Skincare for Skin Health: Counseling the Aesthetic Patient

When it comes to the appearance of skin health, aesthetic providers are the experts. Ensuring patients are making the right decisions about their skincare regimens is key to optimizing results of any in-office aesthetic procedures.

With so many over-the-counter (OTC) options for patients to choose from, they typically welcome advice on the best choices, says Corey L. Hartman, MD, FAAD, a dermatologist in Birmingham, AL. When he’s being prepped for a patient, “The nurse will tell me, ‘She’s coming in because her son’s getting married. She has lines around her mouth. She feels like she looks tired and she wants to go over an overall good skincare regimen.’ That’s always the tag on, and I’m always excited about that because, of course, it all works together,” he says. “I tell patients, it’s like buying a Mercedes and then never changing the oil. It doesn’t make sense to come here for filler or procedure if you are not going to do anything at home to enhance the effect.”

Being able to recommend OTC products from a trusted name like Galderma offers advantages. Galderma’s consumer care brands include innovative, science-based solutions to maintain healthy skin—from the Cetaphil® line to Differin® OTC for mild-to-moderate acne, as well as the Alastin Skincare® portfolio of scientifically proven products for daily skincare regimens and peri-procedural use.

Staying within a brand can offer a simpler solution for patients, says Deirdre Hooper, MD. She always customizes her recommendations to meet her patients’ individualized needs but acknowledges there can be some benefits to using a specific brand. With one brand, there’s usually some consistency in the messaging that the patient is getting, and with OTC products there’s usually some consistency in the person’s likelihood to tolerate the products, she explains. “We’re dealing with a lot of people who have skin issues who may be using prescription products that can cause irritation. Or they may be using a device that causes redness and irritation. You need a skincare product you feel confident is not going to irritate your patient’s skin. I think having confidence and experience with one brand of products is probably ideal, especially as you’re starting your relationship with your patients. It can keep things simple.”

Additionally, patients don’t need as much convincing to use a brand that they are aware of and trust, Sabrina Fabi, MD says. “Restylane® was the first hyaluronic acid filler in the market in 2003, so it’s an established brand. Patients make the association that any product coming from that level of a trusted brand must be good.”

Heidi Prather, MD, a dermatologist and fellowship-trained cosmetic and procedural dermatologist at Westlake Dermatology, is happy to see a company like Galderma, that provides OTC and prescription skincare products, also offering neuromodulators and fillers. “These markets that once were very diverse are starting to merge is this arena of cosmeceuticals with more targeted approaches that we can use for anti-aging in the skin. It makes sense that a company like Galderma not only offers great OTC products like Cetaphil for sensitive skin and great product lines for individuals with acne and eczema, but also offers prescription medications for these conditions as well as injectables for fine lines and wrinkles, such as the Restylane portfolio and Sculptra®. And now with the newly acquired Alastin portfolio, we’re looking at more science-backed, in-office skincare that is suitable for peri-procedural use.”

The Skincare Conversation

Aesthetics providers agree that, as part of an overall consultation, it’s important to know patients’ home skincare routines. They emphasize the need to reinforce the importance of daily sunscreen, cleanser, and moisturizer, and discuss the potential benefits of other products, such as a retinol. Also review what products patients should stop using.

“If a patient is concerned about fine lines on their skin or wrinkles that are formed from frowning, it’s really easy to start with a neuromodulator to address that. Most likely that’s what the patient is expecting to hear, but we have to make sure that the patient is proactive in other areas. We need to ensure they are using sunscreen and that they have a good skincare treatment plan,” Dr. Prather explains. “I always say, ‘If you’re going to do something, let’s make sure it’s effective.’ We’re in a world now where there’s so much data out there. It’s imperative that as experts in the aesthetics field, we’re up to date on that information. We can help direct patients to meaningful skincare plans that are going to be effective for their skin goals.”

Houston-based dermatologist Suneel Chilukuri, MD, recalls a recent appointment with a new patient who reported she was using a toner. “It was actually drying her out more. I said, ‘No, no, you shouldn’t be on a toner.’ And she said, ‘Oh, but I still get these little bumps on my nose.’ I said, ‘No problem. Then we can use Differin OTC. It’s something that works quite well.’”

Skin texture is important in the aesthetic of skin, Dr. Chilukuri says. “What do we deem preventative? Do we combine that preventative care with energy-based device treatments to keep that skin glowing? Do we use a Cetaphil cleanser? It works amazingly well and it’s a Galderma product that we recommend to most people. What are they doing for their sunscreen? Can we combine that sunscreen with an effective moisturizer as well?”

The Cetaphil line now includes a cosmetically elegant 100% mineral SPF facial moisturizer and an expanded facial moisturizer portfolio.

Dr. Hartman says patients value the fact that you can recommend OTC products and explain to them that these are good products, that you stand behind them, that you use them yourself, and that they are made by the same company that makes the products we’re using for in-office procedures.

Young Cho, MD, PhD, a plastic surgeon who practices in Spring, TX, says he relies on an aesthetician in his practice to discuss a patient’s skincare regimen, but he plants the seeds about the role of skincare during the consultation. “I think skincare can provide an element of stickiness to the practice and helps to enhance the patient’s overall aesthetic outcome.”

Julie Woodward, MD, an oculofacial plastic surgeon at Duke Health in North Carolina, says she also typically delegates skincare recommendations to her aesthetician, “who is excellent,” but if a patient has been referred to her by a dermatologist or aesthetic provider they regularly see, she refers the patient back to their doctor for skincare concerns. “I tell patients it is not ideal to have too many people managing their care—they should maintain the skincare regimen their dermatologist or aesthetic provider recommended. The exception to this is when I’m performing their periocular surgery, laser skin resurfacing, and any associated periocular filler treatment. I want to manage their skin through their healing process.”

Ensuring her patients use the right post-procedure products is key to achieving optimal outcomes. Dr. Woodward assures patients that some products are better to purchase physician grade, and others are fine to purchase OTC, such as Differin OTC.

Post-Procedure Care

Like Dr. Woodward, when it comes to post-procedure skincare, Dr. Fabi wants to ensure her patients are using the right products. Dr. Fabi says patients who embark on a laser procedure with her need to understand that what they do every day is going to impact the results from that lasertreatment.

“They can actually undermine the aesthetic treatment that they just paid for or get sub-optimal results if they’re using products that are irritating or aggravating to the skin,” she explains. She recommends post-procedure premium skincare products like those from Alastin. Alastin offers a comprehensive collection of scientifically proven products for daily skincare regimens and peri-procedural use. The product offerings are backed by its patented TriHex Technology, a proprietary blend of peptides and effective botanicals to support the appearance of rejuvenated skin.

Making Skincare Count

Ultimately, aesthetic providers can offer patients customized skincare regimens in which every step counts.

“If you’re going to do one step a day, that better be a really incredible sunscreen because it is your one-step routine that you’re investing in. If you’re doing three or four steps a day, you really want those steps to be in the right order and to be meaningful. That’s where a board-certified dermatologist can make sure that the energy you’re putting into your skincare routine is effective and worth the time and investment you’re making,” Dr. Prather says.

Disclosure: Drs. Suneel Chilukuri, Sabrina Fabi, Corey L. Hartman, Deirdre Hooper, Heidi Prather, Julie Woodward, and Young Cho are all consultants for Galderma. None of the participants has received any financial consideration for their participation in this series.

IMPORTANT SAFETY INFORMATION

The Restylane family of products are indicated for patients over the age of 21, and includes Restylane®, Restylane-L®, Restylane® Lyft with Lidocaine, Restylane® Silk, Restylane® Kysse, Restylane® Refyne, Restylane® Defyne, and Restylane® Contour.

APPROVED USES

Restylane® and Restylane-L® are for mid-to-deep injection into the facial tissue for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds. Restylane® and Restylane-L® are also indicated for injection into the lips.

Restylane® Lyft with Lidocaine is for deep implantation into the facial tissue for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds and for cheek augmentation and for the correction of age-related midface contour deficiencies. Restylane®Lyft with Lidocaine is also indicated for injection into the dorsal hand to correct volume loss.

Restylane® Silk is for lip augmentation and for correction of perioral wrinkles.

Restylane® Kysse is for lip augmentation and for correction of upper perioral wrinkles.

Restylane® Refyne is for mid-to-deep injection into the facial tissue for the correction of moderate to severe facial wrinkles and folds, such as nasolabial folds.

Restylane® Defyne is for mid-to-deep injection into the facial tissue for the correction of moderate to severe deep facial wrinkles and folds, such as nasolabial folds. Restylane® Defyne is also indicated for injection into the mid-to deep dermis (subcutaneous and/or supraperiosteal) for augmentation of the chin region to improve the chin profile in patients with mild to moderate chin retrusion.

Restylane® Contour is for cheek augmentation and for the correction of midface contour deficiencies.

Do not use if you have severe allergies with a history of severe reactions (anaphylaxis), are allergic to lidocaine or gram-positive bacterial proteins used to make hyaluronic acid, prone to bleeding, or have a bleeding disorder. The safety of use while pregnant or breastfeeding has not been studied. Tell your doctor if you have a history of scarring or pigmentation disorders as these side effects can occur with hyaluronic acid fillers. Tell your doctor if you are planning other cosmetic treatments (i.e., lasers and chemical peels) as there is a possible risk of inflammation at the injection site.

Tell your doctor if you’re taking medications that lower your body’s immune response or affect bleeding, such as aspirin or warfarin, as these medications may increase the risk of bruising or bleeding at the gel injection site. Using these products on gel injection sites with skin sores, pimples, rashes, hives, cysts, or infections should be postponed until healing is complete.

The most common side effects are swelling, redness, pain, bruising, headache, tenderness, lump formation, itching at the injection site, and impaired hand function. Serious but rare side effects include delayed onset infections, recurrence of herpetic eruptions, and superficial necrosis at the injection site. The risk of unintentional injection into a blood vessel is small but can occur and could result in serious complications, which may be permanent including, vision abnormalities, blindness, stroke, temporary scabs, or permanent scarring of the skin. As with all skin injection procedures, there is a risk of infection.

To report a side effect with any Restylane® product, please call Galderma Laboratories, L.P at 1-855-425-8722.

To learn more about serious but rare side effects and full Important Safety Information, visit www.RestylaneUSA.com.

Indication: Sculptra® (injectable poly-L-lactic acid) is indicated for use in people with healthy immune systems for the correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles.

Sculptra should not be used by people that are allergic to any ingredient of the product or have a history of keloid formation or hypertrophic scarring. Safety has not been established in patients who are pregnant, lactating, breastfeeding, or under 18 years of age.

Sculptra has unique injection requirements and should only be used by a trained healthcare practitioner. Contour deficiencies should not be overcorrected because they are expected to gradually improve after treatment.

Sculptra should not be injected into the blood vessels as it may cause vascular occlusion, infarction or embolic phenomena. Use at the site of skin sores, cysts, pimples, rashes, hives or infection should be postponed until healing is complete. Sculptra should not be injected into the red area (vermillion) of the lip or in the peri-orbital area.

The most common side effects after initial treatment include injection site swelling, tenderness, redness, pain, bruising, bleeding, itching and lumps. Other side effects may include small lumps under the skin that are sometimes noticeable when pressing on the treated area. Larger lumps, some with delayed onset with or without inflammation or skin discoloration, have also been reported.

Sculptra is available only through a licensed practitioner. Complete Instructions for Use are available at www.SculptraUSA.com/IFU.