PRE AND POST- skincare PROCEDURE

Dr Ginni Mansberg looks at what the evidence tells us

DR GINNI MANSBERG

The founder of science based Evidence Skincare (ESK), and author of bestseller, The MWord, How to Thrive in Menopause, Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women’s health, menopause and all things skin. Dr Mansberg is the “Sunrise GP” on Channel 7, the host of Channel 9’s Embarrassing Bodies Down Under and Medicine or Myth on SBS. She is also the host of Help I Have a Teenager on the Mamamia Network, Things You Can’t Talk About on TV, a podcast on Audible, as well as the host of Drivetime Medical, an educational podcast for health care professionals. She was named most trusted health care professional in Australia in 2022. Dr Mansberg teaches primary care at the University of Notre Dame, is a speaker, a non-executive director and consultant.

What skincare should we recommend for our patients before and after cosmetic procedures? The literature has been surprisingly inconsistent about skincare recommendations before and after treatments, from the minimally invasive and non-energy-based ones (injectables, microdermabrasion, microneedling, threads and chemical peels) through to energy-based procedures including ablative and nonablative lasers, intense pulsed light (IPL) and radiofrequency (RF) microneedling. Surveys of practitioners offering these treatments show a lack of consensus on best practices. No wonder it’s confusing!

Common sense tells us that we want pre-treatment skin that is well moisturised with as little recent sun damage as possible. Post-treatment, we want to minimise side effects (especially post-inflammatory hyperpigmentation), promote healing, reduce inflammation and enhance results. But what does the evidence say?

With the demand for these procedures on the rise, and more and more patients turning to social media for ‘information’, there is a real need to provide our patients with expert, evidence-based skincare advice. Luckily, we are seeing some guidelines emerge based on published reviews of the available literature, and round table expert discussions.

SUN PROTECTION – A NON-NEGOTIABLE

No surprises here, with virtually unanimous agreement among the experts that no matter the procedure, strict sun avoidance measures are advised for at least four weeks before any procedure and for four to eight weeks after. Ultraviolet radiation from the sun not only causes photoaging but is pro-inflammatory and has obvious effects on melanocytes, increasing pigmentation problems.

Proper sun protection includes daily use of a broad-spectrum sunscreen with a high SPF that blocks UVA and UVB rays from the sun. This should be reapplied every two hours and be supplemented by a broad-brimmed hat and sunglasses when outdoors. This also applies to patients with skin of colour. Look for a sunscreen with physical sunscreen ingredients (zinc oxide and titanium dioxide), they tend to be better tolerated by sensitive skin than chemical sunscreen ingredients. ESK’s daily sunscreen, Zinc Shade, contains zinc oxide as its active ingredient, a mineral sunscreen that sits on the skin, rather than being absorbed into it, physically blocking UVA and UVB rays. It is proven to be safe and effective and is non-comedogenic with anti-inflammatory properties. The formulation feels light on the skin without that white sheen that patients usually dislike, so it is suitable for everyday use.

GENTLE CLEANSING

Twice daily gentle cleansing is recommended in the lead-up to the procedure and in the days and weeks afterwards, with a soap-free, physiologic (4-5) pH cleanser. Harsh cleansers, particularly alkaline soap-based ones, tend to be pro-inflammatory. Gentle cleansing also means no physical scrubs, rinsing off with lukewarm water and gently patting dry without any vigorous rubbing. Easy does it! With a pH range of 4.5 - 5, ESK’s Calming Cleanse is a soap-free creamy cleanser containing soothing botanicals that is gentle enough to be used twice a day.

MOISTURISER AND ACTIVE INGREDIENTS

Pre-procedure we’re looking for well hydrated skin with an intact barrier function. Moisturisers with gentle actives are ideal. We want to avoid anything that might trigger inflammation or sensitivity (including fragrance). After the procedure, we are looking to soothe inflammation and promote healing. ESK’s Repair+ is a nourishing moisturiser that contains niacinamide, a proven antiinflammatory, anti-oxidant, moisturising and pigmentation stabiliser, along with a slug of hydration-boosting ceramides and mid-molecular weight hyaluronic acid, peptides, squalane and panthenol. It’s also fragrance-free. You can complement Repair+ with Hydraboost HA Serum for an extra hydrating and collagen-promoting shot of hyaluronic acid in an evidence based mix of molecular weights.

PIGMENTATION CORRECTORS

Pigmentation issues are a common indication for cosmetic procedures, and also ironically one of the main concerns around side effects, namely post-inflammatory hyperpigmentation. For both reasons, most guidelines recommend considering a pigmentation corrector in the pre-procedure skincare routine, especially in patients with skin of colour. Hydroquinone is often suggested but has well-known downsides. 4-N-buterylresorcinol (4-N-B) is a tyrosinase-inhibitor proven to reduce melanin production that’s gentler and as effective (if not more) than hydroquinone. Don’t forget that retinoids like retinal are also tyrosinase inhibitors and other antioxidants such as niacinamide and vitamin C in the form of L-ascorbic acid also help combat pigmentation. So too do hydroxy acids.

Note that most guidelines recommend holding off on retinoids and anti-pigment ingredients including vitamin C and hydroxy acids, for the first week after most treatments, particularly ablative ones, as they may irritate. They can be gradually introduced ont to four weeks postprocedure depending on the need, or held off until healing is complete.

ESK has a suite of products containing proven pigmentation-busting ingredients suitable for use before and after procedures. Enlighten contains tyrosinase-inhibiting 4-N-B, Ultimate A contains retinal – gentler and more effective than its old-school cousin, retinol; both products also contain niacinamide. You’ll find AHAs in Smooth Serum or the more gentle PHAs in Gentle Glow, and L-ascorbic acid in a stable form in Reverse C Serum.

CONCLUSION

With proper attention to skincare before and after cosmetic procedures, we have a golden opportunity to help our patients get the best possible results. Thankfully we now have some emerging expert consensus to guide us and a suite of evidence-based ingredients to choose from.