Many of my facial plastic surgery patients benefit greatly from medical grade skin care as part of their treatment plan. For example, I strongly recommend that all of my patients start a medical grade skin care regimen prior to surgery and then continue with the treatment after surgery. For my rhinoplasty patients, preparing the skin before the procedure can help remove some of the oil and debris from the skin and get the skin in a better state prior to surgery, which helps promote better healing and quicker recovery.

For my facelift, neck lift, and eyelid lift (blepharoplasty) patients, they can often be confused as to why they need medical grade skin care after the procedure. They might ask a question, such as “Why do I need to use these products after I have had my face lifted or my neck lifted?”  I always tell them that they can think of the situation much like they would think of a home remodel.

The analogy is that if one was to perform a remodel of a house, they would not be satisfied with simply doing the remodel, but not painting the remodeled area at the conclusion of the project. Painting of the remodeled area is an important part of the renovation project. Similarly, one can think of doing the facelift or neck lift as remodeling the home and the medical grade skin care is like the paint on the exterior of the home. Not painting the home after a remodel project would be unthinkable. Similarly, it is unthinkable that one would go through a facelift, neck lift, or eyelid lift procedure without following up with medical grade skin care.

When is the best time to start medical grade skin care?

One of my favorite sayings is “the best time to plant a tree is 20 years ago. The second best time is right now.” This wisdom could also be applied to skin care. The best time to start skin care might have been years or even decades ago. However, the best time to start if you haven't already started medical grade skin care as part of your skin care regimen is right now.

Before surgery, I prefer patients to be started on the skin care regimen as soon as possible. Usually, at least a month is enough time to get some of the benefits of the skin care improvement that can be seen with medical grade skin care. Sometimes, a longer period of time of treatment might be beneficial. For example, there is good evidence that demonstrates that the use of medical grade skin care for several months before a laser resurfacing procedure, such as a carbon dioxide CO2 laser, whether it be fractionated laser or a non fractionated laser, may be beneficial in terms of improving the wrinkles, pigment, and skin tightening.

For some of the more aggressive medical grade skin care components, I might recommend that the patient stops using these products one, two, or even three or four weeks before the procedure. For example, tretinoin, retinol, or other vitamin A derivatives may slow down the wound healing process. However, it is important to note that many of these concerns with the vitamin A derivatives have been debunked. In general, I am a very conservative person, however, and so I still take a course that maximizes the safety of the patient and their skin.

What are the key components of a medical grade skin care regimen?

I think the key components of a medical grade skin care regimen must be fine tuned to the individual. However, having said that their regimen must be specific to the person and their particular situation, here are a few necessary foundational elements that can be helpful for all patients, regardless of skin type and condition.

Vitamin A Derivates, such as Retinol or Tretinoin

First, I believe that it is key that a patient begins to use a vitamin A derivative. The component that I think strikes the right balance between effectiveness while minimizing side effects, is retinol. This compound helps improve cell turnover and decreases wrinkles, tightens the skin, and reduces pigmentation. Retinol is more gentle than some other vitamin A derivatives, such as tretinoin. It is a wonderful medication and is the cornerstone of a true medical grade skin care system. The side effects from this treatment can be skin dryness, peeling skin, and skin redness. Using this component of medical grade skin care is important, but avoiding sensitive areas is also important in its use. For example, the area around the eyes, especially at the corners of the eyes, the corners of the mouth, and the neck can all be very sensitive.

Many patients start this important treatment, but find that the side effects are too difficult to bear. This can be for a few different reasons.

First of all, they may start too fast. It is important to not go too quickly with this treatment. I typically recommend that patients begin using this component of their medical grade skin care system every third or fourth night for about a month. They can then slowly, over a period of a few months, begin to increase the frequency with which they use this medication.

Second, patients may find that the old attitude of “if a little is good, a lot must be better” is not a good philosophy when it comes to medical grade skin care. Many patients start out using too much of the product. Typically, the right amount is much less than what patients might think that they need. I typically recommend that the patients use a small, pea sized ball of the medication for the entire face. This is much less than what many people think is necessary.

Third, some patients might find that the first area they apply the skin care receives a greater amount of medication than the rest of the face. For example, they may apply the pea sized ball to the left cheek first. The left cheek may be getting a higher dose than the right cheek, which can cause the left cheek to have a more sensitive response than the right cheek. I advise all of my patients to apply tiny dots around the face before rubbing the medication into the skin. This helps more evenly distribute the medication to all surfaces of the facial skin.

Fourth, some patients may find that they need to dilute the retinol. Deluding the retinol with a little bit of moisturizer can go a long way towards applying a more even distribution with less concentrated effect. I typically recommend that most patients start with one part retinol to four parts moisturizer. They should place a tiny amount of retinol and then about four times more moisturizer, mix it together in the palm of the hand, and then apply evenly to the entire face. The patient should use this mixture for the first month or so and then each month after that, decrease the retinol component by one part until after a few months, there is no more moisturizer that is being added to the retinol.

In summary, the cornerstone of any good medical grade skin care system is a vitamin A derivative containing component, such as retinal or tretinoin. The side effects from peace medications can be partially offset by being conservative with how much is being used, applying it evenly throughout the face, and starting slowly.

Sun Block

Sun block is a key component of a medical grade skin care system. Ultraviolet, also known as UV, rays lead to skin cancer, pigment issues, and wrinkles. There are multiple studies that show that blocking harmful ultraviolet rays helps improve the signs of aging, decreases the risk of skin cancer, and decreases pigmentary problems of the skin. In other words, sun block is much more than simply preventing a sunburn.

When choosing a sunblock, it is important to find one that blocks both UV - A and UV- B radiation. Some sunblocks will only block one type of ultraviolet ray. Be sure that the sunblock that you use blocks both forms of radiation. In addition, using a sunblock is important to do every single day even if it is cloudy and even if you are staying indoors the entire day. One type of ultraviolet Ray can come in through glass and can cause damage even when you are inside.

I also hear a lot of patients tell me that they are really good about wearing sunscreen or sunblock. When I talked to them in a little more detail, I find out that they will wear a hat when outdoors and will put sunblock on their face when they are not wearing a hat. Ultraviolet rays can reflect off concrete, snow, water, and pretty much anything else. Wearing sunblock, even when wearing a hat, is important to protect yourself against reflected ultraviolet rays.

When looking for a sunblock, one useful tip is to look for a sunblock that contains either titanium or zinc as one of the ingredients. This allows the sunblock to reflect the Rays off of the skin, because it acts as a barrier. Other types of sunscreens contain chemicals that absorbs the UV rays. This is less effective than sunblocks that contain zinc or titanium.

Cleanser

Cleansing the face is an obvious and important part of a skin care regimen. I prefer a cleanser that can remove all of the oils from the skin and also help clean up any bacteria that are on the skin. Finding a good cleanser is key, because it will help remove the oils from the skin so that the medical grade skin care can better penetrate into the deeper layers of the skin.

Toner

Like the name suggests, medical grade skin care toner helps tone the skin and helps prepare it so that the other active ingredients can be more effective. It is often overlooked and ignored, which decreases the overall effectiveness of the medical grade skin care treatment. Do not forget your toner!

Moisturizer

Moisturizer is also an important component. Finding the right moisturizer can be very difficult. Some moisturizers do not do a good enough job providing hydration to the skin, whereas others leave an oily feel to the skin. Finding a moisturizer that is not too oily, but provides excellent hydration is important.

Finding a good moisturizer that also helps counteract the effects of retinol is also important. One must be sure to find a moisturizer that helps repair the effects of retinol.

Vitamin C Serum, preferably with Ferulic Acid

Vitamin C is a powerful antioxidant. Free radicals destroy tissue and lead to premature aging. Vitamin C can help counteract these effects by scavenging the free radicals. Most vitamin C formulations are in the form of a serum. A serum helps penetrate into the deeper layers of the skin better. This is important to help repair the damage that might already be present on the skin, but also it is important to help as a preventive measure. Many people feel that vitamin C serum is one of the most important parts of their skin care regimen, a conclusion that some scientific studies support.

Microdermabrasion Scrub

Our skin cells frequently turnover and there can be a lot of debris that builds up on the skin surface. This might be keratin, dead skin cells, oils, etc. Using a scrub to help exfoliate the skin as an important part of a skin care regimen. Most high quality medical grade skin care systems will contain a microdermabrasion scrub. I recommend that my patients use this about once per week to help remove a buildup of skin waste that needs to be removed. In addition to making this skin look and feel softer and smoother, the scrub will also remove oil, keratin, and dead skin cells, which will allow the medical grade skin care products to work more effectively.