Whether a patient has undergone laser rejuvenation or skin resurfacing to address their sun damaged skin, the most important post-treatment skin care instructions that clinicians can give, say experts, must address sun protection and sun exposure.
“Sun protection is an absolute must, especially during the post procedure period, in order to prevent complications,” says Vivian W. Bucay, M.D., principal owner and dermatologist at Bucay Center for Dermatology and Aesthetics, San Antonio, TX.
The difficulty for clinicians lies in encouraging solid patient compliance relating to protection from sun exposure, the very reason for photoaging treatment in the first place.
Sun protection and avoidance applies to patient compliance no matter what the procedure, from laser rejuvenation and chemical peels to skin resurfacing and more.
“A common misperception is that results of a treatment will last indefinitely, and patients overlook the need for maintenance,” says Dr. Bucay. But it’s important for clinicians to clear up such misconceptions and explain proper skin care, which is primarily just a matter of patients limiting their sun exposure and taking proper precautions with sunscreen and protective clothing when sun cannot be avoided.
Dr. Bucay recommends addressing patient expectations in a thorough, unhurried consultation even before the procedure is scheduled.
“To understand a patient’s goal is the key. I write everything down and create a long-term treatment plan. They can understand ours is a long-term relationship that will require effort on both sides in order to achieve an optimal outcome,” says Dr. Bucay.
Even if a patient has a “one and done” attitude about treatment for aging skin and has no intention of further procedures, they need to be instructed and reminded that proper skin care afterward and certain lifestyle changes will prevent complications and eliminate or delay the need for subsequent treatments or touch ups.
Never Too Late to Protect
“It’s never too late to start strict sun protection to stop and even reverse some sun damage,” says S. Manjula Jegasothy, M.D., president, Miami Skin Institute, and clinical associate professor of dermatology, University of Miami Miller School of Medicine. “The top 10 proven products for preventing photoaging are [all] broad-spectrum sunscreens that protect against UVA, UVB and UVC radiation.”
Dr. Jegasothy takes a “protect your investment” approach when instructing her patients who have undergone an anti-aging procedure such as a chemical peel, laser treatment or neurotoxin injection.
“When I tell them [patients] that getting a lot of sun exposure after a procedure will just cause their sun damage to return more rapidly, they tend to listen and get a lot less sun exposure,” says Dr. Jegasothy. “Of course the most effective way to avoid photodamage is strict sun avoidance. I tell patients it is possible to live a full, healthy lifestyle outdoors while still protecting from sun damage, photoaging and skin cancer.” She urges patients to walk in the shade, sit under an umbrella or shade, and schedule outdoor workouts before sunrise or after sunset.
“Most people don’t realize that these are small lifestyle changes and choices they can make that really maximize their sun protection, prevent photodamage and still not reduce their fun factor,” says Dr. Jegasothy.
Both Drs. Bucay and Jegasothy find that the most common mistake patients make with regard to sun protection is overestimating sunscreen’s longevity and not reapplying sunscreen frequently enough.
“An SPF of 30 is adequate if reapplied every 30 minutes.” Dr. Jegasothy tells her patients. “Use only creams or lotions. Many experts feel that sunscreen sprays provide uneven coverage.” She also recommends sun protective clothing and points out that clothing loses its sun protective effect if it gets wet from physical activity and sweat.
Skin Care Product Rx
Dr. Bucay tries to keep her instructions simple in hopes of gaining post-op patient compliance.
“With so many products and technologies available to prevent and treat photoaging, navigating the options can be overwhelming,” says Dr. Bucay.
The two agents that she considers non-negotiable when it comes to keeping skin healthy and youthful after treatment are the use of sunscreen and a retinoid (either by prescription or over the counter).
Dr. Bucay also often recommends the oral antioxidant polypodium leucotomos extract, known as PLE and found in the oral supplement Heliocare. While PLE does not replace sunscreen, it is another tool in the fight against photodamage. PLE decreases the effects of UVA, UVB, infrared radiation and visible light on the skin. It also can help with skin firmness and elasticity by decreasing the production of matrix metalloproteinase (MMPs), the enzymes that break down collagen and elastin. She prescribes a once daily capsule each morning and reminds patients to not consider PLE a substitute for sunscreen.
Dr. Bucay judiciously prescribes alphahydroxyacid, such as glycolic acid, for nighttime use when sun is not a factor. Since this agent increases a patient’s sun sensitivity and risk of subsequent cancers, she insists on rigorous sunscreen use.
She educates her patients on how their compliance during recovery can impact results by explaining when they don’t understand or don’t want to comply, they are more likely to experience complications, such as scarring, infection or post-inflammatory hyperpigmentation after laser resurfacing or a medium to deep chemical peel. When they do comply, they are more likely to gain aesthetically pleasing results.
To emphasize what can happen as a result of non-compliance, Dr. Bucay shows her patients photographs of complications in other patients. This drives home her message of the importance of strictly adhering to the individualized protocol she gives each patient. Dr. Bucay lists instructions step-by-step, including a morning and evening regimen. She has customized information sheets for different procedures that she tailors to each patient’s case, which include pre-treatment and post-treatment instructions.
“Education empowers patients and enhances patient compliance,” Dr. Bucay notes. “If they understand the rationale behind a treatment protocol, they are more likely to follow it.