INDIVIDUAL ARTICLE: Algorithm for Nonenergy and Injectable Treatment Pre-/Post-Procedure Measures

Abstract

Background: Nonenergy and injectable treatments are frequently used for facial rejuvenation. Many publications have addressed methods to reduce adverse events related to the procedure; however, no algorithm exists on temporol before, during, and after measures for nonenergy and injectable treatments. Methods: A panel of dermatologists and plastic surgeons convened a virtual meeting to develop an algorithm for measures before, during, and after nonenergy and injectable treatments based on the best available evidence and the panelists' experience and opinion. For the project, a Delphi method was applied, which was adapted from face-to-face meetings to a virtual meeting to discuss the outcome of literature searches to reach a consensus on the algorithm. Results: The four sections of the algorithm address measures for optimizing outcome before, during, and after the procedure. Prevention includes avoiding excessive sun exposure and the use of a broad-spectrum sunscreen with an SPF 30 or higher. Before nonenergy-based and injectable treatments, the avoidance of alcohol, retinol peels, and agents such as acetylsalicylic acid and nonsteroidal anti-inflammatory drugs, amongst other agents, is advised. Isopropyl alcohol, chlorhexidine, or hypochlorous acid (HOCl) prepare the skin before nonenergy and injectable treatments. The advisors recognize HOCL as particularly useful as it is active against bacterial, viral, fungal microorganisms and biofilm. The literature is inconsistent about the use of topical agents and skincare before and after the procedure. Conclusions: The algorithm aims to support an optimal treatment outcome for their patients, providing physicians with guidance on measures before, during, and after nonenergy and injectable treatments.

Fractional Er:YAG Laser and 0.01% Bimatoprost in Leucoderma From Iatrogenic Melasma Treatment in a Skin Phototype V Patient

“…Excimer laser, narrow-band UVB (NB-UVB), fractional carbon dioxide (CO 2 ) laser, fractional Er:YAG 2,940-nm laser, fractional nonablative 1,550-nm laser, and skin grafting showed efficacy in treatment of leucoderma from various causes. 4,5 Fractional Er:YAG laser noticeably lightened melasma in our patient. Unfortunately, leucoderma remained the same (Figure 1B).…”

“…Histopathology from hyperpigmented areas showed an increase in melanin and melanosome transfer, without atypical melanocytes. 5 To improve the leucoderma, fractional laser-assisted drug delivery with topical bimatoprost, followed by a daily application of bimatoprost, was therefore considered for our patient. Risks and benefits related to treatment, especially the darkening of melasma from bimatoprost, were discussed with the patient before the treatment initiation because this was an off-label use of bimatoprost.…”

Aesthetic considerations for treating the Asian patient: Thriving in diversity international roundtable series

“…However, Asian skin is also more prone to post‐inflammatory hyperpigmentation (PIH), melasma, lentigines, freckles, and other dyschromias, occurring earlier than in Caucasian counterparts 10 . This propensity is relevant when managing the Asian face with energy‐based devices; it is important to be aware of the potential for PIH and to ensure appropriate energy settings are used and pre/post procedure measures are taken 11,12 …”

“…10 This propensity is relevant when managing the Asian face with energy-based devices; it is important to be aware of the potential for PIH and to ensure appropriate energy settings are used and pre/post procedure measures are taken. 11,12 Importantly, skin quality concerns change over time, and predominating concerns differ depending on patient age. 13 A recent consensus manuscript by Park and colleagues provides detailed information on approaching these issues using multiple modalities aimed at addressing aging in multiple tissue layers.…”

A Retrospective Analysis of Complications of Minimally Invasive Cosmetic Procedures Seen at a Referral Practice in Houston

“…Before treating any patient, a thorough history and physical should be performed to assess for signs that may predict a higher risk of pigmentary changes or scarring conditions. 5 Although technological advancements have improved the safety and efficacy of many aesthetic procedures, complications are still possible and potentially devastating for patients. In the future, we plan to report the senior author's experience in effectively managing these complications.…”