Editorial Board Forum: Skincare in Practice

How would you characterize the role of skincare in aesthetic practice today?

Jason Emer, MD: It is one the most important parts of my practice. Skincare complements all the treatments we do and helps us prevent issues such as scarring, redness, and hyperpigmentation after energy-based procedures or peels. It also helps patients be a part of the treatment course. They feel as if they are working with the physician and aesthetician towards a goal by applying the skincare daily; it's a part of the routine. It significantly impacts the outcome, and this can be seen even more in conditions like acne, hyperpigmenation/melasma, and rosacea where skin sensitivity and dryness impact the overall treatments.

Jose Raul Montes, MD: I do not conceive any surgical or less invasive procedure without an appropriate pre- and post-treatment skincare plan. A great outcome after any procedure will be potentiated by skin color and texture improvement. In addition, it is highly recommended to start a good skincare routine when the person is young to improve the early signs of aging and overall appearance. In the social media era, more than ever, skincare has taken an important role at any age.

Sabrina Fabi, MD: What patients put on their face every single day can have a synergistic effect on the procedures we do in the office, whether it's treating acne, melasma, or wrinkles, as much as they can do harm if the wrong products are being used. Multiple studies have shown the additive effect skincare products have on the procedures we perform.

Do you dispense skincare in your practice? What has been the benefit?

Shannon Humphrey, MD: We dispense skincare in my practice. The truth is patients expect their dermatologist to make recommendations for skincare...The benefit is we can ensure patients are protecting the investment of their treatment and maintaining healthy looking beautiful skin at home. Plus, let's face it, it feels great to take care of yourself. Our patients love finding an evidence-based cosmeceutical regimen that is perfect for them.

Dr. Montes: We carry a few selected skincare lines. Our patients certainly value the notion of having the same professional who they have already entrusted with their surgeries and/or injectables, provide their skincare treatments and products.

Dr. Fabi: We tend to carry products that have shown evidence to make a difference in clinical trials. This way we can feel more confident that they will make a difference in our patient's skincare regimen. We are fortunate to perform many clinical trials in our practice and typically see first-hand what works and what doesn't from the studies we perform.

Dispensing has been a benefit to the practice, because these products add to the results I can offer my patients, when they can only afford to come in three months. In addition, it allows me to have more control of what they are putting on their face.

Dr. Emer: It is a huge benefit to my practice. Patients love our aestheticians and come in every two weeks for facials, skincare assessments, and customized skincare regimens.

With so many options available, how to do select skincare to dispense or recommend?

Dr. Emer: We offer at least two to three options per product type (e.g., cleansers, retinols, vitamin C, etc.) so that patients have a variety of options or in case one brand/type is not compatible with the patient's skin. We evaluate what treatments we do and the compatibility of the products for those treatments as well as the conditions we are treating and the type of products our patients need to enhance those treatments or improve their clinical conditions. We have over 100 products from various companies as well as formulating our own skincare that will be available in three to six months. Our staff all try the products, do Visia skincare assessments before and after, and let us know their thoughts and how we can position the product in the practice before we bring it to our patients.

Adam Schaffner, MD: I rely on clinical studies, before and after photos, peer recommendations, and patient feedback to assist in selecting skincare products to offer my patients.

Dr. Montes: We select professional skincare lines that are backed by science and that are ideal for the type of procedures we perform...In addition, we carry a skincare line for skin maintenance and prevention, which offers good antioxidants and promotes hyaluronic acid synthesis, among other products. It is of vital importance to be knowledgeable of other products that are in the market, in order to assist patients as they transition from their original selection into a routine that will provide significant improvement to their skin.

Every year we evaluate what has worked for us and make changes in our inventory accordingly.

Which products are most beneficial right now? Is there is an unmet need?

Dr. Montes: The most beneficial product will vary depending on the patient's needs. However, in general, I find that among the most beneficial ones are those that encompass antioxidants (such as CE Feluric, SkinCeuticals) and retinol, which promote skin renewal. In order to reduce sensitivity to Retinol, it can be combined with a hyaluronic-based product, such as H.A. Intensifier (SkinCeuticals), providing optimal results. Although skincare has improved over time, I believe that there is still a need for an effective skin tightening topical product.

Dr. Emer: Right now we find that growth factors and stem cells are the most beneficial in our practice and there is unmet need for them. They help reverse DNA damage, help for post-procedural healing, and improve the impact of all the other products we have patients use as a “standard” skincare in our practice, such as vitamin c, retinol, glycolic cream, and enzymatic exfoliation (i.e., Restorsea).

Dr. Fabi: Post-procedure products, like the Alastin post procedure kit, have been great. It is well tolerated after laser resurfacing and adds to the results, allowing me to worry about one less thing as patients recover from such an aggressive procedure.

Dr. Schaffner: EltaMD® has great sunblock products. An unmet need is to develop a single product which can provide sunblock, moisturizer and anti-oxidant effects as well as exfoliate, nourish, fill, lift and decrease wrinkle depth..at the same time. It would be a best seller!

Dr. Humphrey: Many patients are looking for “natural” options that are preservative free, gluten free and organic. My dream would be a product line that is both supported by linical science while meeting the value-based preferences of our naturally minded patients.