The algorithm (Figure 3) contains 4 sections: pre-procedural consultation; preventive actions before the procedure; practices during the procedure; and post-procedure care.
Section 1: Pre-Procedural Consultation
Before an aesthetic procedure can be deemed suitable for a specific patient, the individual's medical history is gathered. Medical conditions, medications, dietary supplements, and allergies to drugs, latex, or topical products are detailed. Outcomes of previous skin or surgical treatments are obtained, especially responses to dermabrasion or chemical peels. The expert panel agreed physicians should ask to examine scars that may not be obvious. People with hypertrophic scars, keloids, or changes in pigmentation will need periprocedural cosmetic practices to reduce the risk of these complications.8,9
The patient's motivation for seeking a procedure should be sought. Expectations of cosmetic benefits need to be realistic for a satisfactory outcome. Baseline photographic imaging can be helpful, followed by a detailed discussion about side effects and complications.8,9
The provider should acknowledge structural and functional differences in ethnic skin to discuss potential complications.4 Skin pigment is the most obvious difference. Increased melanin content and wide melanin distribution within epidermal keratinocytes confer greater protection against ultraviolet damage. Yet, melanocytes are labile in dark skin, leading to more pigment disorders. In SOC, hyperpigmentation is a frequent sequela of inflammatory dermatoses, skin injury, or photodamage.23-28 Inflammation induces cytokine production from epidermal keratinocytes, dermal fibroblasts, and other cells, which enhance melanin production.23 The result is postinflammatory hyperpigmentation (PIH) with uneven skin tone or dyschromia.23 Dyschromia is a significant concern for patients of color and is a frequent presenting complaint in dermatology clinics.4,24,25
In addition to undesirable pigment changes, invasive or traumatic procedures increase the risk of scarring.23 Scarring may occur through a complex interaction between fibroblasts, other cutaneous cells, and cytokines that foster excessive collagen production while inhibiting the degradation of extracellular
