Maximize surgery results and minimize recovery time with topicals

More plastic surgeons than ever before are stocking up their office shelves with skin care products designed to aid both preoperative and postoperative patients. Advanced technology is emerging to enhance surgery results and offer a multitude of options for those seeking age-defying skin. Plastic Surgery Products spoke recently with industry experts who shared their preferences.

PSP: Postoperative bruising, swel­l­ing, and scarring are concerns for anyone considering facial surgery. What can be done to lessen the trauma of surgery on skin?

Marini: A critical factor in outcome is based on skin conditioning prior to the procedure. I suggest that patients begin a preoperative program anywhere from 3 to 6 weeks prior to their procedure. It isn’t necessary to use excessive amounts of products or rely on complicated steps. Simplicity ensures patient compliance, which will maximize results. The key to simplicity comes with a systematic approach I call the Skin Care Management System. A professionally managed program includes:

• A cleanser (preferably containing Gly­colic Acid);

• Skin-rejuvenation products containing a technology that addresses cumulative sun damage and augments repair and some reversal of the damage;

• A resurfacing product containing acid or a combination of acids to help counter mild to moderate acne, rosacea, coarse texture, discoloration, and fine lines;

• A hydrator providing excellent barrier function that supports skin rejuvenation; and

• Sun protection.

Products such as supplemental resurfacing agents or therapeutics like Benzoyl Peroxide can be used as accelerators or supplemental additions. Conditioning and resurfacing topical agents increase the skin’s receptivity and responsiveness to surgery by reducing the stratum corneum barrier and increasing the skin’s metabolism. This accelerated exfoliation causes the epidermis to produce cells more rapidly and stimulates new collagen formation in the dermis.

CosMedical Technologies
Loretta Ciraldo, MD, FAAD

Loretta Ciraldo, MD, FAAD, founder of CosMedical Technologies, a skin care line sold through private label to physicians in 40 countries, has maintained a private practice in cosmetic and general dermatology since 1983. She is a medical correspondent for the Sunday edition of Today in South Florida, and she writes columns for both Les Nouvelles Esthetiques and Plastic Surgery Assistants Network publications.
GlyMed Plus
Christine Heathman

Christine Heathman is CEO of GlyMed Plus, an aesthetic/medical skin care line based in Utah and marketed internationally. For 8 years, Heathman has served as educational director/VP of the American Esthetician Association, and she helps build and unify the esthetician profession throughout the United States. As architect of her product line, she understands manufacturing as well as the importance of ingredients and safety guidelines.
Jan Marini Skin Care
Jan Marini

Jan Marini is president and CEO of Jan Marini Skin Research Inc, a California-based company that has provided cutting-edge, therapeutic skin care to physicians and licensed skin care professionals since 1994. Marini has been a product researcher for more than 30 years, and her skin care technologies are found in medical practices across the United States as well as in more than 80 countries worldwide.
Revision Skin Care
Tatiana Kononov

Tatiana Kononov is the Principal Scientist with Revision Skincare since 2001. She is a member of the Beta Gamma Sigma Honor Sociery, the American Chemical Society and was recently Chair of the Southwest Chapter of the Society of Cosmetic Chemists. Extremely proficient in the science of skin care formulation, she is well versed in regulatory and quality control matters.

Ciraldo: It’s impossible to have surgery without the chance of bruising, swelling, or scarring. However, utilizing topical vitamin K can minimize several postoperative drawbacks. Many plastic surgeons use Cos­Medical Technologies Vitamin K Crème (bid) for 2 weeks prior to surgery. It is well-tolerated and can decrease the severity of bruising. It can also be used postoperatively after the sutures have been removed to help bruises resolve faster.

Heathman: Postoperative morbidity of bruising and swelling is one of the most addressed concerns regarding patient recovery after surgery assessment. Aside from the no-control factors of genetics, medications, and supplements, low-dose ultrasound DermaSound Elite can modify the inflammatory response in a series of treatments prior to surgery and in conjunction with the GlyMed Plus preoperative skin care program. I also recommend GlyMed Plus E-Sensual Cream, a semiocclusive medical-grade vitamin E cream, and GlyMed Plus Arnica, known to reduce swelling and bruising. These combinations return skin to “normal” at a faster rate—elevating patient satisfaction for the physician.

PSP: Topicals get a lot of press. Do they give injectibles a run for their money, and will they ever replace surgery?

Kononov: The ingredients incorporated into today’s topical treatments are definitely advanced and much more functional than the simple “moisturizers” offered in the past. Although I believe in the effectiveness of certain topical treatments, I don’t think they directly compete with injectibles and surgeries. The latter provides instantaneous changes, topical treatments do not. Sur­geries and injectibles are also much more permanent than topical treatments. The obvious and important benefit of topical treatments is their effectiveness with a lack of invasiveness.

PSP: One dilemma we face is aging around the eyes. Do topicals really work to combat wrinkles and dark circles?

Marini: Yes, topicals work! Until now, when individuals would ask me what they could do to improve dark circles, I would answer, “Pick you parents!” Dark circles are generally a combination of hereditary with cumulative sun damage, plus these factors:

• Thinner skin on lower eyelids, which allows pigment and vessels to be more visible;

• Gravity, which causes under-eyelid skin to move downward, initiating more stretching and thinning. This allows the blood vessels and pigment to become more noticeable;

• Cumulative sun damage, which exacerbates these characteristics by increasing skin thinning and melanin content; and

• Inflammation.

A combination of retinol and vitamin K decreases pigment and repairs blood vessels; this is demonstrated in published medical studies. Retinoids decrease the appearance of lines and wrinkles, reorganize collagen, and help prevent the deposit of pigment in the epidermis. But these agents are highly unstable. The key is a stabilized polymeric controlled-release system that ensures complete stabilization and provides a controlled/constant release of actives. Results are rapid with noticeable improvement.

Kononov: Do topicals work? Absolutely! Like any product in the marketplace, specific brands are superior to others. We have found that the eye area is often the easiest to treat topically. The skin around the eye is very thin, and topicals have more of an effect on thinner skin. There are numerous ingredients today, such as specific peptides and standardized botanical extracts, that are clinically proven to diminish wrinkles and smooth out the skin around the eye. Revision Skincare’s Teamine Eye Complex contains several of these effective ingredients. Teamine is guaranteed to reduce the appearance of dark circles, puffiness, fine lines and wrinkles. This product has been so successful, it is now the number one eye cream for dark circles dispensed by dermatologists!

PSP: Peels prove so beneficial, but what about obvious discoloration?

Ciraldo: In general, I recommend against strong peels. It is virtually impossible to avoid a demarcation line near the jaw. I prefer lighter peels, like our 35% or 70% Professional Glycolic Acid Peel. The key is to apply maintenance products at home, such as the exfoliators (AHA Marine Moisture Crème) to the neck, chest, and facial areas. Also, a bleaching agent like hydroquinone (Glycolic Fade Crème) can be used to fade hyperpigmented areas.

Heathman: The purpose of a peel is to cause keratinocyte dyscohesion, reduce fine lines and wrinkles, combat dry skin, increase cellularity and clarity, reduce keratoses, refine pores, increase inner cellular substances of gags, and “rev” up cell turnover. No one peel suits all solutions or superficial problems. Skin color or texture abnormalities need different peel solutions, depth, exposure time, and pH values to be effective.

Superficial peels won’t correct 3-D, problems and too-aggressive peels cause more harm than good for superficial problems. Peels require a pretreatment time, and all skin types should be evaluated with regard to ethnicity to avoid problems like postinflammatory hyperpigmentation. There are many types of peels, so it’s imperative that the skin technician is familiar with each one to be effective. Peels performed with precaution and prudence are safe and effective for approximately 80% of the population. GlyMed Plus makes an extensive variety of skin peels for all skin types and colors.

PSP: Botulinum Toxin Type A revolutionized skin maintenance. Will anything else come close?

Kononov: No, it’s revolutionary and here to stay. But, the one constant in the field of skin care technology is change—and it is sure to come. Only the tip of the iceberg has been discovered when it comes to the field of peptides related to skin care. There are currently several anti-aging type peptide ingredients available which function similarly to Botulinum Toxin Type A. Revision Skin­care’s Revox is one of the leading products containing this new technology. To help physicians, aestheticians and consumers choose an effective product, Revision guarantees that Revox contains the highest percentage of anti-aging type peptides, more than any other product on the market. In the future we will continue to see phenomenal advancements in topical treatments and injectibles. These treatments will remain desirable because of predictability of results and lack of permanence.

Heathman: All manufacturers claim their skin products are the best. However not all achieve predictable or even favorable results. More important than product is the organized application and systematic protocol applied that identify the skin’s needs. There is no one product for healthy skin; and to achieve an optimal outcome, a balance between the “latest wrinkle ingredient” and the skin’s natural needs must be met. A skin care product can contain the antioxidant needed for cell protection; however, that is not enough. Cells demand hydration for proliferation and optimal health. Hylauronic Acid is an integral component found naturally in our skin that diminishes with age. It is the major component of the extracellular matrix and plays a major role in maintaining extracellular space, facilitating ion, solute, and nutrient transport.

Ciraldo: I believe visible improvement can be achieved if products with high concentrations of active ingredients are used. I recommend sunscreen with Titanium Dioxide or Micronized Zinc Oxide to prevent damage. When treating hyperpigmentation, hydroquinone remains the gold standard; and when combined with Glycolic Acid, as in our Glycolic Fade Cream, it achieves excellent results. Glycolic Acid rejuvenates skin by exfoliating and then rebuilding cell properties.

PSP: What is the next big breakthrough in skin rejuvenation?

Marini: An exciting new area of skin-care research focuses on instructions transmitted to cells and the cells’ ability to interpret and carry out these instructions, hopefully resulting in healthier and more youthful-looking skin. Of all the claims being made for topical technologies, these two agents get my vote with results that are truly remarkable:

• Thymosin beta-4: A string of 43 amino acid peptides help regulate immune cells and it is a powerful antiinflammatory and wound-healing agent. Research demonstrates the powerful effect Thymosin beta-4 has on aging skin because of its ability to communicate with cells to reduce free radical activity by stimulating the production of collagen and elastin.

Pentapeptides GM and GD: Pentapeptides are tiny strings of amino acids (proteins) that communicate with cells by directly improving or correcting instructions that cells need to function properly. These breakthrough peptides are different from early nonspecific peptides. Now we can selectively define the scope of each individual peptide, which enables us to “program” the desired type of repair or assistance.

PSP: After facial surgery, it takes months for skin to return to normal. What can speed up the healing process?

Heathman: Hylauronic Acid is the reason a baby’s skin is so vibrant and why small children do not scar from injuries. Traumatized skin recovering from facial-rejuvenation surgery needs more Hylauronic Acid to heal effectively and reduce the scar tissue. My experience with postoperative conditions is sometimes it takes years for skin and its supporting residents (nerves and cells) to return to normal; sometimes, normal never does return. Before a patient undergoes facial-rejuvenation surgery, he or she must be healthy. This seems like an antidotal statement, but a patient’s recovery speed correlates with his or her health. Recovery also depends on whether the patient has had professional skin treatments and therapeutic body massages, and if he or she followed preoperative and postoperative instructions from the surgeon. And, of course, good genetics did not hurt recovery speed, either!

I have 25 years’ experience with preoperative and postoperative patients, and there is no “magic” involved. Optimal healing involves good patient screening and individuals who are 100% compliant with their program. Scars are related to many genetic and ethnic factors, and the patient’s scarring history should be thoroughly evaluated. Knowing the patient’s genetic skin map and healing history is good patient care. n