Post- procedure Skin Care Instructions for Ablative Resurfacing Treatments
(such as Dermabrasion, Deep Chemical peel, Plasma or CO2 Laser)

Post-procedure skin care is really important for immediate unwanted annoying symptoms and remote risk of late complications of the treatment. For many, the downtime of the procedure can be quite minimal, especially if a less invasive treatment was performed. Therefore, not all the following instructions may apply in your case. Common sense will often dictate what you should do. We are always available for any clarification or questions if needed.

If you have any questions and concerns during office hours please call us for advice. For after hours questions and concerns you may text Dr. Shafa at (949) 426 – 7744

What is the downtime of an ablative resurfacing procedure ( Plasma and CO2 Laser)?

Healing phase may vary depends on many factors that may include the following:

Location of the treated area

around the mouth peels and heals faster, while around the eyes takes longer

Depth and Intensity of the energy used

higher energy is used to correct deeper skin damage, which requires longer healing time

Age of the patient and thickness of the skin

post-procedure skin care

performed by the patient

Patient’s other associated disease or regular medication in use

Patient’s “genes” – some people just heal faster

Day of the Procedure

Right after the procedure, a thick layer of Aquaphor healing ointment, known as a “greasy cover”, will be applied to your skin. If you are comfortable, do not touch your skin until the next day. No showering the day of the procedure.

If you feel irritation and discomfort of the treated area, then you may use cold compresses every few hours, each time for 10 minutes. In-between the cold compresses, keep the skin moist by reapplying Aquaphor-healing ointment.

Cold compresses

In a bowl with water and ice cubes, soak washcloths, gauze, or paper towels and then leave the saturated cloth over the treated area. When it becomes warm, change it to another cold cloth. Keep the washcloth sanitary by changing or washing it frequently. Please avoid pushing the healing ointment into your eyes.

Wet Healing Phase (“RAW SKIN”) – Days # 1 up to 4 after procedure

Days # 1- 4 after the procedure, your skin will undergo a wet healing phase (i.e. raw skin). Swelling is expected on the second and third days and subsides thereafter. You may experience slight stinging, itching, or tightness in your skin, but these side effects are usually mild. Very rarely will you experience oozing skin. To control these effects, follow the instructions below.

Keep the skin moist and “greasy” all the time

by reapplying healing ointment such as Aquaphor or Vaseline. Remember that raw skin needs a moist environment to heal faster and diminishes risks of complications.

Keep the skin clean by washing the treated area with a cleanser

day after the procedure, you may take shower twice a day, every morning and evening. Rinse the treated area with warm water and Cetaphil cleanser to wash off the excess ointment and oozing liquid, if present. Avoid hot water showers. You may wash your face up to 5 times per day with water and Cetaphil cleanser if you desire and feel it is needed.

Prevent infection by using a vinegar soak

Add one tablespoon of white vinegar to a bottle of 12 oz. water and keep it in the fridge to cool. You may add ice cubes to your bowl. Pour the diluted vinegar into a bowl and soak a paper towel in it, then place it on the treated area. Leave it on the skin for 5 minutes each time, then tap dry it with a dry paper towel, gently followed by reapplying healing ointment. Repeat the vinegar soak after each skin wash up to 5 times per day.

Control skin swelling and irritation with cold compresses

You should not feel pain during the post procedure phase. However, swelling is expected, and you may experience mild itching, stinging, numbness, irritation or discomfort. To treat this, place cold compresses on the treated area for 10 minutes and repeat as needed. Sleeping with an elevated head (by using two pillows) will also diminish the swelling.

Do not rub your healing, raw skin

Remember not to touch your skin before washing your hands with water and soap for 20 sec. When you wash and rinse your skin, use the towel to blot dry -do not rub the skin! Doing so removes the “natural Band-Aid” prematurely before the wound is healed.

Nature’s Band-Aid

A small amount of yellowish liquid, which can ooze with or without a tiny amount of blood, at the site of the skin puncture is normal. In fact, it is part of the healing process. This serum and platelet in the blood have antibodies that prevent infections; promote growth factors to repair and heal the wound; and create a physical protectant for the wound. Later, this natural wound cover will change to a brown scab. Do not rub it off! Your skin will eject it when it is ready.

Avoid fever blisters

Herpes virus, the cause of fever blisters, is dormant in the body of many healthy people, especially individuals with a history of fever blisters. Any stress to the body and skin such as surgery, peel, laser, etc. can cause a flare and outbreak of the dormant fever blister. The good news is that we can prevent such an incident by giving you a Rx for Valtrex to be taken one day before and a few days after the procedure. Make sure you receive this prescription.

Itching control

Itching is a part of new skin formation and also caused by dry skin. Do not scratch your skin. Keep the skin moist by using cold compresses with gentle pressure to control itching. If that is not enough, you may take Benadryl (25 mg ½ tab, up to 2 tabs) as needed at bedtime or/ and Allegra (180 mg, up to 3 times per day) for itching. (If you have Claritin or Zyrtec for allergy at home you can take it 3 times per day for itching, although we believe that Allergra works better.)

Exercise

Vigorous exercise, irritation, and sweating can slow down the healing of the skin. We recommend refraining from exercise for one week; you may start moderate exercise at the second week and return back to your regular routine the third week after plasma resurfacing procedure.

Pain control

Pain is not expected during the healing phase, but the treated area may feel like a sunburn. If you feel some discomfort and you desire to take pain pills, you may take Tylenol (up to 3000 mg per 24 hours(. Avoid aspirin, NSAIDs or any type of blood thinner such as Ginkgo, Garlic, Ginseng, and Vitamin E, which may prolong bleeding.

Diet

Stay well hydrated during the healing phase. Do not miss your balanced meals. Avoid taking supplements with blood thinning features.

Dry Healing Phase, Brown Skin – Day # 3 up to 6 days after procedure

Scabbing

This is the stage when your skin starts scabbing. During this phase, you want to keep the crusts and scabs clean and soft. You may do so by regularly cleaning the skin with water and cleanser, followed by healing ointment. Do not let the scabs dry out until your skin ejects the dead layers over time. You may gently watch off the dead skin and residual healing ointment gradually as dead layers are ejected. Do not peel or scrub off the crusts and scabs forcefully, which can leave a scar. Cold compresses may not be needed any longer, although it can be continued if you desire.

New Skin Phase, Red Skin – 1-2 weeks after the procedure

The new skin

After any skin resurfacing, new skin will look red and, later, pink since the discolored old damaged skin is replaced with a rejuvenated skin. When all the crusts and scabs are peeled off,a new, fresh baby skin appears. The new skin is very sensitive to irritants such as the sun, wind, and chemical physical forces, so it must be treated with special care.

Stop using greasy ointment - instead, start using moisturizer cream

Keeping the skin moist and well hydrated with a moisturizer, such as cetaphil or vanicream, will help the skin continue with regeneration. Use it several times a day.

Now, you can use makeup

The pink skin will eventually resolve and is generally easily covered with makeup. Preferably, stay indoors and avoid use of make up.

Protect your new baby skin by using sunscreen

Keeping the sun off your face is very important for proper healing and preventing discoloration after ablative/invasive skin procedures. Avoid direct sun exposure for weeks after the procedure. The fresh red skin is extremely sensitive. Use fragrance-free sunblock, sunglasses, and a wide brimmed hat if outside or riding a car. Remember that the effects of sunblock last for 2 hours; don’t forget to reapply sunblock if you are exposed to the sun repeatedly.

Driving

Most of the treated area of the face should not interfere with driving, except treatment around the eyes. In that case, you may notice increased sensitivity to light and wind, tearing and possibly blurry vision for a 1-2 days after procedure. Use your common sense! If you have significant swelling around your eye or blurry vision, you must avoid driving until you feel comfortable with your vision. Using sunglasses is encouraged because it helps with light and wind sensitivity, as well as protects the skin from sun exposure and skin discoloration. Wait one week before wearing contact lenses again.

Discoloration Phase, Pink or Brown Skin – a few weeks after the procedure

This stage may or may not exist for most patients, but if it does happen, it is temporary. You must continue following a careful skin regimen to achieve the ultimate desired skin resurfacing result as soon as possible.

Pink discoloration

People with red hair and light color eyes are at risk of having pink skin weeks up to months after the procedure. Pink skin can be camouflaged with makeup and must be protected with sunblock all the time.

Brown discoloration

People with darker skin, such as olive skin, are at higher risk of light and patchy discoloration weeks after the procedures called PIH (post inflammatory hyperpigmentation). Sun exposure and any irritation to the skin, like hot or cold air and bright overhead light, can contribute to hyperpigmentation. This is only temporary, and it is reversible with appropriate after care.

About 30% of patients will experience hyperpigmentation after skin resurfacing. To avoid and treat this, we may advise you to use bleaching cream a few weeks prior to the procedure and continue after the crusting phase to decrease the risk of PIH.

You can camouflage the discoloration by using a thick layer of makeup. Apply makeup that is one to two shades darker than your skin. When it is dry, reapply as needed. This can be removed with water.

Revlon-erase may be considered for hard to cover areas. Find a shade that is one to two shades darker than your skin.

FINAL RESULT: – 3 to 4 month after the procedure

Your case is individual, and no two people are alike. Feel free to share your concerns and questions with us so we can tailor the advice to your case.

Follow up

See us for a follow up 2 days after the procedure, then 2 weeks, and 6 weeks thereafter. A follow-up visit is provided as a courtesy at no charge. In case of urgent questions, Dr. Shafa can be reached at her cell phone. Please text her, and she will return your text as soon as possible.