Optimised skin health: preparing the skin before a procedure

By Allie Anderson / 01 Aug 2014

Allie Anderson speaks to practitioners about the role of primed skin in the run up to an aesthetic procedure

It’s said that beauty is only skin-deep, but when it comes to medical aesthetics it seems the two are irrevocably entwined. Beauty – in the aesthetic sense at least – fundamentally entails healthy skin, and there is an ever-increasing appreciation, by both practitioners and patients, of the association between inner health and outer beauty. No wonder, then, that optimum skin condition, both on the surface and from the inside, is fundamental in performing a successful aesthetic treatment.
“When patients come to you, they have to appreciate that they have a certain canvas, and there’s only so much fillers and Botox can do for you,” says consultant dermatologist Dr Sandeep Cliff. “People seem to think that these treatments are a panacea for complete skin rejuvenation. But if you’re given a poor canvas, then while you can make some improvements, you’re not going to get the ‘wow factor’ that many patients are hoping for.”
Dr Cliff highlights the importance of looking after the skin, not just in the run-up to a treatment, but as a preventative measure from a young age. This maximises the quality of the facial canvas should a patient decide to undergo a procedure to improve or enhance their appearance later in life. 

PREPARATION IS PARAMOUNT

Practitioners employ different protocols to boost skin health in the weeks and months leading up to an aesthetic treatment. Some less intensive treatments, such as fillers, botulinum toxin and superficial peels, require very little preparation at home according to Dr Cliff. Although he sometimes recommends a topical solution six to eight weeks before the planned treatment to even out the skin’s texture. “I tend to use a range which includes antioxidant-containing cleansers to improve texture. By using topical antioxidants in combination with fillers and Botox, you’ll have the best of both worlds, enhancing the deeper structures of the skin and its superficial texture.”
Preparation for the application of chemicals, on the other hand, is generally aimed at acclimatising the skin to the active ingredients, says Dr Rabia Malik, a specialist in chemical peels. “There’s a whole spectrum of different concentrations and various depths of penetration depending on the type of treatment,” she comments. “Anything more than a superficial peel requires a minimum of two weeks’ preparation.” This typically involves patients using vitamins A and C topically, as well as, in some cases, including a form of alpha hydroxy acid in their homecare regime. “Using the peel in the homecare regime conditions the skin for the stronger in-clinic treatment,” says Dr Malik. 

KNOWING YOUR PATIENTS

As the benefits of a holistic approach to medical aesthetics are becoming more widely acknowledged, practitioners are increasingly promoting a ‘whole-patient’ approach to treatment. Rather than simply employing a quick-fix solution to an aesthetic symptom, says consultant nurse practitioner Constance Campion, the focus ought to be on delivering a “patient-orientated symphony of care”, with the skin at its core. “The skin is the mirror of the mind, body and soul,” Constance says, “so it’s a key indicator to what’s going on with a patient.”
A thorough assessment, including an in-depth skin analysis and comprehensive consultation, is therefore the first step in preparing for a treatment. Not only does this process reveal whether additional skin enhancement or skin health restoration is indicated, it can also bring to the fore more fundamental issues in a patient’s life, such as unhealthy diet, lack of sleep, and poor mental (and sometimes physical) health – all of which need to be addressed before a treatment can be undertaken. “As a nurse, I’m responsible for the physical, spiritual and emotional needs of my patients,” Constance adds. “Does care go out of the window because we’re in aesthetics? I don’t think so.”
Getting to know your patients will also help guide the nature of the skincare regime you recommend for them to carry out at home, in the run-up to a treatment. Generally speaking, patients who are spending a lot of money in clinic are keen to take on board a practitioner’s advice and do whatever they can to optimise the results of their procedure, however onerous the regime. For Dr Cliff, keeping things simple is essential. “Gone are the days when patients expect to apply one cream and then another; nobody wants anything too complicated,” he says. “I advise patients to use an emollient moisturiser that contains sun block in the morning, and some sort of topical antioxidant with added retinoid in the evening, to allow the skin to rehydrate and rejuvenate.”

Skin preparation with Innovative Skincare
Dr Charlene DeHaven, clinical director of California-based Innovative Skincare, believes that aligning a patient’s regime with their existing skincare preferences is crucial. “Some patients are ‘minimalists’ and will not take the time to apply a large number of products. Multi-tasking products will be recommended for them,” she says. “Others are ‘power users’ and are quite willing to spend a great deal of time on skin regimes and are willing to use multiple products.”
According to Dr DeHaven, reputable products with a proven track record, the quality of which can be backed up by extensive experience and training, are essential. Most notable is a good, thorough yet gentle cleanser to exfoliate whilst also cleaning pores, alongside one or more other topical products such as serums, gels and creams that contain various cosmeceutical ‘actives’. Dr DeHaven adds that, in general, “the regime should address and achieve optimising epithelial turnover to physiologically more youthful values. It should improve skin cell metabolism, internal hydration and surface dryness. Improving fine lines and wrinkles as much as possible is also important so that further gains may be achieved via the procedure, lessening uneven pigmentation, decreasing pore size, and improving skin texture.”
Equally important is making sure patients know what to avoid. At the top of the list is excess sun exposure, which as well as increasing the risk of skin cancer, will also thin the skin, causing inflammation and discolouration – giving the skin a mottled and rough texture. “Patients should also avoid abrasive treatments, such as microdermabrasion and other types of peels,” says Dr Malik. “Some patients use bleach to lighten the hair on their face, but the chemicals in bleach can affect how the active ingredients in their treatment penetrate the skin, increasing the risk of interaction and side effects.” 

FROM THE INSIDE OUT

Healthy skin relies not just on what we do to it on the outside, but also how we treat it from the inside. “I believe the skin is an organ, not a face, and it’s connected to every organ in the body, so every organ in the body can affect how skin functions,” says Constance, highlighting the importance of addressing the nutritional needs of a patient in relation to their skin health, and the treatment they are undertaking.
“Our dietary choices dramatically affect the health of our skin, as well as ageing processes,” says nutritionist Kim Pearson. “Optimising skin health through diet will mean getting the most out of any aesthetic treatment and its results. It also potentially helps with healing time and recovery.”
There is a great deal of focus on topical antioxidants to prevent and combat premature ageing. But increasing the intake of antioxidants in the diet – by eating more vegetables and low- sugar fruits – can also help to protect the skin’s cells from free radical damage, noticeably improving skin health. “Fried, burnt and processed foods, as well as sugars, create free radicals so eliminating these in the diet in the first place is important,” Kim says. Patients seeking treatments to fill wrinkles and plump the skin may be surprised to learn that collagen can be boosted through diet too. “Collagen is protein, whether it’s from the skin, or from chicken, eggs and tofu. Once in the digestive system it’s broken down into amino acids and distributed throughout the body for different uses, including maintaining a healthy skin structure,” Kim explains. She adds that, despite the current trend for collagen- containing drinks to improve skin density and enhance the effects of medical aesthetic treatments, she believes most people would see equally good results by increasing their dietary intake of protein.
Constance also highlights the role of advanced glycation end- products (AGEs) in causing stiffening, weakening and noticeable ageing of the skin. AGEs are created through a process called glycation, whereby sugar molecules bind to the skin’s collagen. Reducing sugar in the form of refined carbohydrates is thus very important to skin health. Oily fish, particularly wild salmon, according to Kim, is a good source of the essential nutrient omega 3, which has anti-inflammatory properties and can help combat dry skin and maintain a supple complexion. “Supplementing certain nutrients can also be beneficial,” says Kim. “There are combinations available that boost a number of skin nutrients, including vitamins A, C and E, B-vitamins and zinc. Patients should also look out for supplementary sources of antioxidants, such as green tea catechins, anthocyanins from dark berries, citrus bioflavonoids, carotenoids such as lycopene and lutein from tomatoes, resveratrol from red wine and genistein from soy – all of which can offer potent protection to the skin.” Nutrition and diet must be addressed up to several months before an aesthetic procedure, in order for it to impact its success. In the shorter term, practitioners should advise patients to maintain hydration and ensure they are fully recovered from any illness or recent surgery before placing the body through the stress of additional treatments. “Rapid weight loss should also be avoided as this impairs protein synthesis, which is required for good healing and tissue regeneration,” comments Dr DeHaven. Skin- polluting agents such as those from traffic fumes and tobacco smoke can negatively affect skin health. Kim points out that smoke creates free radicals – unstable molecules that cause damage to cells and catalyse ageing – and is one of the main reasons that smokers’ skin ages significantly faster than that of non-smokers. Patients should therefore consider cutting down or stopping smoking to encourage healthier skin, as well as for general well-being. 

But if you’re given a poor canvas, then while you can make some improvements, you’re not going to get the ‘wow factor’ that many patients are hoping for. 

IN THE CLINIC

While the success of most procedures relies upon the patient having adhered to the advice and prescribed regime in the months and weeks beforehand, there is still room for some eleventh-hour prepping in the clinic immediately prior to the procedure. For the likes of botulinum toxin or a volumising treatment, this usually involves applying a thorough yet gentle cleanser. “My protocol also includes some light exfoliation, and I use a device called a Foreo, which uses sonic pulsations to lift debris from the surface of the skin,” says Dr Malik. “It’s a similar concept to other cleansing devices, but it’s less abrasive and more hygienic because it doesn’t use a brush. With peels, preparation can involve using a degreasing solution to remove any sebum from the skin.”
In the event that a patient has not been following a practitioner’s advice, all is not necessarily lost. “Things can still be done to help, such as extra cleansing, resurfacing or applying antioxidant serums and anti-inflammatories, as well as wound healers,” comments Dr DeHaven. “However, in all medical disciplines, prevention is always better than attempts at last-minute treatment.” Oral medication, though not typically necessary except in the case of pre- or post-treatment infection, is sometimes indicated. “Arnica in tablet form can be given a few days before dermal fillers and volumisers, and post-treatment, to prevent bruising,” says Dr Cliff. “I’d also tell patients to avoid taking aspirin-containing products that are more likely to make you bleed.”
Dr DeHaven adds that, since the outer layers of skin have very few blood vessels, medication taken orally tends to have difficulty reaching these areas. “There are no blood vessels in the epithelial layer of skin and nutrients must reach epithelium by the process of diffusion only. In the dermis, capillaries become much less dense progressing up from deep to superficial dermis. Orally ingested supplements are delivered from the gastrointestinal tract to target organ using the blood vessels. For these reasons, delivery of orally ingested nutrients is quite small in skin’s outer layers, and so topical products are essential in optimising results.” Similarly, Constance takes the view that with the advancement of more natural, biological solutions one should rarely need to resort to medication to improve skin health. “For example if we didn’t use antibiotics in the treatment of acne and instead used the alternatives that are now available to us, we’d make a huge contribution in the aesthetics and cosmetic dermatology arena to reducing antibiotic resistance,” she says.
Skin is an integral part both of a medical aesthetic treatment itself, and of its result. Adopting a multi-pronged approach to skin health ultimately means patients will leave the clinic looking and feeling their best, for as long as possible. 

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