Concomitant Use of Dermo-Cosmetic Skin Care in Aesthetic Procedures: Systematic Review with Expert Panel Recommendations

Abstract

Purpose

As demand for nonsurgical aesthetic procedures increases, interest is also growing for desirable skin quality—radiant, healthy, and glowing skin—by patients seeking treatment to improve appearance. Although aesthetic medicine physicians are well positioned to advise on the role of basic skin care products in maintenance of results and healing, clear guidelines and protocols are currently lacking regarding the standard use of these products before and after aesthetic procedures.

Methods

An international panel of dermatologists (n = 6) and plastic surgeons (n = 2) convened virtually in March 2022 to discuss the role of skin care before and after nonsurgical aesthetic procedures (including injectables, energy-based devices, chemical peels, and microdermabrasion). As an outcome of that meeting, expert recommendations were developed for periprocedural skin care with the goal of improving recovery time or treatment outcomes for each procedure based on clinical evidence from a systematic literature review of relevant articles published through June 2022 combined with the authors’ experience.

Results

Overall, 104 publications were identified and reviewed; publications could be counted more than once if they covered more than one topic (energy-based procedures, n = 70; injectable procedures including microneedling, n = 25; chemical peels, n = 21; microdermabrasion, n = 10). Common periprocedural skin care included daily routines utilizing cleansers, moisturizers, toners, hydroquinone, antioxidant serums, and sunscreens (as needed) across procedure types. Evidence supports pre/post-procedure routines (cleansers, moisturizers, toners, hydroquinone, antioxidants, sunscreens) across injectables (n = 25 studies), energy devices (n = 70), peels (n = 21), microdermabrasion (n = 10); high-evidence data limited, petrolatum/antioxidants show particular benefit post-laser.

Conclusion

Panel consensus endorses tailored regimens to optimize recovery/outcomes. However, very few studies were designed to evaluate a specific routine vs no skin care treatment. Further studies are needed to provide clinical evidence supporting the effectiveness of periprocedural skin care in reducing healing time and improving aesthetic outcomes. Herein, we provide evidence- and expert-based recommendations for incorporating daily skincare, including cleansers, moisturizers, antioxidant serums, depigmenting agents, and sunscreens, into periprocedural care for minimally invasive aesthetic treatments. These regimens should be adapted to procedure type and individual post-procedural responses and symptoms to optimize outcomes and address specific patient needs.

Introduction

The number of nonsurgical aesthetic procedures performed over the past decade has increased substantially,^1–3 and this growth is expected to continue.⁴ According to The Aesthetic Society’s most recent National Databank Statistics report published in 2022, injectable procedures—including neuromodulators and dermal fillers—were the top nonsurgical procedures performed in 2021 regardless of sex and age.³ Furthermore, injectable procedures increased by at least 40% from 2012 to 2017² and again from 2021 to 2022.³

With this increase in demand for nonsurgical aesthetic procedures comes a desire by both patients and physicians to optimize treatment outcomes and duration of the effects.^5–7 The effectiveness of nonsurgical aesthetic treatments was ranked as a top consultation topic on a global survey of 1315 aesthetic physicians, with an ultimate goal of improving patient satisfaction.⁵ Furthermore, patients seeking these treatments have shown a particular interest in long-lasting over immediate results,^6,7 with natural-looking results emerging as an important patient-reported outcome. On a global survey of aesthetically conscious adults, respondents rated concern for unnatural outcomes as a top treatment barrier.⁵ It is no surprise that following this trend, interest is growing for desirable skin quality—radiant, healthy, and glowing skin—by patients seeking treatment to improve appearance.⁸

Personalized skincare is an emerging paradigm in dermatology and aesthetic medicine, with increasing recognition that periprocedural skincare should be adapted to individual patient characteristics—eg, depigmenting agents for Fitzpatrick IV–VI to mitigate PIH post-sun exposure or injury—and procedural modalities rather than relying on uniform protocols. Growing evidence suggests that appropriate periprocedural skincare interventions may influence postprocedural recovery and the occurrence of adverse effects across a range of minimally invasive aesthetic procedures, such as inflammation and scarring.^9,10 Adding to their benefit is the fact that topical skin care products such as creams, cleansers, moisturizers, and other solutions also provide inherent noninvasive skin rejuvenation effects that slow the progression of skin aging.^11,12 Aesthetic medicine physicians are well positioned to advise on the role of basic skin care products in maintenance and healing; however, clear guidelines and protocols are currently lacking regarding the standard use of these products before and after aesthetic procedures.^10,12,13 Furthermore, physicians are often asked to advise on the skin care products most appropriate for the chosen nonsurgical procedure.¹⁴ Different aesthetic procedures will likely impact skin quality differently, but a thorough understanding of the resulting damage to the skin caused by various procedures remains unknown.¹²

The aim of this position paper is to review the current literature on and identify unmet needs for skin care in nonsurgical aesthetic procedures, including pre- and postprocedure patient management to optimize aesthetic outcomes. Herein, we provide consensus recommendations on skin care before and after aesthetic treatments, including injectables, energy-based devices, chemical peels, and microdermabrasion, based on a systematic literature review and clinical experience.

Methods

Eligibility and Information Sources

A panel of 6 dermatologists from the United States, Poland, Brazil, Italy, the United Kingdom, and Germany (n = 1 each) and 2 plastic surgeons from Canada and Germany (n = 1 each) convened virtually in March 2022 to discuss the role of skin care before and after nonsurgical aesthetic procedures. As an outcome of that meeting, a systematic literature search was conducted in June 2022, and expert recommendations by procedure were developed for periprocedural skin care.

Search Strategy and Data Collection

The systematic literature reviews identified articles describing pre- and/or postprocedural skin care associated with specific aesthetic procedures of interest (injectables: botulinum toxins, dermal fillers, biostimulators, and products injected by microneedling; energy-based devices: laser, radiofrequency, ultrasound, intense pulsed light; chemical peels; and microdermabrasion). PubMed was searched for articles of interest with English abstracts, without limitations for publication year or type, using specific terms related to skin care (eg, niacinamide, antioxidant, retinol) and the aesthetic procedures of interest noted above (eg, neuromodulator, dermal filler, collagen stimulator, laser, resurfacing, energy-based; Table 1). The search was further narrowed by terms associated with aesthetics (eg, aesthetic, rejuvenation, wrinkle). The articles were screened by 2 reviewers based on titles and abstracts to select relevant articles. Manual searches for reference lists from all included publications were performed to identify potential additional articles. Publications identified for inclusion were then categorized by level of evidence (graded per the guidelines of the Aesthetic Plastic Surgery Journal),¹⁵ publication type, aesthetic procedure type, skin care product type, and skin care timing based on review of the full article (Table 2).

Table 1.

Search String to Identify Literature Indexed in PubMed

Term	Search String Component
Skin care terms	moisturi* [Title/Abstract] OR “skin care” [Title/Abstract] OR “skincare” [Title/Abstract] OR niacinamide [Title/Abstract] OR “vitamin B3” [Title/Abstract] OR panthenol [Title/Abstract] OR “provitamin B5” [Title/Abstract] OR glycerin [Title/Abstract] OR retinol [Title/Abstract] OR retinoid [Title/Abstract] OR “glycolic acid” [Title/Abstract] OR humectant [Title/Abstract] OR emollient [Title/Abstract] OR “skin barrier” [Title/Abstract] OR “vitamin E” [Title] OR “vitamin C” [Title] OR “vitamin K” [Title] OR “vitamin A” [Title] OR “lactic acid” [Title] OR arnica [Title] OR hydroquinone [Title] OR antioxidant [Title] OR “plant extract” [Title] AND “aesthetic*” [Title/Abstract] OR “esthetic*” [Title/Abstract] OR “cosmetic*” [Title/Abstract] OR rejuvenat* [Title/Abstract] OR wrinkl* [Title/Abstract]
	AND
Procedure terms, injectables	botulinum [Title/Abstract] OR neurotoxin [Title/Abstract] OR neuromodulator [Title/Abstract] OR “hyaluronic*” [Title/Abstract] OR “dermal filler” [Title/Abstract] OR “facial filler*” [Title/Abstract] OR “HA filler*” [Title/Abstract] OR “hyaluronic acid-based filler*” [Title/Abstract] OR “temporary filler*” [Title/Abstract] OR “nonpermanent filler*” [Title/Abstract] OR “absorbable filler*” [Title/Abstract] OR “permanent filler*” [Title/Abstract] OR “nonabsorbable filler*” [Title/Abstract] OR “soft tissue filler*” [Title/Abstract] OR “synthetic filler*” [Title/Abstract] OR “injectable filler” [Title/Abstract] OR microneedling [Title/Abstract] OR (collagen [Title/Abstract] AND stimulat* [Title/Abstract]) OR (“poly-L-lactic acid” OR “calcium hydroxylapatite” [Title/Abstract] OR “polymethylmethacrylate” [Title/Abstract]) AND “aesthetic*” [Title/Abstract] OR “esthetic*” [Title/Abstract] OR “cosmetic*” [Title/Abstract] OR skin [Title/Abstract] OR rejuvenat* [Title/Abstract] OR wrinkl* [Title/Abstract] OR “facial tissue augmentation” [Title/Abstract]
	OR
Procedure terms, energy-based devices	laser [Title/Abstract] OR energy-based [Title/Abstract] OR ablative [Title/Abstract] OR nonablative [Title/Abstract] OR non-ablative [Title/Abstract] OR radiofrequency [Title/Abstract] OR radio-frequency [Title/Abstract] OR ultrasound [Title/Abstract] OR “intense pulsed light” [Title/Abstract] AND “aesthetic*” [Title/Abstract] OR “esthetic*” [Title/Abstract] OR rejuvenat* [Title/Abstract] OR resurfacing [Title/Abstract]
	OR
Procedure terms, chemical peels and microdermabrasion	chemical peel [Title/Abstract] OR “acid peel” [Title/Abstract] OR “glycolic peel” [Title/Abstract] OR “superficial peel” [Title/Abstract] OR “medium peel” [Title/Abstract] or “deep peel” [Title/Abstract]OR chemoexfoliation [Title/Abstract] OR microdermabrasion [Title/Abstract] OR microabrasion [Title/Abstract] AND “aesthetic*” [Title/Abstract] OR “esthetic*” [Title/Abstract] OR “cosmetic*” [Title/Abstract] OR rejuvenat* [Title/Abstract] OR resurfacing [Title/Abstract]

Table 2.

Parameters for Article Categorization

Parameter	Category
Level of evidence15
I	Evidence obtained from at least 1 properly designed randomized controlled trial
II	Evidence obtained from well-designed controlled trials without randomization
III	Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than 1 center or research group
IV	Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence
V	Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Publication type	Randomized clinical trial report Nonrandomized, controlled prospective study report Cohort- or case-controlled, multicenter study Case study/series Retrospective study report Consensus report Review Opinion/editorial Other
Aesthetic procedure type	Injectables (botulinum toxin, dermal filler, biostimulator, including products injected by microneedling) Energy-based devices (laser, radiofrequency, ultrasound, intense pulsed light) Chemical peels Microdermabrasion
Skin care product type	Gentle cleanser Moisturizer Ointment Sunscreen Unspecified regimen Ingredients (eg, antioxidants, depigmentation agents, vitamin K, tretinoin, retinoids)
Skin care timing	Preprocedural Periprocedural Postprocedural Both

Development of Expert Recommendations

Information from the literature search, paired with the expert panel’s opinion and experience, was used to develop recommendations on the use of skin care before and after aesthetic procedures. Although all relevant literature was considered, only the results from clinical studies with a high level of evidence (level of evidence, ≤3; randomized controlled trials [RCTs], nonrandomized controlled studies, nonrandomized prospective studies, and open-label studies) were assessed regarding clinical evidence for improvements in either patient recovery time or treatment outcomes with specific periprocedural skincare routines.

Results

Literature Search

The systematic literature search yielded 410 papers containing the identified search terms (Figure 1). Exclusion of articles not related to the use of skin care before and/or after nonsurgical aesthetic procedures of interest resulted in 73 articles. A manual search of the bibliographies of these 73 articles identified an additional 31 papers. Thus, a total of 104 publications were included for further categorization as described above. Articles could be categorized under more than one procedure type if applicable. The highest number of relevant articles was identified for energy-based procedures (n = 70), followed by injectable procedures including microneedling (n = 25), chemical peels (n = 21), and microdermabrasion (n = 10).

Figure 1.

Flow diagram for literature search. ^aIncluding microneedling.

There were a limited number of publications with a level of evidence ≤3 to support literature-based recommendations for use of skin care products during or after procedures for hyaluronic acid fillers or neuromodulators (n = 5), microneedling (n = 5), chemical peels (n = 6), and microdermabrasion (n = 3). Although there were more publications with a level of evidence ≤3 assessing the periprocedural use of skin care products with nonablative procedures (n = 19) and ablative laser resurfacing (n = 30), very few studies across procedure types were designed to evaluate a specific routine vs no skin care treatment. Therefore, recommendations for each procedure are largely based on the expert panel’s opinion and experience. Additional RCTs, including split-face studies of skin care vs no skin care, are needed to fully assess the impact of skin care regimen on treatment outcomes and recovery time.

Periprocedural Procedures: Literature Search Consensus and Expert Panel Recommendations

Injectable Procedures

As injectable procedures (including neuromodulator and hyaluronic filler) have increased in popularity,^12,16 so has the desire for optimized treatment outcomes and duration of effect.^5–7 Inherent to these procedures, however, is the tissue injury caused by injection with a needle or cannula and the risk for bruising and swelling.¹⁶ As topical skin care products are known to improve skin quality and are used in many anti-aging protocols, their use as possible adjunctive treatments to injectable procedures has been of interest.¹⁷ Our systematic literature search identified several relevant articles demonstrating positive outcomes with the use of hyaluronic acid fillers¹⁸ or neuromodulator injections^14,19 and concomitant skin care regimens. Furthermore, some studies examined the effects of a skin care regimen on patients undergoing both hyaluronic acid filler and neuromodulator treatments,^10,17 as combined aesthetic injectable treatment has been shown to improve both patient outcomes and satisfaction relative to treatment with either hyaluronic acid filler or neuromodulator alone.^20–23

Overall, there was a limited number of published clinical studies with a level of evidence ≤3 supporting the use of skin care products during or after procedures for hyaluronic acid fillers or neuromodulators (n = 5). Although the specific skin care products and approaches varied from study to study, results of these studies support the use of cleansers, exfoliators, toners (used to adjust the pH of the skin), depigmentation/bleaching agents, moisturizers, antioxidants, sunscreen, and tretinoin or retinoid topical formulas to improve treatment outcomes.^{10,14,16,18,19}

Expert Recommendations

Based on a review of the literature and their real-world clinical experience, the panel developed the following expert recommendations for the use of skin care with injectable procedures (Table 3).

Table 3.

Skin Care Regimen Recommendations for Injectable Procedures

Neuromodulators, hyaluronic acid fillers, biostimulators
Product	Recommendation
Sunscreen	Avoid sun exposure; sunscreen should be applied prior to any unavoidable sun exposure and open-air activity
Gentle cleanser	Twice a day
Moisturizer	Moisturizer should contain antioxidants and restructuring peptides Apply 20 minutes before sunscreen and at night
Toners, depigmentation agents, exfoliators, alpha-hydroxy acids, tretinoin or retinoid creams	Apply once per day to avoid irritation Use dependent on patient’s personal skin characteristics
Massage	Only recommended for biostimulator procedures to evenly distribute the product The physician should massage immediately following treatment; the patient can be instructed to massage the injection site area 2 times a day for up to 1 week
Microneedling
Product	Recommendation
Gentle cleanser	Use as pre- and postprocedural care
Moisturizer	Moisturizers enriched with vitamins and antioxidants should be considered
Sunscreen	Avoid sun exposure; use sunscreen when outdoors Particularly recommended for use with skin phototypes at risk for PIH
Depigmentation agents	Recommended for patients with skin phototypes at risk for PIH

Abbreviation: PIH, post inflammatory hyperpigmentation.

Sun exposure should be carefully avoided. Sunscreen should be applied prior to any unavoidable sun exposure and open-air activity. This is important to avoid post inflammatory pigmentation, especially in darker skin phototypes. Although it was recommended to apply previous formulations at least 30 minutes before going outside, newer formulations can be applied just before sun exposure.

Concerning the postprocedural skin care regimen, we recommend the use of gentle cleanser to avoid irritation, preferably syndet, and a moisturizer (at least twice a day) as good skin hydration enables faster skin restoration and reduction of inflammatory processes. A moisturizer addressing the problems for each specific patient should be alternated with a topical formulation containing antioxidants and restructuring peptides. The moisturizers could be applied in the morning, 20 minutes before sunscreen, and at night. Additionally, toners, depigmentation agents, exfoliators, alpha-hydroxy acids, and tretinoin or retinoid creams can be used per personal skin characteristics, usually applied once a day to avoid irritation.

Following biostimulator procedures, the physician should immediately massage the treated area to evenly distribute the product.²⁴ The patient can also be instructed to massage the injection site area 2 times a day for up to 1 week.²⁴ Additionally, a topical drug as can be applied as needed, alternating use of an emollient and gentle moisturizer containing antioxidants and restructuring peptides to optimize skin care, or fragmented hyaluronic acid (Table 3).

Microneedling

Microneedling is a type of noninvasive skin rejuvenation procedure that uses multiple needles to penetrate the dermis and create a controlled skin injury. Also known as collagen induction therapy, microneedling induces the rapid healing of micro wounds and leads to new collagen and elastin fiber production and release of growth factors.^25,26 Some of the relevant papers identified in our literature search examined the use of periprocedural skin care regimens, including gentle cleansers, creams, and sunscreens, with radiofrequency (RF) microneedling.^27,28 Another study assessed the use of only a postprocedure skin care protocol following RF microneedling,²⁵ and Abdel-Rahman et al²⁶ found that the use of vitamin C (pure L-ascorbic acid 20%) applied immediately after microneedling significantly improved melasma outcomes relative to platelet-rich plasma use.

Similar to the results with injectables, there were 5 published clinical studies with a level of evidence ≤3 discussing the results of periprocedural skin care (gentle cleanser, moisturizer, topical vitamin C, an anhydrous formulation of topical peptides with antioxidant properties, and sunscreen) with RF microneedling.^25–29 Two of these studies, which investigated the effects of vitamin C and a skin care system consisting of topical peptide ingredients with antioxidant properties, included control groups that would allow a comparison of skin care protocols; however, neither study used a no-treatment control group.^26,29

Expert Recommendations

When recommending a periprocedural skin care regimen for microneedling procedures, it is important to consider the wound healing process. The formed micropores go through a repair process that may require several days before the barrier impairment is completely restored.³⁰ Therefore, a preprocedural skin care regimen of a gentle cleanser is strongly recommended to correct hygiene of the area. Makeup should not be applied on the day before the procedure to avoid the penetration of residual inorganic particles.

After the procedure, besides the general recommendation of the use of gentle cleanser and moisturizers, the application of topical moisturizers enriched with vitamins and antioxidants may favor tissue protection and repair.³¹

Sun avoidance is recommended, and sunscreen must be used outdoors, especially in skin phototypes > Fitzpatrick skin type IV at high risk of post inflammatory hyperpigmentation (PIH). In the latter phototypes, products active against excessive pigmentation could be recommended to prevent PIH and guarantee a smoother and more homogeneous skin tone result. Skin care recommendations for microneedling are summarized in Table 3.

Energy-Based Procedures

Energy-based procedures are a broad class of nonsurgical aesthetic procedures, including ablative and nonablative laser resurfacing, intense pulsed light (IPL), RF, and high-intensity focused ultrasound, that utilize thermal disruption of collagen fibers to achieve skin rejuvenation.^32,33 Since its first use in the 1980s to treat photodamaged skin, rhytides, and acne scars, application of laser resurfacing has expanded to treat a wide variety of aesthetic indications.^34–36 The extent of skin damage with laser resurfacing depends on the depth of penetration; ablative laser resurfacing involves injury of the epidermis and dermis, whereas nonablative lasers treat the underlying dermis and preserve the epidermis, thus minimizing downtime, side effects, and the recovery period.^32,37 As each energy-based procedure has a different method of thermal injury and length of postoperative recovery, the applied skin care regimens—for which there are many options—will also be unique for each procedure.^35,36 For laser resurfacing procedures, the use of adjunctive skin care is known to enhance healing and extend the duration of treatment outcomes.³⁶

With the evolution of laser technology over the decades, development of postprocedure healing agents has also advanced.³⁴ Indeed, the majority of relevant articles identified in our literature search on energy-based devices examined the use of postprocedural skin care with laser resurfacing procedures (n = 32). Only 1 article assessing the use of preprocedural skin care (tretinoin treatment) with laser resurfacing procedures was identified,³⁸ and 7 articles examined the use of both pre- and postprocedural skin care. Several additional articles (n = 5) were identified assessing the use of either post- or periprocedural skin care regimens (eg, depigmentation agent, tretinoin, topical antioxidant) with IPL procedures.

The type of skin care used varied greatly across the clinical studies describing skin care for nonablative procedures with a level of evidence ≤3 (n = 19). However, 8 studies described improvements in treatment outcomes or recovery times with the use of regimens that included some combination of cleanser, moisturizer, depigmentation agent, antioxidants, and sunscreen relative to a control group.^29,39–45

Of the 30 relevant published clinical studies (level of evidence ≤ 3) discussing the combined use of skin care and ablative procedures, the types of skin care with the most clinical evidence addressed postprocedural use of petroleum-based ointments,^46–53 topical vitamin C,^54–56 anhydrous formulation of topical peptides with antioxidant properties,^57,58 cell-conditioned media,^59,60 and sunscreens.^{51,57,58,61–63} Petroleum-based ointments were often used as the postprocedure standard of care, as reflected in the number of studies using this type of skin care as the comparator group.^{46,48–54,57,63–65}

Expert Recommendations for Nonablative Lasers and Other Procedures

Recommendations for periprocedural skincare will vary by the treatment indication. However, as a general guideline, broad spectrum sunscreens should be used on a regular basis. Within the first 48 hours following treatment, only a moisturizer with a calming action and occlusive effect is recommended. After 48 hours, products with antioxidant properties can be added depending on the degree of recovery. Products with a depigmentation agent may be used to address specific patient concerns 7–10 days after treatment (Table 4).

Table 4.

Skin Care Regimen Recommendations for Energy-Based Procedures

Nonablative procedures
Product	Recommendation
Sunscreen	Avoid sun exposure; sunscreen should be applied prior to any unavoidable sun exposure and open-air activity
Moisturizer	Can begin use immediately following treatment Moisturizer should have a calming action and occlusive effect
Antioxidants	Can be used 48 hours after treatment depending on the degree of recovery Apply once per day to avoid irritation
Depigmentation agents	Use 7–10 days after treatment Use is individualized to patient’s personal skin characteristics to address specific patient concerns
Ablative laser resurfacing
Product	Recommendation
Petroleum-based ointments	Postprocedural application as an adjunct in postprocedure standard of care owing to occlusive properties
Sunscreen	Avoid sun exposure; use sunscreens with visible light protection daily when outdoors
Moisturizer	Use a noncomedogenic repair moisturizer that contains niacinamide for skin barrier restoration, antipigmentation, anti-inflammatory, and antioxidant benefits
Fragmented hyaluronic acid and collagen stimulators	May consider adding to skin care routine

Expert Recommendations for Ablative Laser Resurfacing Procedures

After evaluating the studies, we recommend postprocedural application of petrolatum-based ointments as a well-supported adjunct treatment method to enhance results (Table 4). Broad spectrum sunscreens with visible light protection should be used daily. Owing to the skin barrier injury induced by ablative lasers, patients should use a noncomedogenic moisturizer with niacinamide for skin barrier restoration due to its anti-inflammatory, antioxidant, and anti-pigmentation benefits. Use of a topical fragmented HA and collagen stimulator could also be useful. When considering skin care products, it is important to consider the formulation of the products to minimize irritation or sensitization.

Chemical Peels

Chemical exfoliation is a well-established nonsurgical aesthetic procedure used for skin resurfacing and rejuvenation whereby a chemical agent, typically an acid, is applied to the skin to induce tissue injury at a specific depth.^66,67 The damage produced by the acid stimulates inflammation marked by various degrees of erythema, followed by second-intention wound healing and extracellular matrix remodeling, improving the surface appearance of the aging or actinic skin through fibroblast activation for collagen production.^66–69 Chemical exfoliation is also responsible for epidermal cell damage, desquamation, and renewal.⁶⁷ Thus, the surface of the epidermis after peeling is even and more smooth with tighter and better quality of the cornified layer.⁶⁸ Chemical peels may also be used to treat melasma and for lentigo spot removal.^68,70 The most common area for chemical exfoliation is the face due to many defects present and aesthetic needs to address, but non-facial skin can be also efficiently treated and improved.⁶⁸

Based on the depth of injury and penetration of the acid into the skin, chemical peels are classified as superficial, medium, or deep.⁶⁶ Alpha-hydroxy acids (AHA), which are used for the majority of peelings, induce cytolytic tissue damage, whereas potent trichloroacetic acid (TCA) leads to protein denaturation effects that produce a white, dry skin surface known as frosting.^68,71 Options for chemical peeling depth are limited by darker skin, including Fitzpatrick’s classification IV to VI, due to higher risk of PIH following injury.^66,70 Therefore, proper patient selection, peelings combination, and postprocedure skin care regimen are key for exfoliation outcomes. Although glycolic acid (an AHA) is the most frequently used agent for superficial chemical peels,⁶⁷ salicylic acid (beta-hydroxy acid) and TCA may also be used.^66,70,72 TCA, phenol, and laser peels are used for medium and deep exfoliations.⁷³ Many of the articles identified in our search examined the use of chemical peels alone as a type of skin care regimen, but several reported on the use of additional periprocedural skin care, including pre-⁷¹ and post-peel skin care.^67,74–76

Among the 6 clinical studies with a level of evidence ≤3 identified for chemical peels, the use of cleansers, moisturizers, tretinoin/hydroquinone-based products, and sunscreen have been evaluated for their tolerability and potential effects on efficacy and healing.^{67,71,74,76–78} However, only 2 of these studies provide evidence of improved outcomes using skin care products.^67,71

Expert Recommendations

Preprocedural use of 0.05% or 0.1% tretinoin for light skin or twice daily periprocedural use of a cleanser, followed by a lipid moisturizing cream and sunscreen as needed, may improve outcomes with chemical peel procedures. Conversely, it is advised to discontinue retinoids 1 to 2 weeks before peeling in darker-skinned individuals to avoid dyschromia and scarring.⁶⁶ To obtain a better lightening effect of the superficial peelings, a pretreatment phase with a topical depigmentation agent, salicylic acid, glycolic acid, kojic acids, retinol, azelaic acid in combination with topical steroids is proposed. The summary of the complex skin care before or after chemical injury and exfoliation is presented in Table 5.

Table 5.

Skin Care Regimen Recommendations for Chemical Peeling Procedures Using AHA, BHA, TCA, or for the Treatment of Melasma

Parameter	Recommendations by procedure/indication
Depth	AHA & BHA	TCA	Melasma
Superficial Sun protection Indications	Most commonly performed Prevent sun exposure Low risk of complications For refreshing, moisturizing, smoothing rough skin surface, keratosis pilaris, acne vulgaris, sensitive skin, all ages	Low percentage TCA 10–20% Must avoid sun exposure Some risk of complications Early actinic damage, smoker’s skin, lentigines, better tolerated by individuals with oily skin	Preferred depth for more predictable results Safer superficial peels, help to avoid intense inflammation which can stimulate melanocytes Must avoid sun exposure. Broad UVB, UVA and VBL protection highly recommended Melasma, post inflammatory hyperpigmentation, dyschromia, light and dark skin individuals (Fitzpatrick skin type I–V)
Medium Sun protection Indications	Combine with TCA Must avoid sun exposure Sun-damaged skin, elastosis, rhytides, actinic keratoses	Higher percentage of TCA up to 30%, or several layers applied, or vigorous rubbing Must avoid sun exposure Better tolerated by thick, oily skin; photoaging; rhytides, actinic keratoses	Recommended to experienced physicians; not appropriate for all patients, avoid on skin pickers or those with compulsive disorders, (Fitzpatrick skin type I, II, or III) Must avoid sun exposure. Broad UVB, UVA and VBL protection recommended. Inflammation should be controlled with antioxidants or medium potency topical steroids Melasma on thick, oily skin; PIH; lighter skin individuals (Fitzpatrick skin type I–III)
Deep Sun protection Indications	Combined with lasers Baker-Gordon phenol peel Limit to experienced physicians for lighter skin carnations (Fitzpatrick skin type I and II) Only limited skin area treated Risk of complications – scarring Prevent renal toxicity from phenol Cardiac monitoring Sedation for the procedure may be helpful Must avoid sun exposure Severe photoaging, actinic keratoses, static rhytides, atrophic scars	High percentage of TCA 50% Limit to experienced physicians for lighter skin carnations (Fitzpatrick skin type I and II) Only limited skin area treated Risk of complications – scarring Must avoid sun exposure Severe photoaging, actinic keratoses, static rhytides, atrophic scars, oily skin preferred	Combination or multilayer Limit to experienced physicians Fitzpatrick skin type I and II Only limited skin area treated Risk of complications – scarring or achromia Must avoid sun exposure for the entire life, must use bleaching creams and serums, topical retinoids with hydrocortisone may help after healing Melasma with actinic keratoses, melasma with static rhytides, melasma with atrophic scars
Patient selection	Evaluate the following patient characteristics  Fitzpatrick skin type  Actinic skin damage  Age skin damage  General health (eg, immunosuppression, diabetes, smoking)  Scarring tendency  Medications (systemic isotretinoin, topical tretinoin only in selected cases, oral contraception)  Oily skin vs dry skin  Skin thickness and regenerating properties (eg, face, neck, décolletage)  Acne changes (comedo, papules, pustules)  Postprocedural compliance—willingness to follow Also consider  Allergies  History of hives (urticaria)  Chronic herpes infection (prevention with oral acyclovir or valacyclovir)
Postprocedural skin care recommendations
Immediately after the peeling	Emollient with antioxidants and soothing ingredients (bisabolol) Emollients should be preservative free, fragrance free, dye free, alcohol free, and easy to apply Avoid sticky makeup	Occlusive ointment to cover frosted skin Petrolatum jelly, Aquaphor Ointment with cholesterol Greasy emollient with antioxidants No makeup	Emollient with antioxidants, bleaching agents, and soothing ingredients Emollient should be easy to apply Avoid sticky makeup
Washing and cleansing	Cleanser with 5.5 pH (syndetic, washing oil, gel, soap less formula) Apply gently with hands Use a toner to optimize skin pH 4.5 to 5 Do not rub (with hands, towel, cotton pads)
Daily care during desquamation	Emollients with soothing properties (bisabolol) containing epidermal lipids Restoration of the cornified layer with beta-glucan Antioxidants (vitamin E, vitamin C) In case of wet skin necrosis and risk of bacterial secondary infection, use silver sulfadiazine twice daily	Avoid picking of epidermal flakes Greasy emollient with antioxidants at least twice daily Cream with 0.1% tretinoin once daily may speed up healing of the white-skinned individuals with thick skin (eg, men) Avoid sticky makeup at this stage	Emollients with soothing properties (bisabolol) containing epidermal lipids Antioxidants (vitamin E, vitamin C) Antioxidants, and antipigmentation (niacinamide) Retinol formulation once daily Emollients should be preservative free, fragrance free, and dye free
Daily care after desquamation	Nonocclusive and noncomedogenic emollients twice daily Emollients containing epidermal lipids Topical retinoids if needed once daily Low concentrated GA, SA, or MA in topical formulation for acne prone skin or for oily skin Mineral 89 (89% Vichy mineralizing water and hyaluronic acid) for the sensitive skin In case of scar formation, treat with a potent steroid ointment or inject transdermally with triamcinolone	Must use a moisturizer Cream with retinoid (0.1% tretinoin) overnight Emollients with soothing properties (bisabolol) containing epidermal lipids once or twice daily Antioxidants (vitamin E, vitamin C) Restoration of the cornified layer with beta-glucan Emollients should be preservative free, fragrance free, and dye free, eg, Mineral 89 (89% Vichy mineralizing water and hyaluronic acid) Nonocclusive and noncomedogenic emollients Careful with high temperature to reduce the risk of persistent erythema In case of prolonged erythema, consider cream with ivermectin 1% In case of persistent erythema, consider intradermal microdosing of botulinum neurotoxin type A In case of scar formation treat with a potent steroid ointment or inject transdermally with triamcinolone	Nonocclusive and noncomedogenic emollients Many factors influencing melanin production or depletion in topical products Ascorbic acid Niacinamide Tranexamic acid (can be also oral) Plant natural products Kojic acid Retinoids Retinol Hydroquinone 2–4% (not available in EU) Corticosteroids (low potency hydrocortisone) Azelaic acid Regular daily application, once or twice daily
Sun protection	Sunscreen use is mandatory prior to sun exposure	Sun avoidance Use sunscreen prior to sun exposure	Sun avoidance Use sunscreen prior to sun exposure; broad UVB, UVA and VBL protection highly recommended

Note: Table adapted from Singh-Behl et al.⁷⁹

Abbreviations: AHA, alpha-hydroxy acid; BHA, beta-hydroxy acid; GA, glycolic acid; MA, mandelic acid; PIH, post inflammatory hyperpigmention; SA, salicylic acid; TCA, trichloroacetic acid, UVA, ultraviolet A; UVB, ultraviolet B; VBL, visible blue light.

Microdermabrasion

Microdermabrasion is a noninvasive, nonchemical, nonsurgical procedure used to superficially resurface, revitalize, and rejuvenate the skin.^80,81 This procedure is the treatment of choice for improving acne scars,⁸² but it is also used by practitioners to improve or correct enlarged pores, photodamage, hyperpigmentation, superficial rhytides, stretch marks, and minor scars.⁸¹ Microdermabrasion is a subtle procedure—equivalent to a superficial chemical peel—that is carried out by introducing crystals to the surface of the skin and resulting in detachment of sebum and corneocyte components.^80,81 Despite the increasing popularity of microdermabrasion as a noninvasive aesthetic procedure, literature on its clinical efficacy is scant,⁸¹ a previous finding that is also reflected in our systematic literature search. We found relatively few articles on microdermabrasion and skin care (n = 10) compared with the other procedures analyzed in this review. Relevant articles identified in our search focused on the use of topical retinoids;^81,83 topical antioxidant-rich serums;⁸⁴ basic skin care regimens consisting of cleansers, moisturizers, sunscreens;⁸⁰ and ultrasound-enhanced delivery of a combination of products (eg, hyaluronic acid, retinol, and oligopeptides).⁸⁵

Furthermore, a limited number of these publications had a level of evidence ≤3 (n = 3). The results of these studies provide clinical evidence for the use of cleanser, moisturizer, tretinoin cream, and antioxidant sera.^80,83,84 Of these, only 2 studies included a control group and there was no overlap in the skin care used for each study.^83,84

Expert Recommendations

Prior to the procedure, a cleanser, moisturizer, tretinoin cream, and antioxidant serum may be used with caution related to acids to avoid developing irritation prior to the procedure (Table 6). For up to 7 days after the procedure, a noncomedogenic barrier moisturizer may be used to reduce transepidermal water loss and any discomfort. The moisturizer should have minimal ingredients to avoid sensitization or irritation.

Table 6.

Skin Care Regimen Recommendations for Microdermabrasion

Product	Recommendation
Cleanser	May be used prior to procedure
Moisturizer	May be used prior to procedure For up to 7 days after the procedure, a barrier moisturizer with minimal ingredients is recommended to reduce transepidermal water loss
Tretinoin cream	May be used prior to procedure
Antioxidant serum	May be used prior to procedure

Adverse Events

Pre- and postprocedural skin care regimens can be used to prevent and/or treat AEs resulting from noninvasive aesthetic procedures.^10,86 The periprocedural introduction of skin care agents, particularly those containing peptides, are thought to modulate skin damage by upregulating new collagen and elastin production, thus reducing the severity of AEs that can appear after these procedures.⁸⁷ Different types of procedures produce various levels of injury and thus require unique skin care management. For example, bruising—which typically occurs hours after injectable procedures or more rapidly if a blood vessel is affected—was reduced with the use of a postinjection serum.¹⁶ Additionally, postprocedure skin care regimens containing antioxidant and sunscreen agents have been found to reduce the postprocedural erythema caused by RF microneedling²⁹ and erythema, burning/stinging, and itching in patients undergoing IPL.⁸⁸ Mandy et al⁸³ also reported an absence of 2 AEs that commonly occur after microdermabrasion procedures—milia and post inflammatory pigmentation—in patients who received 0.05% tretinoin cream postoperatively. However, no guidelines or expert consensus on the standard use of skin care agents before or after minimally invasive aesthetic procedures currently exist. Further research is needed to develop targeted periprocedural skin care regimens for nonsurgical aesthetic procedures.¹²

There was only 1 relevant clinical study (level of evidence ≤ 3) assessing the effect of preprocedural skin care alone on the incidence of AEs.⁸³ Similarly, few clinical studies assessed improvements in AEs with periprocedural use of skin care products relative to a control group for injectable procedures (n = 1),¹⁶ chemical peels (n = 2),^67,77 and microdermabrasion (n = 2).^83,84 Therefore, the panel was unable to provide specific recommendations for these procedures based on the literature. Across procedure types, postprocedure sunscreen use is recommended to protect the skin from sun exposure.

With regard to energy-based devices and AEs, several studies of nonablative procedures described reductions in erythema, hyperpigmentation, tenderness, stinging/burning, dryness, itching, scaling, edema, and telangiectasia with the use of postprocedural regimens that included combinations of a cleanser, moisturizer, bleaching agent such as hydroquinone, fluocinolone, and antioxidants relative to a control treatment.^{29,39,40,43,44}

Discussion

The systematic literature review identified 104 publications supporting periprocedural demo-cosmetic use across injectables (n = 25), energy-based devices (n = 70), chemical peels (n = 21), and microdermabrasion (n = 10), aligning with the study’s aim to provide evidence-based guidelines for recovery and outcomes. However, few level 3 studies (RCTs, controlled trials) directly compared skin care regimens to no treatment, limiting causal inference; recommendations thus integrate high-evidence data (eg, petrolatum ointments, antioxidants post-laser) with panel expertise on common routines (cleansers, moisturizers, sunscreens). These findings correlate with objectives by addressing procedure-specific skin barrier disruption—eg, PIH risk in darker phototypes—and broader context of rising nonsurgical procedures, where adjunctive care reduces AEs like erythema and extends results, though RCTs are needed for validation.

This review highlights the role of periprocedural skincare as a supportive adjunct to minimally invasive aesthetic procedures, while underscoring the need to adapt regimens according to procedural modality, tissue injury, and postprocedural healing dynamics. Based on available literature and expert clinical experience, appropriate skincare interventions may contribute to improved recovery, tolerability and aesthetic outcomes, although high-quality comparative evidence remains limited.

Across procedures, consistent themes emerge, including the importance of barrier support, inflammation control, photoprotection, and the timing of active ingredients in relation to the wound-healing process. Notably, sun avoidance and the use of broad-spectrum sunscreen are emphasized to reduce baseline inflammation and mitigate pigmentary risk across all types of discussed procedures.

Photoprotection remains a cornerstone of periprocedural care, with strict sun avoidance and regular sunscreen use recommended for all patients to reduce erythema and the risk of post-inflammatory hyperpigmentation.

Preprocedural skincare aims to optimize skin hygiene for reduced risks of procedure-related complications and improve outcome. Across injectable procedures, microneedling, chemical peels, and microdermabrasion, the use of gentle cleansers is consistently recommended to ensure adequate hygiene while minimizing irritation. Avoiding makeup immediately prior to procedures, particularly before microneedling, may reduce the risk of particulate penetration through a transiently compromised barrier.

Incorporating antioxidants and moisturizers may also improve outcomes, particularly chemical peels and pigment-targeting interventions. The use of low strength tretinoin before superficial peels may enhance efficacy in light skinned individuals, while discontinuation of retinoids is advised in darker skin individuals.

Postprocedural skincare should be dynamic and aligned with the degree of barrier disruption and the stage of healing process. In the immediate post-treatment period, particularly within the first 48 hours, calming and occlusive moisturizers are recommended to support barrier repair and reduce transepidermal water loss. For injectable procedures, adjunctive measures such as postinjection serums and massage following biostimulatory treatments may help reduce bruising and improve product distribution.

Antioxidant-containing formulations may be introduced to mitigate oxidative stress and inflammation, especially following microneedling and nonablative energy-based procedures. In individuals prone to pigmentary alterations, early but cautious introduction of depigmenting agents may help promote more uniform skin tone outcomes.

Procedures associated with more extensive barrier injury, such as ablative laser resurfacing, require enhanced protective care, including petrolatum-based ointments in the early healing phase, followed by noncomedogenic soothing and repair moisturizers containing ingredients such as niacinamide, fragmented hyaluronic acid, or collagen-stimulating ingredients. For chemical peels and energy-based devices, minimalist formulations are preferred initially to avoid irritation, with gradual reintroduction of active agents based on individual tolerance and recovery.

Conclusions

Periprocedural dermo-cosmetic regimens—emphasizing gentle cleansers, moisturizers, antioxidants, depigmenting agents, and sunscreens—enhance recovery and outcomes for nonsurgical aesthetic procedures, as evidenced by systematic review and expert consensus. While clinical experience bridges evidence gaps, future split-face RCTs evaluating routines versus controls will strengthen protocols, particularly for diverse skin types and combined treatments.

This review highlights periprocedural skincare as an important supportive component of minimally invasive aesthetic treatments, despite the limited and heterogeneous evidence base. Available data suggests that appropriate skincare may improve recovery, tolerability, and clinical outcomes when adapted to procedural modality and tissue response.

Preprocedural care should aim to optimize skin condition through gentle cleansing, hydration, and photoprotection, while postprocedural regimens should be staged according to barrier disruption and healing kinetics, prioritizing calming and occlusive products initially and introducing active agents as tolerated. Overall, these findings support a personalized, procedure-adapted approach to periprocedural skincare, while underscoring the need for well-designed studies to establish evidence-based guidelines.

Funding Statement

This work was funded by Galderma SA, Lausanne, Switzerland. Galderma SA was responsible for convening the virtual meeting of physicians in March 2022. Galderma SA was also involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Ethics Approval and Informed Consent

All participating experts provided informed consent prior to the commencement of the study for their anonymized professional opinions to be collected, evaluated, and included in this manuscript. Ethics approval was not required for this non-interventional expert-opinion work, as no human subjects, patient data, or interventional procedures were directly involved.

Disclosure

A Nikolis is a consultant, researcher, and has served on advisory boards for Galderma, Allergan, Prollenium, and Merz. MS Nestor has received research grants from Galderma. J Czuwara is a consultant for Galderma, Vichy-L’Oreal, Pierre Fabre, Lecturer for Bayer, Merck, and Bristol Myers Squibb. M Depfenhart is a consultant for Allergan/Abbvie, Croma GmbH/Austria, and Galderma. J W Fluhr has served as a consultant and speaker for Galderma, Bayer, B. Braun, Beiersdorf, Bioderma/Naos, Expanscience, NeoPharma, Pierre Fabre, L’Oréal, Sebapharma, Unilever, Coloplast, Nestlé, Mann & Schröder, Courage & Khazaka, ECARF, and Moll. FAS Addor is a speaker and researcher for Galderma (Cetaphil products). G Pellacani is a consultant/advisor for AbbVie, Eli Lilly, Galderma, LEO Pharma, L’Oréal, Menarini, Novartis, Pierre Fabre, and Sanofi; and received grants from AbbVie, LEO Pharma, and Pfizer. K Piotrowski, Y Zielinski, N Lachmann, I Prygova, and I Berlin are employees of Galderma. The authors report no other conflicts of interest in this work.