatologic Surgery (ASDS). Consumer Survey on Cosmetic Dermaotlogic Procedures; 2019. Accessed 11/March/2020 from: https://www.asds.net/Porta ls/0/PDF/consumer-survey-2019-infog raphic.pdf
12. Matarasso SL, Carruthers JD, Jewell ML. Restylane Consensus Group. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (restylane). Plast Reconstr Surg. 2006;117(3):3.
13. Rho NK, Chang YY, Chao YY, et al. Consensus recommendations for optimal augmentation of the asian face with hyaluronic acid and calcium hydroxylapatite fillers. Plast Reconstr Surg. 2015;136(5):940-956.
14. Kapoor KM, Chatrath V, Anand C, et al. Consensus recommendations for treatment strategies in indians using botulinum toxin and hyaluronic acid fillers. Plast Reconstr Surg. 2017;5(12):1574.
15. Fitzgerald R, Graivier M, Kane M, et al. Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations. Aesthet Surg J. 2010;30:36.
