An Overview of Skin Preparation

By Dr Rekha Tailor / 23 Feb 2018

Dr Rekha Tailor details how to effectively prepare the skin for chemical peels and injectable treatments

Optimum skin condition is fundamental to enhance the outcome of a treatment, reduce the risk of complications, and help to enhance and prolong the results of a treatment, resulting in happier and more satisfied patients. With proper skin preparation, generally both the epidermis and dermis are improved, skin is smoother, pigmentation is more even and barrier function is optimised. The resulting skin has a healthy glow, is more tolerant and less irritable.

Consultation

A comprehensive consultation, thorough assessment and in-depth skin analysis is the first step in preparing for any treatment. Fundamental issues such as an unhealthy diet, lack of sleep, and poor physical health all need to be assessed before treatment as they can contribute to oily skin, acne, skin dullness, broken capillaries, eye bags and dark patches of skin.

It is essential in the process of managing patients’ expectations to take a series of photographs to discuss with the patient what can realistically be achieved and improved. Photography-based skin analysis systems can take standardised photographs as well as providing a computerised analysis comparing patients’ scores to others of a similar age, which is very useful.

It is vital that patients are informed of everything they need to know every step of the way, so a comprehensive treatment plan is developed for this purpose.

Diet and lifestyle

It is important to always ensure patients are well-hydrated and that they have increased their intake of antioxidants by including more vegetables and low-sugar fruits from the current minimum recommendation of five portions per day to ten portions per day. These protect the skin from free radical damage and improve general skin health.1

Dietary protein also helps to maintain a healthy skin structure and should be increased,2 along with reducing the intake of sugars and refined carbohydrates, as well as eating plenty of oily fish rich in omega 3. In order to achieve the best results, diet and nutrition should be addressed several months before a treatment. In the short term, it is important to maintain hydration.

Sleep should be assessed as it allows the body to rehydrate and recover moisture; also, a rise of growth hormone permits damaged cells to be renewed  

As we know, alcohol increases the risk of bruising so it is best to advise patients not to drink the day before injectable procedures. It is also important to check if the patient smokes; smoking can inhibit vascular circulation, hence it can impede healing and increase the risk of infections, so it should be recommended for patients to stop smoking. Smoking also reduces the body’s supply of vitamin A and the absorption of vitamin C, both of which are essential in slowing the ageing process, therefore this should be a standard recommendation to your patients.3

Sleep should be assessed as it allows the body to rehydrate and recover moisture; also, a rise of growth hormone permits damaged cells to be renewed.4,5 Additionally, with sufficient sleep, there is greater circulation and oxygen flow to the skin, and toxins are also expelled. Long-term lack of sleep results in collagen degradation and premature ageing.1 It would be ideal if patients rested well at least one week before treatment, but as a minimum, a good night’s rest before the day of the treatment is essential.

 Air pollution is damaging to health and diseased skin and people with sensitive skin are more susceptible to pollution damage  

Environment

It is also important to check whether patients are exposed to pollution and traffic fumes, particularly if they live and work in a city.6 Exposure creates free radicals, which damages cells, causes ageing and also affects skin healing.7,8 In a study in 2010, on 400 women, measurements were made on skin ageing and also how much pollution the women were exposed to. They found that air pollution was linked to signs of skin ageing such as lines, age spots and hyperpigmentation. Increased pollution was associated with a 20% increase of age spots on the forehead and cheeks, as well as more pronounced nasolabial lines, demonstrating that there is a connection between pollution and extrinsic ageing. In 2014, there was an analysis of several studies which showed that skin damage due to pollution is a global problem; exposure to pollutants contributes to premature skin ageing; ozone depletes antioxidants from the skin; air pollution is damaging to health and diseased skin and people with sensitive skin are more susceptible to pollution damage.9

Health

Another crucial element in preparing the skin for treatment is to find out if the patient has any allergies to any substances that are in the injectables or skin peels. This could be ingredients in the peel solution such as glycolic acid, lactic acid or salicylic acid. Reactions to the skin from these products can include changes to the skin colour, itching, a skin rash or hives.10 With regards to fillers, some patients are allergic to local anaesthetics such as lidocaine, however this is rare.11 Signs of allergic reactions can be severe, and even fatal, if the patient were to suffer anaphylaxis.12 Reports of allergic reactions to botulinum toxin are uncommon.13,14

It is also important to check for systemic diseases, for instance, myasthenia gravis (MG), if a neurotoxin is going to be injected. MG is an autoimmune condition that causes muscle weakness and muscle fatigue. Treatment of an MG patient with botulinum toxin could worsen their symptoms.15 Hence, I believe a person with MG should not be treated. Patients on immunosuppressant and chemotherapy medication are more prone to infections and therefore should also not be treated. Practitioners should exclude patients who have a history of cold sores since an injection could precipitate an outbreak. If a person has a history of this then an antiviral medication needs to be prescribed to prevent a breakout.16

Before any treatment begins, patients must also be fully recovered from any illness or surgery. This is important so that patients recover quickly and reduce the risk of complications.

Preparation

To reduce the risk of infection and a biofilm developing, which can lead to chronic infection,17 it is imperative that the skin is prepared using sterile gloves and an aseptic technique prior to administering injections. This regime is crucial before any aesthetic procedure, as it contributes to optimum results and a speedy recovery time.

Specific treatments can be used to reduce the risk of bruising. This includes taking Arnica tablets, a herbal supplement, before injectable procedures, and consuming pineapple, which contains bromelain, before treatment which has been suggested to reduce swelling and inflammation.18 Patients should also avoid taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), fish oils, vitamin E and other blood thinners due to the risk of bleeding.

Skincare routine

A good place to start, which is both simple and effective, is to introduce patients to a good daily skincare regime. Skincare usage can result in dispersion of pigmentation and hence a more uniform and even skin tone. It can also improve the barrier function of the skin, reduce inflammation and plump and firm the epidermis, hence reducing the risk of bruising. It is best for patients to start this regime six weeks before treatment if possible.

Ingredients patients could benefit from in their skincare regime, depending on their individual needs, include:

Hydroquinone: supresses pigment production, however it is important to note that it can only be used for up to four to five months due to the risk of inflammation, rebound hyperpigmentation and reduced tolerance.19

Vitamin A (retinol): breaks up existing pigmentation and increases cell turnover to brighten and even skin tone.

Vitamin C (ascorbic acid): exfoliates surface skin pigmentation and helps to brighten skin.

Glycolic acid: helps to exfoliate and remove excess pigmentation from the skin’s surface.

SPF 40+: to guard against UV damage and hyperpigmentation.

By improving the skin quality and thickness, the risk of the Tyndall effect from dermal fillers is reduced. The Tyndall effect is a bluish discolouration that appears if hyaluronic acid is injected too superficially in the skin, therefore, by thickening the skin, this is less likely to occur.20

Conclusion

For a successful outcome with many procedures, the patient needs to adhere to advice for several weeks beforehand. For some treatments, such as botulinum toxin and filler injections, less preparation is needed by the patient beforehand, but ensuring a good diet, hydration and healthy lifestyle can enhance the treatment results and reduces the chances of side effects. If a patient chooses to have a procedure done, skin preparation helps the skin through the ordeal, and will make it easier for them to see the results they want faster and more safely.


References

  1. V. Lobo, A. Patil, A. Phatak, and N. Chandra, Free radicals, antioxidants and functional foods: Impact on human health, Pharmacogn Rev. 2010 Jul-Dec; 4(8): 118–126.
  2. Susan C. Taylor, What to Eat for Glowing Healthy Skin, American Academy of Dermatology, November 15, (2007)
  3. Rossi M, Pistelli F, Pesce M, et al. Microvasc Res. (2014) May;93:46-51, Impact of long-term exposure to cigarette smoking on skin microvascular function.
  4. Esteé Lauder Clinical Trial Finds Link between Sleep Deprivation and Skin Aging’, University Hospitals, (2013), <http://www.uhhospitals.org/about/media-news-room/current-news/2013/07/estee-lauder-clinical-trial-finds-link-between-sleep-deprivation-and-skin-aging>
  5. Rachel Leproult and Eve Van Cauter, Role of Sleep and Sleep Loss in Hormonal Release and Metabolism, Endocr Dev, (2011) <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065172/>
  6. Andrea Vierkotter, et al., “Airborne Particle Exposure and Extrinsic Skin Aging,” Journal of Investigative Dermatology, July 22, 2010; (130):2719-2726, http://www.nature.com/jid/journal/v130/n12/full/ jid2010204a.html
  7. Khalid Rahman, Studies on free radicals, antioxidants, and co-factors, Clin Interv Agin, (2007) Jun; 2(2): 219–236
  8. Dr Jane Leonard, The Effects of Pollution on Skin, Aesthetics, (2016)
  9. Jean Krutmann, et al., “Pollution and skin: From epidemiological and mechanistic studies to clinical implications,” Journal of Dermatological Science, September 13, 2014;1811(14)00193-5/abstract.
  10. WebMD, What is Salicylate Allergy? (2017) <http://www.webmd.com/allergies/salicylate-allergy>
  11. Dorota Jenerowicz, Adriana Polańska, Olga Glińska et al. Allergy to lidocaine injections: comparison of patient history with skin testing in five patients, Postepy Dermatol Alergol, (2014) <https://www.ncbi. nlm.nih.gov/pmc/articles/PMC4112262/>
  12. Emma Davies, Anaphylaxis, ACE group, (2016) <http://acegroup.online/wp-content/uploads/2016/01/ Anaphylaxis-v1.3.pdf>
  13. Careta MF, Delgado L, patriota R, Report of Allergic Reaction After Application of Botulinum Toxin. (2015) <https://www.ncbi.nlm.nih.gov/pubmed/26063836>
  14. Norbert Brüggemann, Lien Dögnitz, Lutz Harms et al. BMJ Case Report, (2009) <https://www.ncbi.nlm. nih.gov/pmc/articles/PMC3028521/>
  15. Ian Wright, Andrea Civitarese, and Richard Baverstock, The use of intra-detrusor onabotulinumtoxinA in patients with myasthenia gravis, Can Urol Assoc J, (2016) <https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5065409/>
  16. Nestor MS, ‘Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery’, J Drugs Dermatol, (2005). <http://www.ncbi.nlm.nih.gov/ pubmed/16300226>
  17. Souphiyeh Samizadeh, Biofilm, Aesthetics, (2016) <https://aestheticsjournal.com/cpd/module/biofilms>
  18. de Lencastre Novaes LC, Jozala AF, Lopes AM, de Carvalho Santos-Ebinuma V, Mazzola PG, Pessoa Junior A, Biotechnol Prog. (2016) Jan-Feb;32(1):5-13, Stability, purification, and applications of bromelain: A review.
  19. Rashmi Sarkar, Pooja Arora and K Vijay Garg, Cosmeceuticals for Hyperpigmentation: What is Available? J Cutan Aesthet Surg, (2013) <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663177/>
  20. Sclafani AP, Fagien S., ‘Treatment of injectable soft tissue Filler Complications’, Dermatologic Surgery, 35: s2 (2009) pp.1672- 1680. 

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