The Pre & The Post: Clinical Skin Care Protocols Before and After Surgery.
Many cosmetic surgeons and dermatologists are now augmenting their practices with medical aestheticians.
This valuable service helps to provide a full-service range of treatments for patients and to assist in cosmetic procedures by caring for the skin properly, pre and postoperatively.
“Every patient is different, but one thing that remains the same is that the skin heals at a faster rate of speed if you boost the skin’s renewal process,” say Wendy Canzanese, Medical Aesthetician at The Austin-Weston Center for Cosmetic Surgery, located in Reston, Virginia.
Canzanese works with patients in her Medical Aesthetique office housed in The Austin-Weston Center before and after many procedures.
This cosmetic surgery center was the first free standing facility established exclusively for cosmetic surgery in the Washington, D.C. area and has been in business over 25 years. The center has three surgeons on board, Dr. George Weston, Dr. Byron Poindexter and Dr. Robert Sigal, and over 1,100 operations are performed every year.
The medical office also serves as an educational center as visiting surgeons from around the world come to learn surgical procedures that The Austin-Weston Center for Cosmetic Surgery’s team of doctors has pioneered.
Pre Surgery Preparation
With this type of busy patient flow, aesthetician Canzanese is kept on her toes. She shares that the focus on skincare for cosmetic surgery patients is first to prepare the skin and get it in the best possible condition before surgery takes place. The focus after surgery is to speed along the healing process, as well as to advise patients on their home skincare regimen and to help quell the anxiety that patients often have post surgery. “
The focus is on patient comfort,” says Canzanese. “Listening to the patient is the most important thing. We want to get them on the best road to recovery as soon as possible.
” No two patients or procedures are alike, so every facial protocol will be different for preparing the skin and will be custom designed by Canzanese, along with the doctors at The Austin- Weston Center for Cosmetic Surgery.
“Preparing the skin involves pre-treating it with Vitamin A,” says Canzanese. “One month before a face lift, for example, we’ll do a light to medium depth chemical peel. Seven to ten days following that, we may begin a Vitamin A regimen depending on the depth of the peel.”
Determining the type and depth of the peel is based on the surgery timeline and the patient’s skin type. Proper skin analysis is key, and Canzanese stresses the importance of also understanding the Fitzpatrick Scale. Making proper analysis of the skin helps the aesthetician avoid undue irritation or causing hyperpigmentation.
Canzanese also points out that for aestheticians in a medical practice, chemical peels are very different from those in a spa setting. “The pH of chemical peels in a medical setting are lower than those in a spa, and it is the pH level as well as the percentage of acid that determines a peel’s depth,” she says. The lower the pH level, the deeper the acid penetrates.
Also, the medical aesthetician is still only working in the most superficial outer layer of the skin, while surgeons work much deeper into the epidermis and even down into the dermis. Being in a medically supervised environment allows Canzanese to use these highly effective chemical peels on pre surgical patients as well as her own clients in the Medical Aesthetique.
Side effects from these deep peels can include erythema, peeling, itching and burning. “The patient’s discomfort must be considered,” says Canzanese. “We work with them in a manner that they’ll be comfortable in their skin.” Some patients who are professionals and must quickly return to work can’t camouflage the after effects as easily as others and need a different type of protocol.
Choosing a Vitamin A Therapy
“Vitamin A reaches down to the dermis where new cells grow, making them reach the surface sooner for faster cell turnover,” says Canzanese. There are many options for Vitamin A therapy, however a prescription strength is necessary for clinical grade skincare.
Retin-A, developed over 25 years ago for the treatment of acne, is now widespread as a treatment for wrinkles. As we age, our cell turnover rate naturally slows and Vitamin A therapies help speed the cell renewal along.
Canzanese uses the Bio Medic medical grade line of skincare products, including its MicroPeel Plus chemical peel for certain patient protocols.
The MicroPeel Plus works to loosen the dead cells on the surface of the skin and reveal new cells underneath, showing improved smoothness. Sebum and cellular debris are stripped from the surface, new cells are stimulated at the dermal level and the renewal process is accelerated. The procedure continues to work a week after the initial treatment by still digesting dead cells and revitalizing skin.
This peel forms a transparent white mask on treated areas that appears as the chemicals evaporate. Once the mask has completely formed, the end of procedure is indicated. As with all chemical peels, it is vital to research all patient contraindications, consider medications and advise mandatory sun protection as the skin is especially vulnerable to sun damage following any peeling process.
All product instructions and advisements must be strictly followed.
Post Operative Healing
Immediately following surgeries at The Austin-Weston Center for Cosmetic Surgery, all patients are on a doctor prescribed healing regimen before they are released to Wendy Canzanese’s care.
At this point, the focus is on the patient’s well being and healing. “The patients have tightened muscles, they feel tense, dry, itchy and there’s often numbness. There’s sometimes great anxiety as to how to take care of the ‘new me’,” says Canzanese. She works to calm the trepidation and fear of patients and get them comfortable touching their faces again. “We go over what is normal for the skin to feel like after surgery and what is not,” she says.
Instruction in face massage is also included. Massage helps to circulate the blood and accelerate healing. “Basically, you use a very light touch, depending on the incision,” Canzanese notes. “On the mandible area, use a light sweeping action and delicate circles.
Use light compression over incisions, but never anything too harsh or with too much pressure. There’s a certain amount of massage that you should and shouldn’t do. The style is soothing and comforting.”
Some aestheticians use a lymphatic drainage technique such as Dr. Voder. Canzanese however, refrains from lymphatic drainage on her patients, stressing that if done improperly it can cause uncomfortable side effects such as earaches or neck discomfort.
Canzanese custom designs a home care regimen for each patient based on their procedure and their skin type and condition. She recommends clinical products that are hydrating and emollient. “I recommend that patients do not do at home exfoliation immediately following their surgery,” says Canzanese.
She advises to avoid any harsh products for the face or anything abrasive. Sun protection is extremely important and patients are advised to use a broad spectrum sunscreen daily.
After three to six weeks, patients can return to the Medical Aesthetique for a facial with Canzanese. Based on a patient’s ability to heal they determine together when to begin a more aggressive at-home skincare regimen.
Canzanese also may recommend using a thermal spring water such as La Roche-Posay’s, which is sprayed onto the skin and contains selenium, a powerful antioxidant. “The spring water has antiinflammatory properties, provides antioxidant protection, refreshes, soothes and tones the skin. It’s very refreshing and I recommend chilling it in the fridge for use on the face after resurfacing procedures to cool and hydrate,” says Canzanese.
Other considerations that post surgery patients will have for their skin is to avoid things that cause swelling, such as baths that are too hot, and especially hot tubs. A sanitary environment is preferred. “Your bathroom should be sanitized and your pillowcase and clothing kept very clean. Don’t use old makeup brushes or put anything that might be bacteria-laden close to your skin.”
Camouflage Makeup after Surgery
Canzanese uses mineral makeup to help camouflage the scars, redness and bruising on post surgery patients at The Austin-Weston Center for Cosmetic Surgery. Because it is anti-inflammatory and has no additives, preservatives or fillers, mineral makeup is recommended by dermatologists and plastic surgeons for skincare post surgery and for sensitive skin.
Canzanese also recommends mineral makeup after treatments such as light chemical peels, microdermabrasion, intense pulsed light and laser. She instructs patients with simple techniques to apply the mineral makeup themselves, much the same way that one would cover a blemish or birthmark and emphasizing careful blending and feathering of the makeup around the edges.
“After surgery, patient’s faces change daily and bruising can be unpredictable,” she notes. “I try to be realistic with expectations for camouflage. I recommend light to medium coverage to boost patient confidence for returning back to work and their normal lives.”
She advises patients to apply the makeup with sponges and a special camouflage brush, which is narrow with condensed hair and a tapered tip, unlike fluffy cosmetic brushes.
Canzanese uses the ColoreScience mineral makeup line and prefers its ease of application and results over other products she has tried. “Some lines create too much shine from the amount of mica they contain and some tend to look too matte or powdery,” she says. “This line is anti-inflammatory, therapeutic, FDA-approved and gives great coverage and results.”
Also beneficial is the fact that mineral makeup provides natural sun protection, due to the fact that ingredients like zinc oxide and titanium dioxide cause dangerous UVA and UVB rays to actually bounce off the skin. Other ingredients, like green tea, chamomile and beeswax are antioxidant and anti-inflammatory.
Above all, The Austin-Weston Center for Cosmetic Surgery emphasizes a team effort in taking care of their patients.
Being able to offer them services to help prepare the skin before surgery and speed the healing afterward has been a huge benefit for all involved. Patients are assured of the best skincare possible and a thorough follow-up after their operations and the surgeons know their patients are well taken care of.
For Canzanese, being able to help patients through the entire process of their transformation and ease their recovery has been challenging and satisfying.
She is able to offer the highest quality products and services in a medically supervised environment for clinical results and give patients needed support and skincare that comforts.
Visit www.austin-weston.com/services/skin-care/ for more information or call 703-893-6168 to learn more about skin care options such as BOTOX® Cosmetic, JUVÉDERM® Injectable Gel, Chemical Peels and other skin care solutions available to Northern Virginia, Maryland and Washington DC area residents.
The Austin-Weston Center for Cosmetic Surgery board certified plastic surgeons can help you look and feel your best.
Writer: Louis Provenzano
Contributing Writers: George Weston, M.D., Dr. Robert Sigal, M.D., Byron Poindexter, M.D.
Category: Skin Care