Optimised Skin Care,at A Glance
- Best ResultsImmediately
- Treatment Recovery0 days
- Procedure Time1 min daily @home
- Skin SpecialistDermal therapist, nurse
- Duration of ResultsLong lived
- Back to WorkImmediately
Skin care to optimise laser results
Optimal skin care using basics such as retinol, niacinamide, ascorbic & alpha hydroxy acids can optimise & prolong the results you have received from procedures such as laser resurfacing or chemical peels. A targeted yet simple skin care routine augmented with no downtime clinical procedures can maintain skin health. The future of biostimulation (collagen induction) lies in biostimulatory injectables as they amplify the results from lasers & skin directed treatments.
FactsFacts on Skin Care to Optimise Laser Results
- Simple scientifically proven skin care will optimise results from any procedure
- Timing post procedure is critical to reduce skin irritation
- My go to ingredients include antioxidants, retinol, & vitamin B
- Vitamin C, AHAs & specific skin brightening against are then added
- Augment home skin care with clinical procedures to maximise gains
- Biostimulatory injectables can amplify your laser procedures
Why is skin care important before & after procedures?
A well formulated skin care routine will give you longer lasting results from any skin directed procedure. This includes lasers, peels, skin tightening, dermal fillers, muscle relaxants & even surgery.
The aim of any skin care routine is to protect, preserve, supplement & correct. Read more on how to integrate sunscreens, antioxidants, vitamins & skin care acids.
What does retinol do?
Retinol is the most frequently prescribed skin vitamin. This is a form of vitamin A (which forms the ABCs of skin care). Retinol has the following benefits-
- Increases turnover of skin cells, hence acts as a chemical exfoliant
- Reduces pigmentation production, hence can improve dull skin
- Increases collagen & hyaluronic acid production, reducing wrinkles
- Minimises pore size via stimulation of collagen
- Reduces oil production useful for breakouts
The most important concept to understand is that powerful skincare products will cause skin irritation; the threshold of irritation depends on factors such as your skin type (& threshold) & the concentration of active ingredients. In reality there are many other factors that come into play including your skin’s barrier function, application site, the addition of other chemicals such as propylene glycol to aid in absorption, hydration of epidermis, molecule size, as well as a host of other biological factors.
Refer to the hints below as to how to start retinol. Remember, formulations really do matter.
Why do I prefer retinol over prescription retinoids?
The majority of people will not know how to sensibly titrate prescription retinoids, especially if you are using other skin care products such as AHAs, ascorbic acid, & pigment correctors. Retinol will have a better side effect profile (especially in combination with other products). Exceptions apply.
Prescription retinoids including tretinoin, retinoic acid, adapalene, & tazarotene are best for mild to moderate acne. They can be used by experienced patients who understand their skin’s threshold & do not suffer from sensitive skin conditions such as rosacea. Be guided by your skin care expert regarding your skin’s suitability for retinoids.
How soon can you start or restart retinoids after a procedure?
Start retinoids after your skin has completely healed. I suggest use every alternate day at half the normal concentration. You can dilute your usual application amount by half mixing it with your moisturizer of choice. This is a guide as to when to restart your retinol – retinoids –
Very gentle lasers & procedures: Pico, nano, Spectra,HIFU, RF, Dermal Toning: Restart 24 to 72 hours
Gentle lasers & procedures: microneedling, Fraxel, C+B, LaseMD, IPL, BBL, HALO laser, retinoic acid peels, glycolic acid 50-70%; restart day 4-6
Medium downtime procedures: microneedling RF, Genius RF, Infini RF, Morpheus 8 RF, Fraxel HD, Fraxel-IPL, CO2 fractional lasers, erbium fractional, restart day 5-9
Heavy resurfacing, deep peels: CO2 & ablative laser resurfacing, deep chemical peels. Restart day 8 to 21
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Why is niacinamide awesome?
Niacinamide or vitamin B3 is an awesome ingredient to add to your line up. Why? Because it has anti-inflammatory properties, & it helps with skin barrier function. This is my go to ingredient if you have sensitive skin.
In the context of post procedure skin care, B3 can be added as early as 7 days after fractional laser resurfacing / microneedling RF. In fact this ingredient can be used to reduce pimples, spots & dots after RF procedures/lasers.
What is the big deal with ascorbic acid?
Ascorbic acid, commonly known as vitamin C, has many profound effects on skin health. This ‘active’ is part of the ABCs of skin care. Ascorbic acid has the following actions-
- Collagen builder. Promotes cells to produce collagen, elastin & hyaluronic acid.
- Decreases collagen breakdown via regulation of TIMP – tissue inhibitor metalloproteinases.
- Reduces melanocyte activity by inhibiting tyrosinase enzyme; hence reduces pigment output.
- Antioxidant in vitro, & forms part of the trio of ferulic, ascorbic acids & tocopherol.
- Stabilizes other topicals via sacrificial oxidation, hence used in many therapeutic applications.
The timing of when to initiate ascorbic acid is super important. Start too soon post laser/procedure & your skin WILL get irritated. This is because vitamin C is best formulated in an acidic environment with pH ranging from 2.5 to 3.5, as compared to your natural pH of around 5.7 to 6.0.
As a guide, start at 10-15% L ascorbic serum, 12 to 21 days post procedure. Apply a small test patch in front of your ear (say 2 inches by 2). If you do not have any reaction, apply to the rest of your face. Start alternate nights & titrate accordingly. As a guide, ascorbic acid timing is as follows-
- Post nano/pico toning/Spectra: next night for light settings, wait 72 to 96 hours for high settings.
- Post C+B, Fraxel, LaseMD, BBL, IPL: wait 4-8 days depending on settings.
- Post CO2 fractional laser resurfacing: wait 7-10 days, depending on settings.
- Fully ablative laser resurfacing: wait 2-8 weeks before commencing.
Do not use ascorbic acid if you are still red/have sensitive skin/ have rosacea. Be guided by your allocated nurse I have assigned to your case.
Why do I like AHAs?
AHAs including glycolic, lactic, citric, & mandelic acids are great exfoliants. This improves the appearance of dull skin by accelerating the turnover of cells. At higher concentrations, AHAs can stimulate collagen production.
AHAs can also be combined with retinoids to help increase the penetration of the latter (don’t try this unless you really know your skin’s threshold). The application of AHAs 10-23% can ‘prime’ the skin, increasing the bioavailability of other topicals including retinoids, pigment correctors, antioxidants & other molecules.
As a guide, I prefer the use of potent AHAs infrequently in a pulsed manner, namely every one to two weeks. Your allocated dermal therapist or nurse will guide you through the types of skin acids, concentrations & application frequencies.
Office glycolic & lactic acid peels are several steps above home skin care. Peels have higher concentrations – often up to 70%, at a much lower pH; less than 2. The clinical staff at Cutis will guide you.
What does a basic skin care routine look like?
The most basic skin care routine starts off with sunscreen. This is the absolute cornerstone of skin care. Concentrate on getting the correct amount & frequency of sun protection before considering other skin care products.
Step one; a starting amount is 2mls twice a day, or two finger lengths. If used correctly, one 50 ml bottle should last you 3 weeks.
Step two; antioxidants in the am. These include tocopherol, resveratrol, ferulic, & ascorbic acids. Antioxidants protect against UV & environmental stressors that damage skin cells.
Step three; actives in the pm. These include retinol, retinoids, niacinamide, & ascorbic acid. This list forms the cornerstone of skin care, be guided by your skincare expert.
Step four; correctors as required. These are specific ingredients to address your skin concerns. For example, if you have oily skin, AHA & BHA maybe added, whilst if pigmentation is your primary concern, arbutin, licorice root, botanicals, skin care acids (AHAs, BHAs, Kojic, Ascorbic) or hydroquinone may be indicated.
What are biostimulatory agents & why are they much better than skin care?
From 2024, these new injectables are the way of the future. They work by providing biostimlation, namely to increase collagen production in the deeper layers of skin. This amplifies the results from lasers.
Unlike dermal fillers (which give volume), collagen stimulating injectables increase ‘fibrosis’ or collagen, in turn providing improvements in skin laxity & tone.
What types of biostimulators are there?
Australia has several types of biostimulators- HA based & non-HA based.
HA based hybrid biostimulators entered the Australian market in 2022. This is a very weak biostimulatory agent, but it is very useful for skin hydration as it improves skin turgor. More on this injectable.
Non-HA based injectables include PLLA, CAH, Rejuran & PCL. Of this group, PCL is the most powerful.
Rejuran is a polynucleotide that can improve skin quality.
How many sessions of biostimulators will I need?
2-4 sessions depending on your age, facial volume & expectations. A simple program goes like this:
Year 1: HA + non-HA, 2 sessions of each.
Subsequent years: 1 session of each.
Are skin procedures such as laser resurfacing better than skin care?
Skin care products are great for inflammatory skin conditions. Products are better for conditions like acne, rosacea (except for red veins), sensitive skin, melasma pigment, oily skin etc.
Skin directed procedures are better if you have volume loss (fillers), sun damage, deep pigmentation such as sun spots, freckles, age spots/warts, textural changes including lumps, bumps, scars, pits, enlarged pores, etc.
Often procedures augment products and vice versa. For example pigmentation due to melasma is best treated with a combination of products, tablets (t.acid) & laser procedures.
Inflammatory acne is best treated with LED light therapy & vascular lasers to reduce the inflammatory response whilst waiting for topicals & oral medications / lifestyle changes to take over.
Age related skin concerns including sun spots, pigment, wrinkles & textural changes are best addressed with lasers or deep peels, but maintained with good skin care & smaller procedures.
In summary, products complement procedure. They are not mutually exclusive.
Timing of pigmentation correctors are super important following procedures such as lasers or chemical peels. Most anti-pigmentation creams / lotions are super irritating hence short contact applications should be trialled.
A good way to start a short contact application is to apply, leave on for 30 minutes, then wash off. If you have no skin irritation, increase by 10 minutes for subsequent applications. This is especially important if you are starting hydroquinone after laser resurfacing or a more powerful pico laser session.
As a guide, start HQ as directed. For most cases, it would be 5 to 8 days post laser (Fraxel, LaseMD, CO2, Erbium). Be guided by the nurse I have assigned to your case.
Other pigment correctors include-
- Arbutin; alpha & beta. Converted to HQ, less irritating.
- Ascorbic acid. Start at 10%, increase cautiously, maximum at 20%.
- Licorice extract: medium irritation potential.
- Bearberry: low irritation potential.
- Citric & salicylic acid: low concentration can be used 4+ days post procedure (most cases)
- Glycolic & lactic acid; delay application till week 2-3. Powerful exfoliants.
- Kojic acid; 1-2% start 1-9 days post treatment.
- Cysteamine; moderate to high irritation potential
- Botanicals; most have low irritation potential (apart from essential oils)
When can you go back to your own skin care routine post procedure?
Great question, difficult answer as it depends. Be guided by your clinician that I have assigned to you. Some formulations are more irritating than others. See the specific skin care ‘actives’ for an estimate. Miscellaneous skin care products include-
Retinol / retinoids (including prescription Accutane, Oratane, Adapalene, Tretinoin): 5-21 days post laser resurfacing. Start every second night, increase as tolerated.
Hyaluronic acids: you can recommence 3- 10 days post procedure. Note HA topicalls often have propylene glycol, preservatives, fragrance, etc… hence you are not putting pure hyaluronic acid on healing skin.
Proactive, Benzoyl Peroxide: 5-12 days post procedure. This can be highly irritating.
Salicylic acid washes: 5-10 days post procedure. This includes AHAs such as glycolic & lactic acids. Titrate accordingly.
Tea Tree Oil, Witch Hazel, green tea & naturopathic topicals: Wait 8-14 days. TTO & other essential oils have a high sensitisation rate. Not recommended for open channels.
Miscellaneous topicals: moisturisers, toners, astringents, weird snail extracts etc. If you have a banal moisturizer, recommence 5-10 days post procedure, after stopping the topicals we have provided for healing.
If in doubt, discuss your case with your allocated dermal therapist or nurse.
What simple steps can you take to maintain the results you have from procedures?
Apart from the DIY at home tips, you can augment your post-laser results with simple in clinic procedures with little or no downtime. Here are some of my favourites-
Retinoic acid peels: we use pure retinoic acid ranging from 1 to 5%, either as a stand alone peel or delivered via non-ablative laser resurfacing. Peels are cost effective with a tailored downtime of 2-4 days of gentle peeling.
AHA Glycolic/Lactic peels: lunchtime chemical peels with no downtime. Glycolic peels can maintain the results you have from laser resurfacing.
Tixel Resurfacing: is an excellent alternative to lasers. Treatments can be tailored to give a 1 to 3 day downtime. Tixel can improve delivery of vitamins, hyaluronic acid & Botox to the dermal layers of skin.
Microneedling: I do think microneedling can work, however I prefer procedures with controlled heating. Tixel works a lot better than microneedling.
HIFU, RF, Tempsure, Pelleve: Simple no downtime procedures can help maintain skin tone, reduce laxity & provide ongoing skin tightening.
Your allocated dermal therapist or nurse will guide you through what skin directed procedures you should have to help maintain your results.
What is the proper way to sun protect after a laser procedure?
Sun protection reduces both UV & visible light. This is especially important if you have had a laser or deep peel procedure. Exposure to UV & visible radiation will prolong your recovery & exponentially increase your side effects following the procedure, this includes-
- Prolonged redness: UV can triple your recovery time.
- Post inflammatory hyperpigmentation: exposure can give you brown patches that take 4-9 months to heal. More common in Asian, ethnic & darker skin types.
- Flushing & blushing, flare up of rosacea, more common in lighter skin types.
- Activation of cold sores
Application guides as follows:
- Nano/Spectra/Pico lasers: commence day of procedure. Immediately after laser.
- Fraxel, C+B, LaseMD lasers, BBL, IPL, HALO lasers: day 1-4 depending on settings.
- CO2 fractional lasers: day 2-6 depending on depth.
- Fully ablative laser resurfacing Ultrapulse/CO2/Sciton Erbium: day 7 to 14 depending on depth.
- Scar revision (light resurfacing): day 2-5 depending on density
- Scar revision (heavy resurfacing): day 5 to 10 depending on depth.
Timing is critical, especially if you are using hybrid sunscreens. Apply too soon & you will increase the rate of irritation/allergic contact dermatitis. This may prolong healing times.
Be guided by your allocated therapist or nurse performing this procedure.
Sunscreens should be viewed as adjunctive management & not monotherapy. Hats, shade, & sensible practices can reduce UV & visible light exposure. Note: if you sit next to a window or if you can see outside (office, home, car, train, bus) you are getting long wavelength exposure that includes UVA (in most cases), visible light & infrared light. These wavelengths will activate your melanocytes to produce pigment.
Sunscreen application amount + frequency as follows:
- Apply a minimum of twice a day post procedure, timing as above.
- 2 finger lengths.
- Preferred physical blocker & or hybrid – low irritant sunscreen. Brands include Invisible Zinc, La Roche.
- One 50 ml bottle should only last 14-25 days if used correctly.
Who should you see for skin care advice?
Discuss your skin care aims with my clinical team at Clinic Cutis. Dermal therapists & nurses will guide you accordingly. A bespoke clinically prescribed skin care routine takes into consideration –
- Your goals
- Your skin type, including skin colour, ethnicity
- Your skin sensitivities
- Background skin conditions including rosacea, photo damage
- Your lifestyle & the amount of sun exposure you may get
- If you have oily, dry or combination skin
- Your current skin care routine
Disclaimer: my work is procedural, namely I cut, lase, peel, inject. I do not give skin care advice however can refer you to my clinical team.
Davin’s Viewpoint on Skin care to Optimise Laser Procedures
Really easy concept to understand- when you see a dentist for teeth whitening and a clean & scale, you maintain the results with bruising & flossing. Same applies to skin.
Procedures including laser resurfacing & chemical peels can markedly improve skin texture & quality. These procedures remove DNA damaged cells, allowing new cells (with less damage) to replace older cells. The source of these new cells comes from the hair follicles. Cells that lie within the deeper confines of follicles have had less DNA mutations, hence act as ‘stem cells’ that re-populate the epidermis.
It is thus paramount to maintain your results. The timing of when to start really depends on the procedure you had. As a guide, for level one resurfacing (pico, Clear & Brilliant), you can start ‘actives’ at day 3-5 post laser. For fully ablative resurfacing, namely level 4 -5, waiting 8-16 days maybe prudent. This of course is modified if you have prepisosing skin conditions such as rosacea, sensitive skin, flushing & blushing etc.
So what is the best way to maintain results? After photoprotection & antioxidants, my go to is a retinoid, followed by niacinamide & lastly ascorbic acid (not because I don’t like vitamin C, but because it is the hardest to titrate, given the low pH). Augment your routine with clinical peels, every 4 to 8 weeks. My choice is retinoic acid peels, 1-5%. This really supercharges your skin. For a more intense approach, laser assisted dermal delivery can convert a superficial retinoic acid peel into a deeper mid-layer peel. This is not for everyone, discuss with your allocated nurse/therapist about this procedure.
If you understand your skin’s threshold & know how to subdue irritant contact dermatitis, you can add a strong AHA/BHA formulation every 7 to 14 days. This functions as an exfoliant & as a priming agent. I personally prefer higher concentration with a lower pH, less frequently, compared to a toner – wash- scrub on a daily basis. I do think the high percentage/low pH formulations do so much more than a sub-therapeutic, sub-irritant method of daily application.
Once you have achieved your goals, maintain you skin care with suitable procedures, these include-
- Pico or nano laser toning to reduce pigment pores, wrinkles & fine lines.
- Laser genesis for improved skin quality, especially if you are prone to redness.
- RF with Tempsure/Pelleve to maintain collagen production.
- Fraxel, Lase MD, C&B for maintenance of skin quality & texture
Biostimulatory injectables offer a significant advantage over laser procedures (to help maintain collagen) as they-
- Have little to no downtime
- Stimulate collagen efficiently
- Address skin quality issues
- In some cases can be tiered to improve volume, depending on the agent and mix
For more skin care advice, book a consultation with our dermal therapists or nurses @cliniccutis. More complex cases of sensitive skin are seen by our medical team. Please note I do not give skin care advice as my work is procedural.
Skin care advice in Sydney is done via Louise at Dr Van Park’s clinic in Woollahra. For biostimulatory injectables, you can see me or Dr Kate. Please email the practice for more information as to availability.
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