"For optimum results, you cannot perform IPL and just send the patient home. That patient needs to do things at home, before and after the procedure, in order to get the most out of the in-office procedure and truly maintain results," Kathy A. Fields, M.D., a San Francisco-based dermatologist and assistant clinical professor at University of California, San Francisco, tells Cosmetic Surgery Times.
An example, she says, is the patient who comes in for IPL treatment then goes home without solid sun protection awareness."Your patients may be wearing sun protection, but it might be titanium dioxide. Two months later, those people are back on your doorstep and angry because every little brown spot is back and they feel they did not get their money's worth," Dr. Fields says.
She will present her ideas at the American Society of Cosmetic Dermatology and Aesthetic Surgery annual meeting, taking place Nov. 30 to Dec. 3, 2006, in Las Vegas.
Clarity begins at home
Leveraging in-office treatments with effective at-home regimens starts with an excellent consultation and defined benefits for the patient, Dr. Fields says.
If the physician's goal is to remove brown spots and vascular lesions on the face, the physician has to be clear that the procedures available in the office will result in much improvement, but will not be perfect nor last forever. By complying with the recommended at-home regimen, patients will fare better.
Dr. Fields likes to start the at-home regimen a good month before surgery or treatment. If the treatment is for melasma, actinic damage or hyperpigmentation, Dr. Fields recommends gentle exfoliation with a scrub cleanser and a full-face hydroquinone-based system (though never on the spots). (Editor's Note: See associated cover story on the Food and Drug Administration (FDA)'s proposed hydroquinone ban.)
Her at-home treatment also includes the strict daily use of high SPF sunscreen with avobenzone, zinc or the new Mexoryl (L'oreal), as well as every other day use of a retinoid. She uses the same regimen for trichloroacetic acid (TCA) peels that aim to reduce hyperpigmentation.
For one week post-procedure (IPL or TCA), Dr. Fields stops the use of scrubs and retinoids and tells her patients to adhere to strict sun avoidance and sun protection to avoid skin irritation.
She has patients resume the regime after the week off. The at-home regimen is safe, she says. However, she warns patients that retinoids are drying and should be used every other day or Monday, Wednesday and Friday of each week to improve compliance.
What's new? What works?
Dr. Fields often adds some of the newer anti-aging preparations to her patients' at-home regimens.
"There is a huge list of chemical entities, including antioxidants and peptides, that have entered into the wrinkle arena," she says. "But it is very difficult to know from the companies what is real and what is not."
Dr. Fields says that, while all the new anti-wrinkle agents have excellent theory, few have reproducible or compelling scientific data.
"Yet, we consider these products to have value and think they are worth using," she says. "Vitamin C has been around since the 1990s and the data looks good, but real 'befores' and 'afters' have yet to be published for straight vitamin C."
Peptides do seem to penetrate and can be routed and programmed to build collagen and even slow muscle contraction.