Proper pre- and post-operative skin care speeds up healing time, protects the cosmetic surgery investment, and ensures the best possible results. The goal is to prepare skin for each procedure and determine the best course of action to achieve a healthy and speedy recovery. “Professional skin care is essential for optimal results after any aesthetic procedure, especially in [patients] undergoing face- and neck-lifts,” says Dr. Jonathan Brower, board certified plastic surgeon. Some suggested cosmetic procedures for mature clients for the face and neck include a face-lift (rhytidectomy), neck-lift (lower rhytidectomy), upper and lower eyelid surgery (blepharoplasty), eyebrow-lift (forehead lift), cheek augmentation, nose surgery (rhinoplasty), chin surgery (mentoplasty), and buccal fat removal (cheek reduction).
When designing a skin care plan for face- and neck-lift surgery, it is important to consider that most clients will have a mature skin type. This skin type tends to be on the drier side and needs consistent exfoliation to increase cellular turnover and moisture. “I have a low threshold to refer clients to a qualified aesthetician if I think they need to improve their skin quality and elasticity prior to surgery, a process that may take up to one year if there is significant damage. To complement my aesthetician’s efforts during this time, I will get the client started on a neurotoxin and prescription tretinoin regimen to soften fine lines and lighten dark spots. My expectation is that clients will keep up with all these modalities for an optimal result,” says Dr. Brower.
OPTIMIZING SKIN
{mprestriction ids=”3,4,26,18,6,7,8,9,14,18,43,44″}
Scheduling a series of in-spa professional exfoliation treatments prior to the surgery date benefits the healing process and optimizes results. If clients need to repair sun damage or smooth out texture on the surface of their skin, microneedling and chemical peels are great options. In-spa physical exfoliation treatments, such as microdermabrasion and dermaplane facials, are great options three to four weeks prior to cosmetic surgery to provide a mild form of superficial ablation to skin, removing the outer layer of dead skin cells. These treatments increase product penetration of hydrating ingredients to prepare skin for surgery. Dermaplaning, or epidermal leveling, also has the benefit of removing any vellus hair on skin, which may help create a smoother surface for the surgeon. Red LED therapy, or phototherapy, complements all the exfoliation treatments mentioned here. Treatment stacking with these nonablative procedures will bring great benefits to skin and speed up recovery time. Phototherapy prior to surgery may reduce the incidence of hypertrophic scars and keloids.[1] These professional methods combined with a proper homecare routine will brighten skin, restore collagen, promote healing, and help obtain a better cosmetic outcome.
HOMECARE HEROES
Skin needs to be healthy, strengthened, hydrated, and exfoliated before going into surgery. When using topical products formulated to prepare skin, common symptoms such as post-inflammatory hyperpigmentation, bruising, tightness, milia, vascular irregularities, erythema, and dryness can be reduced. Some key factors to take into consideration during the consultation are allergies, medications, skin type, Fitzpatrick type, and product and procedure history. This helps create a customized skin care routine for the client to start their journey through surgery.
Many products in a recommended pre-operative skin care routine may be used post-surgery while in the recovery stage. Mature skin tends to be on the drier side and incorporating ingredients to reduce transepidermal water loss will quickly boost hydration. Serums and hydrators with ingredients like squalene, ceramides, urea, glycerin, poly hydroxy acids (gluconolactone), lactic acid, and aloe vera are great choices to prepare and heal skin.
Cleansers may include an exfoliating agent like an alpha hydroxy acid or enzyme to aid in skin cellular turnover, and a zinc-based sunscreen is a must to reduce any ultraviolet A or B ray damage prior to the big day. Retinols are used to strengthen skin and can be combined with tyrosinase inhibitor topicals to decrease the risk of any hyperpigmentation or post-inflammatory hyperpigmentation. Ingredients such as niacinamide, hexylresorcinol, arbutin, silymarin, tranexamic acid, kojic acid, and L-ascorbic acid will all be effective.
PREPARING THE CANVAS
Board certified plastic surgeons may recommend combining multiple surgeries when possible. Adding an eyelift to a face- and neck-lift surgery is ideal when needed to have a single recovery period. This shortens the amount of downtime post-surgery for a combined duration. With eyelid and forehead-lift surgery, the eyebrows must be considered prior to the procedure. The area will be tender and too sensitive for any eyebrow services, such as waxing, threading, or lamination. If necessary, these services can be done prior to the surgery to bring confidence during the healing process. Incisions may be healing in the hairline or around the ears after cosmetic facial surgery.
POST-CARE
Some plastic surgeon offices have fully accredited operating and recovery rooms in the office, which allow for more access to the patient on the surgery date. Post-care instructions are given to the patient and any family or friend who may be accompanying them prior to the surgery. This provides more certainty and clarity on how to care for their skin when clients are released home.
Post-care recovery typically starts about two weeks after surgery with a skin care professional. Many clients are eager to heal and return to work and daily activities. Once cleared by the physician, the first step is to offer a paramedical camouflage makeup application. This helps conceal bruised skin, contour swelling, and hide incision sites. Covering up incisions along the ears after face- or neck-lift surgery and on the eyelid following upper eyelid surgery is a great way to guide clients back to everyday life. Providing small take-home kits of camouflage makeup after a demonstrated in-spa tutorial helps boost confidence during the recovery period.
Dry Skin
Dry skin accompanies most surgical procedures as a result of the temporary tissue swelling. Hydrating professional facial treatments and topicals are a must to aid in the recovery process. When the stratum corneum remains hydrated, skin has an environment conducive to healing. Instruct clients to allow the time for wounds to heal and refrain from peeling skin or picking scabs in an effort to speed up recovery. This may increase the likelihood of infection or worsen scarring. Providing an adjusted at-home skin care routine benefits symptom repair.
Example post-care cosmetic surgery skin care routine:
- Cleanse with a gentle soap-free cleanser
- Apply a recovery serum with hydrating and soothing ingredients
- Apply an ultra-hydrating moisturizer to occlude skin’s moisture barrier
- Apply a medical-grade silicone topical to apply over closed incisions sites
- Apply a zinc-based sunscreen (morning only)
- phply Hydrating lip care
This regimen may change based on the client’s recovery rate, skin condition, and lifestyle.
Edema
Another symptom to regulate post-surgery is edema. Swelling can take time to resolve, and lymphatic drainage massages help reduce this time. They are typically recommended after two to four weeks to reduce inflammation on the face and body. These gentle massages may be performed in the office manually or with an ultrasound machine once cleared by the surgeon. In conjunction with lymphatic drainage massages, low-level light therapy, or LED therapy, has been proven to reduce pain, increase tissue repair, shorten recovery time, and prevent post-inflammatory hyperpigmentation.1 Phototherapy has been shown to accelerate tissue repair, decrease wound size, accelerate the resolution of erythema, accelerate wound closure, and prevent dehiscence.2
SCAR MANAGEMENT
Scar management starts prior to surgery and continues in the post-care recovery process. Once incision sites or wounds have fully closed, sutures have been removed, and scabbing and oozing have resolved, topical agents, such as medical-grade silicone, can be applied to occlude the area and reduce transepidermal water loss to increase scar tissue healing. Clients can also massage their scars daily to break down scar tissue while applying the topical. It is recommended to continue the routine in the morning and night for at least three to four months to reduce the appearance of the scar once it is healed. If scars start to become hypertrophic, the surgeon may inject the site with an intralesional corticosteroid to reduce the raised tissue. This injection can be done multiple times if needed at the surgeon’s discretion. Once the scar is at least 12 to 18 months old, other treatments are available to reduce redness, hyperpigmentation, hypopigmentation, and texture.
Intense-Pulsed Light
A study suggests that intense-pulsed light therapy (IPL) is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin but also in reducing the height, redness, and hardness of scars.3Microneedling treatments assist with the mechanical breakdown of scars and allow for a new, natural wound healing cascade (as opposed to negative wound healing factors that were present in the initial injury and resulted in the scarring).4Needling the scar in a series of treatments also normalizes melanogenesis, reducing post-inflammatory hyperpigmentation.
Scar camouflage can be used on surgical scars at least one-year post-operative. It is a needle and pigment technique that blends scars into the surrounding natural skin using permanent makeup pigments to restore the color. This can renew confidence with cosmetic surgery patients. Scars may be behind the ears or on the outer hairline near the neck, and this can hamper them from wearing their hair up, exposing the healing skin. Once the scar is camouflaged, it appears to match the natural skin surrounding it, reducing its presence. All these methods can be performed and tolerated on the face and body post-surgery. Tummy tuck, breast reduction or lift, gynecomastia, and body-lift scars may take longer to heal considering the daily movement and pressure unavoidable to those areas during normal daily activities.
PROTECT THE INVESTMENT
Further skin maintenance post-cosmetic surgery will endure healthy and strengthened skin to protect clients’ surgical investment for many years. “It is important that expectations are set up front and that surgery is not a one and done treatment for facial aging so clients will participate in ongoing skin maintenance. During every consultation, I spend some time educating clients about the tripod of facial aesthetics: skin care, neurotoxin, and shape (surgery). I explain that investing in skin care and keeping up with neurotoxin treatments is necessary to get the best results and most longevity after a face- or neck-lift,” says Dr. Brower. Monthly professional exfoliation treatments and medical-grade skin care products for at-home care will increase collagen synthesis and stimulate the production of elastin, preserving results. Daily application of a zinc-based sunscreen will reduce ultraviolet A and B damage, such as hyperpigmentation, degradation of collagen, and skin cancer.
For the best results, patients undergoing cosmetic surgery are encouraged to seek the help of a qualified skin care professional to prepare and repair their skin before and after the procedure. This includes everything from exfoliation, homecare routines, potential post-surgery skin conditions, and scar management. With a multi-pronged approach to age management, restorative youth is possible.
References
- Barolet, D. (2008). Light-emitting diodes (LEDs) in dermatology. Seminars in Cutaneous Medicine and Surgery, 27(4), 227–238. https://doi.org/10.1016/j.sder.2008.08.003
- de Oliveira, R. A., Fernandes, G. A., Lima, A. C., Tajra Filho, A. D., de Barros Araújo, R., & Nicolau, R. A. (2013). The effects of LED emissions on sternotomy incision repair after myocardial revascularization: A randomized double-blind study with follow-up.Lasers in Medical Science, 29(3). https://doi.org/10.1007/s10103-013-1503-2
- Erol, O. O., Gurlek, A., Agaoglu, G., Topcuoglu, E., & Oz, H. (2008). Treatment of hypertrophic scars and keloids using Intense pulsed light (IPL).Aesthetic Plastic Surgery, 32(6). https://doi.org/10.1007/s00266-008-9161-7
- Setterfield, L. (2017).The Concise Guide to Dermal Needling (3rd ed.). Acacia Dermacare.
{/mprestriction}
Erin K. Bradford, president and founder of Advanced Aesthetics Skin Care Studio, is a nationally recognized practicing skin care expert and paramedical micropigmentation specialist who has worked alongside plastic surgeons for over 20 years. She was a previous faculty member for The Aesthetic Society. She currently provides pre- and post-cosmetic surgery skin care and scar management at her skin clinic in Greenville, Rhode Island.
