Today’s skin care specialist, patient and plastic surgeon have available an array of choices related to rejuvenating treatments and cosmetic procedures.  Sometimes is can be confusing as to the appropriate sequence for these options to insure the patient’s best outcome.   I hope this article will give you some basic principles as a guideline for safe and effective results. 

My very first concern when I see any patient is “Have they been on steroids in the past six weeks or Accutane® in the past six months?  These two drugs will greatly affect the healing process.  It is important that all members of your team (doctor, nurse and aesthetician) know of any use of these drugs or any other change in the patient’s medical history since they were last seen.

The following list of treatments and procedures with their related factors should be considered prior to care:

Chemical Peels.  For patients of color, hydroquinone (HQ) therapy is recommended four to six weeks prior to peeling to avoid the possibility of post traumatic hyperpigmentation (PTH).  The patient should discontinue Retin-A® (tretinoin) one week prior to a glycolic or Jessner’s peel.  Tretinoin can be used up to the day before a tricholoracetic acid (TCA) based peel.  A superficial peel can be done six weeks after laser to “freshen” to dry skin.  Do not perform a skin peel on any patient who has been on Accutane® until at least six months after drug therapy has ended.  To reduce the risks of complications related to healing, wait six weeks for the patient to be off steroids prior to a chemical peel treatment..

Laser.  Avoid harsh chemical agents for six weeks due to the skin’s extreme sensitivity.  Permanent makeup (micropigmentation) should not be applied for four to six weeks post laser, since it’s necessary to frequently wipe the areas implanted with pigment which could cause unnecessary trauma to the lasered skin..

Microdermabrasion.  The patient should discontinue Retin-A® use one week prior to the procedure.  Cosmetic surgery patients experience hypersensitive nerve activity and will not tolerate the pulling sensation created by the suction device of the microdermabrader for at least six weeks postoperatively.

Collagen Replacement Therapy® or Dermologen®.  Since there are open areas from needle injections, it is not wise to combine treatments (i.e, facials or chemical peels).  By waiting three days between injectable therapies and facial procedures, you reduce the confusion as to the culprit if an untoward reaction occurs.

Facials.  Do not consider performing a facial on a post-surgical patient for at least two to three weeks after the procedure due to bruising discomfort.  After that time you may provide a treatment that addresses the patient’s needs, such as a light, relaxing facial or one designed to gently nourish and remoisturize the skin.  Realize that the skin and muscle in the neck area will feel excessively tight to the patient for about two months, but this sensation should lessen each day.

Hyfrecation.  To prevent infection or undue irritation, avoid the use of chemicals or creams with active agents until the broken skin has healed.  Patients should discontinue Retin-A® or alpha hydroxy acid (AHA) preparations until any crusts heal, usually within three to four days.

Laser Hair Removal.  Performing a test patch is absolutely necessary before treating patients of color.  Hydroquinone therapy is recommended beginning four to six weeks prior to treatment to “turn off” the melanocyte.

Waxing.  There have been reported cases of herpes after waxing the upper lip.  If the patient has a history of herpetic outbreak, it’s advisable to place her on acyclovir for five days, starting the day before treatment to prevent a recurrence.  Never wax someone who has used Retin-A® within the past week, and even then you may remove more than just hair!  Patients with sensitive skin should discontinue using glycolic products for three to four days prior to waxing.  Consider the use of hydroquinone for patients of color to prevent the possibility of PTH.

Electrolysis.  Again consider hydroquinone to prevent PTH.  Do not use creams or chemical on the face for at least four hours after breaking the skin to prevent irritation and/or infection.

Botox Injections.  Do not massage the area for one week after injection in order to keep the toxin from migrating.  The patient should be encouraged to remain upright for six hours following treatment for the same reason.  Patients may exercise the involved muscle during the first 24 hours to increase the absorption of the toxin.

Facial Grafts.  Avoid manipulation (facials or massage) of the area for at least two weeks to allow the graft to “set up.”

Facial Surgery.  Be aware that the patient will feel bruised for two to three weeks, depending on the procedure, area involved and individual recovery rate.  Their nerves are usually hypersensitive for three to four weeks afterwards, so a lot of touching gives them a “creepy, crawly” sensation rather than enjoyment.

Lymphatic Drainage/Massage.  Again, due to bruising, wait at least three to four days, then a light touch is greatly appreciated after a cosmetic procedure.  Remember to have clean hands to prevent introducing infection at the incision sites.

Liposuction.  Endermologie® therapeutic massage is a wonderful tool after liposuction to achieve a smooth result.  A light session may begin two to three weeks after the surgery, depending on the patient’s comfort and the surgeon’s recommendation, and may be increased over time.

Prior to providing ancillary treatments for any patient who is undergoing surgery, the skin care specialist should communicate with the plastic surgeon to insure the timing of the procedure is safe and appropriate.  These general guidelines may be helpful to you in planning, but individual consideration is of paramount importance.  If you have any specific questions you’d like answered, never hesitate to call me! 

Kathy Wright, RN