Anna Williams Capstone Project

Cosmetic Dermatology

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Table of Contents

Neuromodulators (Botox)

Dermal Fillers

Platelet Rich Plasma (PRP)

Deoxycholic Acid (Kybella)

Laser Resurfacing

Hydrafacials

Chemical Peels

Neuromodulators

(Botox, Dysport, Xeomin)

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Neuromodulators

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What are Neuromodulators? (Botox, Dysport, Xeomin)

• Neuromodulators are injectable forms of Botulinum toxin, a neurotoxin that is produced by the bacteria Clostridium botulinum.
• This medication works through inhibiting neurotransmission between nerve endings and muscle fibers where it is injected. This weakens or paralyzes the skeletal muscle.
• The toxin works to prevent muscle contraction through inhibiting the release of a neurotransmitor, Acetylcholine, from the peripheral nerve cells.
• There are multiple different types- in aesthetics, Botulism type A is the most common.

Neuromodulator: Benefits

• If neuromodulators are used correctly, they are a very safe method to improve cosmetic defects that are caused by or worsened by muscle contraction.
• Effects of muscle paralysis are temporary- injected locations typically return to baseline within a few months.
• Relax muscles to decrease facial lines and wrinkles.

Neuromodulator: Risks

• Pain and bruising are common. Minimize these with application of ice prior to treatment, use of topical anesthetic agents, and vibrational anesthesia.
• Side effects are usually mild and short-lived-> swelling at injection site, mild headache, flu-like symptoms.
• Risk of undesired impairment of muscle function, blunted facial expressions.
• Diffusion of toxin into other areas may cause undesireable effects-> brow ptosis, double vision, eyelid droop, excessive tearing, decreased strength of eye closure, and dry eye in the upper portion of the face. In the lower portion of the face there may be flaccid cheek, asymmetric smile, loss of ability to whistle, or drooling.

Neuromodulator: Indications

• For treatment of facial lines and wrinkles as well as more advanced facial sculpting.
• Effective treatment for aesthetic concerns that are caused by muscle contraction.
• Additional signs of aging including sun spots, spider veins, texture changed and skin laxity, often require additional cosmetic procedures to achieve satisfaction, in addition to neuromodulators.
• FDA approval for cosmetic use of neuromodulators is limited to glabellar lines, lateral canthal lines (crows feet) and forehead lines, although it is often used in additional areas.

Neuromodulator: Locations

• As stated in indications section, neuromodulators are only FDA approved for use in glabella, crows feet and forehead lines, but they are often used in additional areas.
• Often used for glabella, forehead, crows feet, depressed brow, bunny lines, nostril flare, drooping nasal tip, nasolabial folds, mouth frown, gummy smile, horizontal crease on chin, marionette lines around mouth, horizontal neck lines.

Neuromodulator: Length of Time

• Effects of neuromodulators are short lived- muscle function typically returns to baseline within a few months.
• Clinical effects begin to appear 1-3 days post-injection, peak in 1-4 weeks, and gradually decline for about 3-4 months.
• Duration of response to neuromodulators depends on injection site, dose, and specific formuation along with how well the individuals body breaks down the toxin.
• Some patients who receive repeated injections in one area may report benefits for 6+ months which may be due to development of muscle atrophy.

Neuromodulator: Preparation for Appointment

• Apply ice prior to appointment to minimize brusing and pain.
• Avoid taking medications that are inhibitors of platelet function (aspirin, vitamin E, alcohol, blood thinners) for 7-10 days is preferable if they are able to be discontinued safely.

Neuromodulator: What to Expect at Appointment

• Injector may use topical anesthetic agents or vibrational anesthesia to minimize pain.
• A small volume insulin syringe with a very small diameter needle is most commonly used. The number of injections and spacing of injections is dependent on the specific cosmetic defect that is being treated.
• Direct pressure will be applied right away after removal of needle to reduce the risk of bleeding and bruising.
• The injection sites may be massaged after injection in attempt to spread the toxin, which may increase the efficacy of treatment.

Neuromodulator: After Appointment Care

• After appointment, remain in upright position for at least 2-4 hours after treatment.
• Avoid direct pressure or rubbing on injection sites and treated areas for at least 24 hours.
• Contract and relax the treatment areas as much as possible during first few days after treatment as this may facilitate uptake of toxin by neurons and accelerate the appearance of the neuromodulator effect.

Dermal Fillers

(Restylane, Juvederm, Radiese, Sculptra, etc.)

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Dermal Fillers

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What are Dermal Fillers? (Restylane, Juvederm, Radiese, etc.)

• Variety of types-> biodegredable products (hyaluronic acid, collagen, calcium hydroxylapatite and poly-L-lactic acid) and products that remain indefinitely in tissue (polymethylmethacrylate microspheres, hydrogel polymers, silicone), as well as viable autologous fat.
• Dermal Fillers are administered as an injectable into desired locations.

Dermal Fillers: Benefits

• Many dermal fillers are biodegradable products that are reversible in cases of undesired placement.
• Permanent dermal fillers should be used only in carefully selected patients.
• Improve lost volume and fill coarse wrinkles for treatment of facial aging.

Dermal Fillers: Risks

• Safety in pregnancy and lactation has not been established.
• Contraindications: infection at or near injection site or allergy to product.
• Early reactions: appear in 0-14 days after injection
• Bruising, swelling, redness, vascular compromise (resulting in tissue necrosis from compression or obstruction of blood vessel-> RARE, but in this case, discontinue injection, massage site, apply heat and nitroglycerin paste), and vision loss.
• Late/Delayed reactions: appear 14 days- 1 year after injection
• Formation of nodules under skin, inflammatory reactions, chronic infections, consequences of filler migration/ undesireable effects.

Dermal Fillers: Indications

• Used for facial aging by restoring youthful appearance through replacement of lost tissue volume and filling in of wrinkles.
• Can be used alone, or in conjunction with other aesthetic procedures to help the appearancce of wrinkles and restore tissue volume loss due to aging.
• Therapeutic applications: correction of defects due to medical disorders, trauma or surgery (HIV associated lipoatrophy, scarring, facial asymmetry, and soft tissue defects.)

Dermal Fillers: Locations

• Upper portion of face: glabella, forehead, lateral brow lift, temporal fossa changes or wasting.
• Mid-Face: nasojugal fold (tear trough depression), cheeks.
• Lower portion of face: nasolabial folds (most common site), around mouth, lips, chin.
• Non-Facial sites: hand rejuvenation, neck, chest, repair of cosmetic contour defects that are unrelated to age (rhinoplasty, post-surgical contour deficiency).

Dermal Fillers: Length of Time

• Biodegradable products:
• Hyaluronic Acid: 6-12 months
• Calcium Hydroxylapatite microspheres: 12 months
• Poly-L-Lactic Acid: 12-24 months
• Autologous fat: months-years
• Platelet Rich Fibrin Matrices: 3 months- years

Dermal Fillers: Preparation for Appointment

• Avoid substances that impair clotting (Aspirin, NSAIDs, alcohol, vitamin E) to reduce incidence and severity of bleeding. If safe, stop about 1 week prior to appointment.
• If considering dermal fillers in the lip, may receive prophylactic antiviral therapy for oral Herpes Simplex Virus.

Dermal Fillers: What to Expect at Appointment

• You will be seated upright to discuss problematic areas with the use of a mirror. This will ensure that the injector has a good understanding about your concerns.
• Makeup will be removed and skin will be cleaned with an antiseptic agent.
• Topical anesthetic therapies and local nerve blocks are commonly used to reduce pain during treatment. Many dermal fillers include local anesthetic to help minimize pain.
• Pain is also reduced through use of the smallest needle that is appropriate, minimizing the number of injections given, and injecting in areas of previous anesthetized skin.
• Ice, skin vibration, and patient distraction may also be used throughout procedure. Procedure will be done in a relaxed and soothing environment to alleviate stress and discomfort.

Dermal Fillers: After Appointment care

• Avoid massaging of injected areas.
• Refrain from high intensity physical activity for at least 6 hours after treatment.
• Sleep with head of bed elevated for at least one night.
• Short term minimization of repetitive facial movements may decrease risk of product migration or displacement.
• Resume normal skin care regimen in about 24 hours.

Platelet Rich Plasma

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Platelet Rich Plasma (PRP)

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What is Platelet Rich Plasma? (PRP)

• Platelets are removed from your own body and are a good choice for replacement and renewal of cells, tissues, and organs since it is non-invasive and has high healing rates. It is also readily available as it comes from your own body and includes an abundance of growth factors. PRP is administered as an injectable into the desired areas.
• These proteins and growth factors from the platelet rich plasma can help stimulate stem cells and improve cellular proliferation, differentiation and regeneration. This leads to skin rejuvenation and enhances hyaluronic acid production within your body.

Platelet Rich Plasma (PRP): Benefits

• Reduce wrinkles, plump up sagging skin, reduce deep creases, improve skin complexion and diminish appearance of acne scarring.
• Little to no down time.
• Can also help stimulate hair growth and regeneration.
• It is considered a growth factor cocktail as it promotes healing of wounds, tissue remodeling and increases blood flow to the area it is injected.

Platelet Rich Plasma (PRP): Risks

• Pain, bruising, and swelling post procedure due to injections. This often resolved within a few days after treatment.
• Risk of injection or pain at injection site.
• Contraindications: Hepatitis C, HIV/AIDS, any blood cancer, cardiovascular disease with use of a blood thinning medication, and skin cancer in treatment area.

Platelet Rich Plasma (PRP): Indications

• Skin rejuvenation, acne scarring, periorbital rejuvenation, lipofilling, and in combination with fractional CO2 laser to maximize results. Often used to help patient's achieve the appearance of younger-looking skin.
• Treatment of hair loss.
• Promote wound healing.
• Used in orthopedics to help athletes recover more quickly after an injury.

Platelet Rich Plasma (PRP): Locations

• Commonly used in face and neck for skin rejuvenation and acne scarring.
• Scalp for hair loss.
• Various locations for orthopedic injuries and to promote wound healing.

Platelet Rich Plasma (PRP): Length of Time

• For aesthetic use, most patients receive 3 or more treatments about 1 month apart for optimal results.
• Results can lost up to 18 months, but this varies by patient.

Platelet Rich Plasma (PRP): Preparation for Appointment

• Drink plenty of water prior to appointment. Ideally, drink at least 8 glasses of water within 24 hours of appointment and 12 ounces the morning of treatment. This will help with the blood draw as it is more difficult if dehydrated.
• Do not take Aspirin, fish oil, or NSAIDs, unless prescribed, for at least 1 week prior to treatment. This will minimize risk of bruising and bleeding. Avoid alcohol and caffeine for 1 day prior to treatment.
• Have a light meal prior to procedure.
• Avoid makeup, retinoids, glycolic acid and vitamin C topical products for 1 week before procedure.

Platelet Rich Plasma (PRP): What to Expect at Appointment

• Blood will be drawn when you arrive to the clinic. This blood will be taken to the lab and spun down into layers so the high concentration of platelets can be collected.
• Platelet rich plasma is then injected into treatment area (often face or scalp).
• Entire procedure takes anywhere from 30 minutes-1 hour.

Platelet Rich Plasma (PRP): After Appointment Care

• Arnica gel may be applied after the procedure. This is a natural agent that helps reduce bruising and swelling post-procedure.
• Do not apply makeup, touch injection site, or exposure yourself to long periods of intense sunlight for at least 3 days after treatment.
• Avoid vigrouous exercise, swimming, sauna or hottubs for at least 3 days after procedure.
• Use only gentle skin products for first 1 week.

Deoxycholic Acid

(Kybella)

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Deoxycholic Acid

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What is Deoxycholic Acid? (Kybella)

• Naturally produced substance in the digestive system that helps break down fats so they are more easily digested by our bodies.
• Commonly used as an emulsifier in food.
• Administered as an injection to reduce fat.

Deoxycholic Acid (Kybella): Benefits

• Nonsurgical option for excess chin fat with shorter recovery time and less risks.

Deoxycholic Acid (Kybella): Risks

• Bruising, swelling, inflammation, pain, and redness for a few days to a few weeks.
• Can experience temporary numbness at injection site, difficulty swallowing, skin ulceration, temporary nerve injury and temporary or permanent hair loss in the treated areas.

Deoxycholic Acid (Kybella): Indications

• Non-surgical option for excess chin fat.
• Can also be used as a non-surgical option for lipomas (noncancerous tumors that are made up of fat cells).

Deoxycholic Acid (Kybella): Locations

• Only FDA approved area is the submental area (underneath the chin). Deoxycholic acid works by killing the fat cells to reduce the appearance of a double chin.
• Used elsewhere in the body for treatment of lipomas.

Deoxycholic Acid (Kybella): Length of Time

• Can receive up to 6 deoxycholic acid injections, spaced at least one month apart to maximize results.
• Most people get at least 2 treatments with about 4-6 weeks in between.
• This treatment permanently kills fat cells, but the need for additional treatment in the future will depend on individual patient and lifestyle.

Deoxycholic Acid (Kybella): Preparation for Appointment

• If safe to do so, stop all medications and substances that increase bleeding (Aspirin, NSAIDs, alcohol, vitamin E) for at least 1 week prior to injection.
• Appropriate to ice area to reduce pain during procedure if desired.

Deoxycholic Acid (Kybella): What to Expect at Appointment

• Procedure takes about 20 minutes and may include up to about 50 injections. These injections are typically placed about 1 cm apart for optimal results.

Deoxycholic Acid (Kybella): After Appointment Care

• Can resume normal activity level right after procedure.
• If there is a lot of swelling present, a compression garment may be recommended to help decrease swelling.
• Expect to see results about 6-8 weeks after the procedure. This will include skin tightening and improvement of the appearance of a double chin.

Laser Resurfacing

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Laser Resurfacing

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What is Laser Resurfacing?

• Lasers are devices the emit one specific wavelength of electromagnetic radiation. They can be used to cut tissue, burn tissue or stop bleeding, along with a variety of other clinical uses. Different laser wavelengths are used for different applications.
• Lasers used for skin resurfacing are monochromatic, coherent and display collimation. Monochromatic means the laser beam is a single wavelength of light that is appropriate to destroy the desired tissue. Coherence means the laser beam is synchronized in time and space. Collimation means that the laser beam elements are administered in parallel which allows for treatment of a small area.

Laser Resurfacing: Benefits

• Skin resurfacing is used to minimize wrinkles, color changes, vascular changes and overall skin laxity. Thus laser resurfacing smoothes and tightens the skin.
• No injections.

Laser Resurfacing: Risks

• Length of time for healing after ablative laser is why many people choose to avoid this procedure. Expect about 2 weeks of downtime for CO2 lasers followed by weeks to months of facial redness.
• Hyperpigmentation or hypopigmentation is a risk with all laser types, but is most common after CO2 laser treatments.
• Persistent redness, dyspigmentation, risk of infections and post-procedure scarring, and risk of reactivation of cold sores (HSV).
• Contraindications: keloid history, isotretinoin (Accutane) treatment within 1 year, prior radiation therapy, ectropion (outward turning of eyelid) or scleroderma.

Laser Resurfacing: Indications

• Laser resurfacing is commonly used for skin and eye applications.
• CO2 laser uses carbon dioxide, nitrogen and helium. This laser works well as a cutting instrument and surrounding tissue is often left undamaged.
• Argon Ion laser produces a blue green light and is most commonly used to stop bleeding and for phototherapy treatment.
• Excimer laser is used for inflammatory skin conditions with little thermal damage.
• Ablative laser resurfacing is used to target sun damage on skin. It works through ablation of the epidermis and superficial dermis and induces collagen production. Ablative lasers are used for wrinkles, discoloration, vascular changes and skin laxity.
• Laser Resurfacing is commonly used for scarring, actinic keratoses (pre-cancer lesions), moles, and other skin conditions and concerns.

Laser Resurfacing: Locations

• Laser resurfacing is mostly used on the face, but many patients also choose to treat their neck or hands.
• CO2 lasers are not approved to be used on the neck or hands.

Laser Resurfacing: Length of Time

• Many wrinkles may return within months after successful ablative laser treatment and additional aesthetic procedures may be needed to obtain optimal results.
• Sun protection will minimze the return of sun spots after laser resurfacing treatment.

Laser Resurfacing: Preparation for Appointment

• Pre-treatment with a topical retinoin (Tretinoin) is often recommended. Topical retinoids have been shown to possibly help improve healing time, although additional studies are needed.
• You will often begin pre-treatment topical skin lightening agents to maximize results and minimize discoloration.
• Oral steroids may be prescribed prior to treatment to help with post-procedure swelling.

Laser Resurfacing: What to Expect at Appointment

• Topical anesthetic creams are often used and are sufficient for local procedures. If treatment of a large area is expected, they may use local infiltrative anesthesia or nerve blocks if deemed necessary.
• For full face CO2 laser, local anesthesia and systemic anxiolytics are needed. Oral narcotics or intramuscular sedation may also be provided for pain relief. At some clinics, IV anesthesia is used for full face CO2 laser resurfacing.

Laser Resurfacing: After Appointment Care

• Use of cold compresses, elevation of treated areas and saline/water soaks are recommended after treatment for comfort and to keep the skin moist.
• Petrolatum ointment should be applied to the treated areas until healing is complete. The area may be dressed after procedure and should be cleaned and changed for the first 24-72 hours.
• Manage pain with Acetaminophen, or prescribed medications if provided.
• Use makeup with green tint to cover up post-procedure redness if needed. Use daily sunscreen to minimize risk of discoloration.
• If scarring occurs, it may be suggested that get topical or intralesional steroids, silicone gel, pulsed dye laser treatments or nonablative laser resurfacing.
• Expect to return to work 2-3 weeks after procedure for CO2 and about 3-8 days for other laser types.

Hydrafacials

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Hydrafacials

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What is a Hydrafacial?

• Hydrafacials are described as microdermabrasion-like exfoliation technique that is paired with the use of hydrating serums.
• It is known for the 3 steps: Deep clean, exfoliate, and hydration of skin.
• Treatment is done by using a mechanized wand on the skin that performs a deep clean and exfoliate. At the same time, this wand is delivering serums into the skin, that are typically customized for skin type and goals of the treatment.

Hydrafacial: Benefits

• Improves skin texture, tone, and overall appearance due to the deep clean and exfoliation aspects of the Hydrafacial. It cleans out the pores, removes dirt and dead skin and allows for better penetration of the hydrating serums that area applied.
• A small study completed in 2008 found that women who have regular Hydrafacials had larger decreases in the signs of skin aging in comparison to those who used serums alone.
• Decreased pore size, less hyperpigmentation and discoloration and decreased fine lines and wrinkles.
• Painless, no needles are needed.

Hydrafacial: Risks

• Mostly free of complications. You may feel slight pressure that is applied by the wand, but it should not be enough to cause pain or redness.
• Hydrafacials should be avoided if there is an active flare of rosacea or eczema present.

Hydrafacial: Indications

• Helps to treat a variety of skin conditions including acne and extreme skin dryness.
• Also used to decrease the appearance of wrinkles and slightly plump the skin.

Hydrafacial: Locations

• Most commonly used on the face.
• New hydrafacial, called Keravive that is used on the scalp to promote hair growth.

Hydrafacial: Length of Time

• Frequency of treatments depends on skin type and provider recommendations. Some recommend repeat treatment every 4 weeks, while others recommend treatment every 2 weeks for optimal results.

Hydrafacial: Preparation for Appointment

• Remove all makeup and lotions.
• No other preparation is necessary for this treatment.

Hydrafacial: What to Expect at Appointment

• This treatment is often performed by a licensed aesthetician or dermatologist. The wand uses a vortex-like function against the skin to clean out dirt, dead skin and oil from the pores. A peel is then applied to help exfoliate and resurface the skin. Next, a vacuum like setting is used in the wand to extract additional debris from the pores. Finally, moisturizing serums are applied to the skin, including antioxidants.
• This treatment is sometimes followed by additional aesthetic treatment such as face masks, dermaplaning, light therapy, or dermal filler.
• Treatment takes less than one hour and no downtime is required afterwards. You are able to resume normal activities right away.

Hydrafacial: After Appointment Care

• Resume normal activities right after treatment.
• You should not experience any redness or peeling after treatment, but it is still best to avoid home exfoliation treatments for at least 3 days after Hydrafacial.

Chemical Peels

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Chemical Peels

What is it?

Indications

Before Appointment

During Appointment

Benefits

Locations

Risks

Length of Time

After Appointment

What is a Chemical Peel?

• Chemical peels are one of the most common facial skin resurfacing procedures.
• They work by inducing controlled skin injury through the application of caustic substances to the skin.
• The primary mechanism of chemical peels is by inducing keratolysis which results in superficial exfoliation. They also work through protein denatruation which helps stimulate and rejuvenate the skin.
• The selection of the appropriate peel is based on the condition being treated, patient skin type, clinician preference/comfort and availability of products.

Chemical Peel: Benefits

• Improvements in skin texture, quality and appearance through the normal wound-healing process that follow the skin injury made by the chemical peel.
• There is extensive clinical experience with chemical peels as they have been used for a long time.
• Quick and cheap procedure in comparison to the alternative. No needles used.
• Good therapeutic flexibility as there are many different options for chemical peels and thus they can be molded to help with patient desires.

Chemical Peel: Risks

• Ocular injury, infection, discoloration, prolonged redness, and scarring. There is also a risk of irritant or contact allergic dermatitis when something is applied to the skin.
• Use caution or avoid if you have increased risk of discoloration, poor wound healing, history of keloids, current/recent isotretinoin (Accutane) treatment, inflammatory skin conditions (rosacea or eczema), active skin infection, pregnancy or lactation.
• Avoidance may be needed if poor healing, history of scarring, or exacerbations of chronic skin conditions. Also need to use caution in those with liver or kidney dysfunction as there is an increased risk of toxicity.

Chemical Peel: Indications

• Used for treatment of actinic keratoses (pre-cancer lesions), sunspots, discoloration conditions, wrinkles, acne scarring and photoaging.
• Light chemical peels only cause injury to epidermis. These peels improve acne, brighten the skin, and even out skin color and texture.
• Medium depth chemical peels cause injury to the epidermis and papillary dermis and thus also work deeper to improve mild wrinkling and scarring.
• Deep chemical peels get as deep as the reticular dermis and thus can treat deeper wrinkles and acne scarring.

Chemical Peel: Locations

• Most commonly performed on the face and neck, but can also be done on the chest, arms and hands if desired.
• Chemical peels can be performed on a focal area of entire region of the skin.

Chemical Peel: Length of Time

• Light chemical peels commonly show subtle improvements with each peel and require a series of at least 2-3 peels or more to achieve noticeable improvement. These peels are typically done about 1 month apart.
• Medium depth chemical peels usually require at least 3 months before repeating treatment.
• Deep peel retreatment should be avoided for at least 1 year.

Chemical Peel: Preparation for Appointment

• Discuss expectations and treatment results prior to appointment. Recovery time should also be discussed to ensure that expectations are appropriate. Often pre-treatment and post-treatment photos from past treatments can be discussed.
• Remove all makeup and lotions prior to appointment. Care should be taken to commonly missed areas such as hairline, eyelids and jawline.
• Skin preparation will optimize the penetration of the peeling agent, thus optimizing results. This will also promote wound healing and minimize discoloration risk. For at least a few weeks prior to chemical peel, you should be using sunscreen, a topical retinoid and a topical lightening agent, such as Hydroquinone.
• May receive infection prophylaxis for cold sores (HSV) if needed to prevent flare up.

Chemical Peel: What to Expect at Appointment

• Before application of chemical peel, aesthetician or provider will collect the necessary supplies, discuss risks and benefits, cleanse the skin and ensure comfort measures are in place such as providing fans or cooling units.
• Light and medium depth peels are performed in a clinic setting while deep peels are most often performed in an OR where there is access to cardiac monitoring and IV fluid administration.
• Comfort measures will be discussed including NSAIDs, oral/IM sedatives, and use of cool air unit or fans.
• Once skin is prepped and cleaned, the chemical peel is brushed on with a swab and then neutralized with sodium bicarbonate or water. The type of peel determines length of time and how many passes are completed.

Chemical Peel: After Appointment Care

• Recovery time is dependent on type and depth of peel. Deeper peels require a longer recovery period. While recovering, it is important to do gentle skin cleansing, regular use of emollients, sun protection and avoiding picking or peeling at skin.
• Recovery for a light depth peel is about 3-4 days. During this time, the skin will be red and then peeling will likely begin.
• Medium depth peels take about 7-10 days to completely heal and there is often associated swelling that will worsen for first 2 days and then begin to resolve.
• Use an icepack and take NSAIDs as needed for pain control.

Sources:

• American Academy of Dermatology Association. (n.d.). Is Platelet-Rich Plasma the secret to younger-looking skin? American Academy of Dermatology Association. https://www.aad.org/public/cosmetic/younger-looking/platelet-rich-plasma-secret-to-younger-skin
• Carruthers, J. Botulinum toxin for cosmetic indications: Treatment of specific sites. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2021.
• Carruthers, J. & Humphrey, S. Injectable soft tissue fillers: Overview of clinical use. In: UpToDate, Dover, J. & Colwell, A. (Ed), UpToDate, Waltham, MA, 2022.
• Carruthers, J. Overview of botulinum toxin for cosmetic indications. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2022.
• Carruthers, J. & Humphrey, S. Injectable soft tissue fillers: Temporary Agents. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2022.
• Cherney, K. (2020, December 9). What is HydraFacial and How Does it Work?. Healthline. https://www.healthline.com/health/what-is-hydrafacial#Do-HydraFacials-work
• Colt, H. Basic principles of medical lasers. In: UpToDate, Cochran, A. (Ed), UpToDate, Waltham, MA, 2022.

• Goldberg, D. Ablative laser resurfacing for skin rejuvenation. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2021.
• Halcyon Dermatology. (n.d.). PRP Facial Rejuvenation. Halcyon Dermatology. https://www.halcyonderm.com/cosmetic/skin-body-treatments/prp-facial-rejuvenation/
• Nanda, S. Chauhan, K. Shetty, V. Dashore, S. & Bhatia, S. (2021, Nov. 25). Platelet-Rich Plasma in Aesthetics. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664171/
• Obagi, S. Chemical Peels: Principles, peeling agents, and pretreatment assessment. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2022.
• Obagi, S. Chemical Peels: Procedures and complications. In: UpToDate, Dover, J. (Ed), UpToDate, Waltham, MA, 2022.
• WebMD Editorial Contributors. (2023, May 12). What to Know about Kybella Injections. WebMD. https://www.webmd.com/beauty/what-to-know-about-kybella-injections#091e9c5e82173e3d-1-2