SUPPLEMENT: Algorithm for Pre-/Post-Procedure Measures for Facial Laser and Energy Devices Treatment

January 2021 | Volume 20 | Issue 1 | Department | ss3 | Copyright © January 2021


Published online December 24, 2020

Michael Gold MD FAAD,a Anneke Andriessen PhD,b David J. Goldberg MD JD FAAD,c Komel V. Grover MBA,d Shasa Hu MD FAAD,e Z. Paul Lorenc MD FACS,f Stephen H. Mandy MD FAAD,g Janelle M.Vega MD FAADh

aGold Skin Care Center, Nashville,TN;Vanderbilt University School of Medicine and Nursing, Nashville,TN
bRadboud UMC Nijmegen,Andriessen Consultants, Malden, Netherlands
cSkin Laser & Surgery Specialists of NY and NJ, Hackensack, NJ; Icahn School of Medicine at Mt. Sinai, New York, NY
dStrategic Development, Swiss American CDMO, Dallas,TX
eDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
fLorenc Aesthetic Plastic Surgery Center, New York, NY; Department of Plastic Surgery, Lenox Hill Hospital, New York, NY
gDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami FL
hMayoral Dermatology, Miami, FL
cDallas Center for Dermatology and Aesthetics, Dallas,TX
dGeorge Washington University,Washington, DC

The use of a clear amorphous antimicrobial gel containing ionic silver with high solubility designed to provide a moist wound healing environment while controlling bioburden with broad-spectrum antimicrobial protection without risk for resistance (US8568711; CA2692094; EP2170081) has been suggested for at-home, post-procedure care. Silver has a strong antimicrobial activity, and there is longstanding experience with its use in wound treatment.32-34 There are various types of silver formulations used, of which sulfadiazine is shown to slow wound healing, whereas nanocrystalline silver has been shown to have benefits.32-34 There is some evidence showing the benefits of silver containing products for short-term use in infected wounds.32-34 However, most of the studies lack robustness.32-34

According to the panel, there is an ongoing debate on the use of antimicrobial prophylaxis, which may be necessary for individual cases when the risk for postoperative infection is significant.6 Antimicrobial stewardship is needed while taking into account the patient’s condition. Details on post-laser care are provided in Table 4.

For post-procedure treatment, at home, a purpose-designed topical treatment option is currently lacking that may reduce inflammation and potentially the amount of downtime, and even maybe manage scarring outcomes.6

LIMITATIONS

The current algorithm aims to be a tool for clinicians to use when treating patients with laser and energy devices for facial rejuvenation. For preparing the skin frequently, products are used that are not purpose-designed for laser and energy devices treatment of the face. At the same time, the choice does not take into account antimicrobial stewardship. More research is needed to develop and evaluate measures that are suited for the purpose and reduce the risk of antimicrobial resistance.

CONCLUSION

The algorithm designed to support optimal treatment outcomes addresses prevention, pre-procedure, during the procedure, and post-procedure measures. Prevention includes sun avoidance and the use of a broad-spectrum sunscreen with an SPF of at least 30. Oral antiviral prophylaxis is recommended for ablative laser treatments. Stabilized HOCl has benefits for pre-, peri-, and post-procedure 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.

ACKNOWLEDGMENT

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) Non-energy devices, and 3) Injectables.

The information obtained from the survey on laser and energy devices is used for the algorithm.

REFERENCES

  1. Krutmann J, Bouloc A, Store G, et al. The skin aging exposome. Dermatol Science. 2017;85(3):152-61.
  2. Porcheron, A, Latreille, J, Jdid, R, Tschachler, E, Morizot, F. Influ- ence of skin ageing features on Chinese women’s perception of facial age and attractiveness. Int J Cosmet Sci. 2014;36:312-20.
  3. Dierickx C. Using normal and high pulse coverage with picosecond laser treatment of wrinkles and acne scarring: Long term clinical observations. Lasers Surg Med. 2018;50(1):51-55. doi: 10.1002/ lsm.22763. Epub 2017 Nov 15.
  4. Wu DC, Fitzpatrick RE. Facial rejuvenation via sequential combined use of multiple laser modalities: Safety and efficacy. Lasers Surg Med. 2016;48(6):577-83.
  5. Ibrahimi OA, Saedi N, Kilmer SL. Laser-based treatment of the aging face for skin resurfacing: Ablative and nonablative lasers. Part 3. Aesthetic Surgical Procedures 2015;Elsevier Inc:549-560. DOI:10.1016/B978-0-323-26027-5.00034-6
  6. Gold M, Andriessen A, Cohen JL, Goldberg DJ, Grover K, Hu S, et al. Pre-/post-procedure measures for facial laser and energy devic- es treatment: A survey. J Cosmet Dermatol. 2020;19(2):289-295. https://doi.org/10.1111/jocd.13259
  7. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clinical Pharmacy. 2016;38(3):655-662.
  8. Søndergaard E, Ertmann RK, Reventlow S, Lykke K. Using a modi- fied nominal group technique to develop general practice. BMC Family Practice. 2018;19(1):117.
  9. Evans GW. Artificial intelligence: Where we came from, where we are now, and where we are going. University of Victoria. 11 July 2017. Available at: https://dspace.library.uvic.ca/handle/1828/8314 (accessed 2020).
  10. Smith Begolka W, Elston DM, Beutner KR, et al. American Acad- emy of Dermatology evidence-based guideline development pro- cess: responding to new challenges and establishing transparency. J Am Acad Dermatol. 2011;64(6):e105-12.
  11. Adamic M, Pavlovic MD, Troilius Rubin A, Palmetun-Ekbäck M, Boixeda P. Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatol- ogy. J Euro Acad Dermatol Venerol. 2015;29(9):1661-1678; PMID: 25931003 DOI: 10.1111/jdv.13177
  12. Jonson D, Paletta F. Skin resurfacing procedures of the upper face. Atlas Oral Maxillofac Surg Clin North Am. 2016;24:117.
  13. World Health Organisation. Globally, an estimated two-thirds of the population under 50 are infected with herpes simplex virus type 1, 2015. http://www.who.int/mediacentre/news/ releases/2015/ herpes/en/
  14. Balasubramaniam, R, Kuperstein, AS, Stoopler, ET. Update on oral herpes virus infections. Dental Clinics of North America. 2014;58(2):265-80.
  15. Beeson WH, Rachel JD. Valacyclovir prophylaxis for herpes simplex virus infection or infection recurrence following laser skin resurfacing. Dermatol Surg. 2002;28(4):331-36.
  16. Nestor MS. Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery. J Drugs Dermatol. 2005(Nov-Dec);4(6 Suppl):s20-5.
  17. Alster TS, Lupton JR. Prevention and treatment of side effects and complications of cutaneous laser resurfacing. Plast Reconstr Surg. 2002;109:308-16.
  18. Tremaine, AM, Avram MM. FDA MAUDE data on complications with lasers, light sources, and energy-devices. Lasers Surg Med. 2015;47(2):133-140. https://doi.org/10.1002/lsm.22328
  19. O’Neill J. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. Rev Antimicrob Resist. 2014;1-16 3.
  20. Bassetti M, Poulakou G, Ruppe E, Bouza E, Van Hal SJ, Brink A. An- timicrobial resistance in the next 30 years, humankind, bugs and drugs: A visionary approach. Intensive Care Med. 2017;43:1464- 1475.
  21. Thum D, Seidl HP, Hein R, et al. Current resistance patterns of Staphylococcus aureus towards topical antibiotics and relevant an- tiseptics in patients with atopic dermatitis and impetigo. J Dtsch Dermatol Ges. 2013;11(9):875-8. doi: 10.1111/ddg.12111.
  22. Wernli D, Jørgensen PS, Harbarth S, et al. Antimicrobial resistance: The complex challenge of measurement to inform policy and the public. PLOS Med. 2017;(8):1-9. https://doi.org/10.1371/journal. pmed.1002378
  23. Van Boeckel et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lanc Infect Dis. 2014;14(8): 742-750.
  24. World Health Organization (WHO). Antimicrobial resistance [in- ternet]. Media Center. 2018. Available from: https://www.who.int/ news-room/fact-sheets/detail/antibiotic-resistance
  25. Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011;86(11):1113-23.
  26. Gold MH, Andriessen A, Batia AC, Bitter P, Chilukuri S, Cohen JL, Robb CW. Topical stabilized hypochlorous acid: The future gold standard for wound care and scar management in dermatologic and plastic surgery procedures. J Cosmetic Dermatol. 2020;19(2):270-277. https://doi.org/10.1111/ jocd.13280
  27. Steinsapir KD, Woodward JA. Chlorhexidine keratitis: Safety of chlorhexidine as a facial antiseptic. Dermatol Surg. 2017;43(1):1-6.
  28. Bever GJ, Brodie FL, Hwang DG. Corneal injury from presurgical chlorhexidine skin preparation. World Neurosurg. 2016;96:610 e1- e4
  29. Chapman I, Hsu, J, Stankiewcz K, Bhatia, A. Use of hypochlorous acid as a pre-operative antiseptic before placement of dermal fill- ers: an alternative to standard options. Dermatol Surg. 2018(4):597- 599. doi: 10.1097/DSS.0000000000001245.
  30. Bhatia AH, J, Schlesinger, T, Weiss, R. Optimizing wound healing for cosmetic and medical dermatologic procedures. Practical Dermatol. 2018;1:42-5.
  31. Biesman B, Cohen, JL, Gold, MH. Integrating HOCl into wound care: The new paradigm for patient management. Practical Dermatol. Special Section: Clinical Insights. 2017;7:1-2.
  32. Khansa I, Schoenbrunner AR, Janis JE. Silver in wound care – friend or foe? A comprehensive review. Plast Reconstr Durg Glob Open. 2019;7(8):e2390.
  33. Dissemond J, Böttrich JG, Braunwarth H, et al. Evidence for silver in wound care - meta-analysis of clinical studies from 2000-2015. J Dtsch Dermatol Ges. 2017;15:524-535.
  34. Li HZ, Zhang L, Chen JX, et al. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: A systematic review and meta-analysis of randomized controlled trials. J Surg Res. 2017;215:98-107.

AUTHOR CORRESPONDENCE

Anneke Andriessen PhD anneke.a@tiscali.nl
Close Menu