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What’s Important?

  1. Use retinoids, ascorbic acid, hydroxy acids, matrikines, and defensins topically 14 days before procedures.

  2. Do not use retinoids, ascorbic acid, or hydroxy acids after procedures until complete re-epithelialization has occurred.

  3. Avoiding foods, supplements, and topical products that increase bruising will improve filler outcomes.

What’s New?

  1. Matrikines used 14 days prior to procedures can speed healing.

  2. Defensins used post procedure may speed healing.

What’s Coming?

  1. Identifying safe ingredients to use during and after microneedling.

  2. Combining ingredients to maximize outcomes.

Cosmetic surgery outcomes are consistently enhanced when proper skincare is employed prior to and after the procedure, be it a biopsy, surgical excision, dermal filler injection, or Mohs surgery. This chapter should serve as a useful guide for how to best educate patients about pre- and postprocedure skincare needs before and after skin surgery.


The aim of the practitioner should be to accelerate healing while limiting infection, scarring, and hyperpigmentation. For the 2 weeks leading up to surgery, products that have been demonstrated to speed wound healing by increasing keratinization and/or collagen production should be recommended. Derived from vitamin A, the retinoid family includes compounds such as adapalene, b-carotene, carotenoids, retinol, tazarotene, and tretinoin. Retinoids such as tretinoin and retinol are key ingredients that should be used prior to wounding. Multiple studies have cogently revealed that pretreatment with tretinoin accelerates wound healing.1–3 Kligman assessed healing after punch biopsy in the mid-1990s and found that the wounds on arms pretreated with tretinoin cream 0.05% to 0.1% were significantly diminished by 35% to 37% on days 1 and 4, and 47% to 50% reduced on days 6, 8, and 11 as compared to the wounds on untreated arms.4 A tretinoin pretreatment regimen of 2 to 4 weeks is supported by the preponderance of studies,5 as peak epidermal hypertrophy emerges after 7 days of tretinoin application and normalizes after 14 days of continued treatment.6 Such an approach gives the skin time to recover from any retinoid dermatitis before the scheduled surgery. Pretreatment with adapalene should be introduced 5 to 6 weeks before any procedure because it exhibits a longer half-life and requires an earlier initiation period.7

Although wound healing studies have not been conducted in this area, pretreating skin with topical ascorbic acid (vitamin C) and hydroxy acids might hasten wound healing by promoting collagen synthesis.8,9 See Table 36-1 for the range of products recommended leading up to a procedure.

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TABLE 36-1 Medications and Supplements Recommended at Least 2 Weeks Prior to Undergoing Cosmetic Procedures

Ascorbic Acid


Growth Factors

Hydroxy Acids




To reduce bruising, patients should avoid aspirin, ibuprofen, naproxen, St. John’s Wort, tocopherol (vitamin E), ω-3 ...

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