Tuesday, 27 June 2017 21:42

Adjuvant Therapies for Pre- and Post Surgical Care

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The field of pre- and post-operative care in cosmetic surgery began in the early 1990s during a time in which the concept of integrative aesthetics services into a medical practice was a fledgling idea.

During that time, awareness of integrative aesthetics within a medical setting moved across the country. The benefits of these adjuvant skills proved to create a valuable contribution to both patients and physicians in the field of cosmetic surgery and dermatology. By 1994, a group of renowned plastic surgeons recognized a greater need for the enhancement of clinical skills and quality skin care right in their practices. Headed by Dr. Fritz Barton, the past president of the American Society for Aesthetic Plastic Surgery, the Society of Plastic Surgical Specialists was formed. The founding society president, Bea Hunter-Erdman, was assigned to research the requirements for education to train nurses, aestheticians, and other staff to become proficient in the adjuvant skin care services. Today, the concept is mainstream.

There is also a growing trend of holistic services integrated into many practices and spas that provide numerous offerings from an enriched toolbox of aesthetic services. Moreover, integrative services are not just for cosmetic improvement; they have also become an integral segment of oncology and hospital spa environments that offer numerous amenities, including skin care, acupuncture, and massage therapy.

pic1Most importantly, skin care professionals understand so much more now about the science of aging skin due to innovative instrumentation that delve deeply into skin cells in order to comprehend their signaling and immune capabilities. Professionals have a greater understanding of a plethora of risk factors that accompany surgical, thermal, and skin care procedures. Professionals are more informed on the wound healing process with a profound awareness of the importance of preserving the integrity of the epidermis and restoration of the skin barrier in order to expedite healing and prevent infection. That said, the significance of continuing education in this field is more essential than ever. There are pioneering educators worldwide who continue to teach and share their knowledge and expertise.

There is no exclusivity when it comes to the skin. The skin is the skin. No matter what environment the professional resides in, medical or spa, it requires a scientific understanding – coupled with teamwork – to support its improvement.

A Total Program Approach
A key goal for adjuvant pre- and post-care is to support the healing, health, and well-being of the client. In-clinic treatments utilizing modalities that encourage the re-building of the structural components of the skin should be performed prior to an invasive procedure. It is also an essential opportunity to educate clients to long-term, preventative care for their skin, with emphasis on good nutrition and lifestyle habits. This education opens a new window of understanding when it comes to the stratum corneum. Experience has shown that preparation of the skin three-to-four weeks prior to a surgical procedure that encompasses in-clinic treatment and homecare makes a difference to the outcome of a procedure. Post-care requires gentle treatment, including lymphatic drainage. A total program of care enhances the ability of the skin to heal, remodel, and become healthier.

The importance of the skin barrier and dermal components
Many skin issues are due to poor barrier defense. There has been a paradigm shift when it comes to viewing the correlation between skin conditions and the function of the skin barrier. In post-operative healing, an essential concept is to understand that the external appearance of the skin is as good as its foundation within the dermis and dermal junction. Lifestyle factors, including excessive environmental exposure, health and disease, and inflammatory issues all contribute to the quality and texture of the skin. Excessive wounding to compromised skin that has suffered from oxidative stress, poor barrier function, and decreased function of fibroblasts and other dermal components may not be the most appropriate approach initially. It is better to rebuild the skin through a strategic program of care that may require a short span of time prior to a more invasive procedure.

Furthermore, the biological aging process, especially after menopause, displays a natural change in the resiliency of the skin and cellular function due to hormone shifts during the biological aging process. There may be health issues – such as inflammatory conditions, autoimmune diseases, or circulatory concerns – that may require daily medications. These conditions may inhibit the optimum outcome of most procedures.

The natural biological process of aging is also highly dependent upon earlier lifestyle habits, health, and stresspic2 levels. For example, some clients spend many years in outdoor sports or neglect their skin during high ultraviolet exposure. As these clients move into their late 40s, 50s, and early 60s, the professional's approach for correction requires a more methodical approach for improvement. It should be recommended that they go through a boot camp for five weeks (twice weekly) where they receive a focused repair session to begin rebuilding the skin barrier and improve the overall health of their skin. They should also have a simple homecare regimen. Improvement varies with each client, since the results are all dependent upon age, health, lifestyle, and the severity of their skin condition. Whatever their condition and age, there are notable positive changes for the majority. Some clients may opt to choose a surgical face-lift, laser, or radio frequency treatment. Whatever the choice, when the skin is healthier, there is a greater chance for optimum outcome. While professionals cannot completely reverse the hands of time, there is combined technology and cosmeceuticals that can create a marked improvement. It does require time and patience, which can be challenging in an instant-gratification society.

What is meant by Adjuvant?
In medicine, adjuvant therapy refers to procedures or substances given after a primary therapy to increase the chance of long-term disease-free survival. Examples for breast cancer may include chemotherapy, hormonal therapy, targeted drugs, radiation, or a combination of treatments. Neoadjuvant therapy is defined as a drug-enhancing helping agent, or antigen-agent, performed prior a surgical procedure or intervention. For example, in the event of breast cancer, chemotherapy may be given to shrink a tumor that is inoperable in its present state in order to have it surgically removed.

pic3Adjuvant corneotherapy refers to combining medical treatment with pharmaceutical cosmetic agents; it is a methodology of prevention or correction of dermatological skin disorders and skin conditions, including atopic dermatitis, barrier disorders, pH imbalance, rosacea, immature stratum corneum impaction, accelerated transepidermal water loss, pruritus, and the loss of skin barrier defense. Epidermal integrity reduces with the process of biological aging. Eczematous inflammatory disorders may also increase when left untreated.

Eventually, these conditions may cascade into persistent physiologic imbalance, poor recovery of the stratum corneum, increased cornification, and chronic cumulative toxic contact eczema, with continued irritation activating increased immune inflammatory response. Extreme xerosis leaves the skin vulnerable to infection.

It is essential to determine the leading cause of the stratum corneum and barrier dysfunction. A prime
pic4 example is to study the behavior of the multifunction filaggrin proteins within epidermal cells during the differentiation and cornification process. The role of filaggrin is essential in preventing epidermal water loss.

Moreover, they impede the entry of microorganisms, allergens, and chemicals. Loss of profilaggrin or filaggrin due to a genetic mutation leads to a poorly formed stratum corneum, leading to water loss. Filaggrin-deficient skin is allergen-susceptible. Furthermore, clients with systemic conditions of asthma, rheumatoid arthritis, and allergies are prone to atopic dermatitis.

Medical-clinical intervention of barrier disorders may include pharmaceutical active agents such as urea, antiseptics, antihistamines, immunosuppressive agents, antibiotics, azelaic acid, retinoids (vitamin A), and re-fattening base creams. In the event of scarred tissue, chemical-peeling agents are often employed. Many of these pharmaceutical agents may inhibit inflammatory processes in the skin or the immune system. They do not, however, support the recovery of the stratum corneum. Application of corneotherapy agents directed towards recovery of the stratum corneum (outside-in therapy) show significant improvement when combined with conventional therapy.

Following the principles of adjuvant corneotherapy, there has been substantial success with the application of atopic skin care products directed and formulated to address the behavior of inflammatory conditions, such as atopic dermatitis, barrier and cornification disorders, and essential fatty acid deficiencies. The intervention of corneotherapeutic agents has been found to expedite correction, healing, and homeostasis. They include phosphatidylcholine; linseed oil; vitamins A, C, E; linoleic acid; D-panthenol; evening primrose; phytosterols; ceramides; urea; and more.

Moreover, adjuvant corneotherapy is highly beneficial when administered for pre- and post-skin care, such as when combined within the context of plastic or reconstructive surgery. It is suggested to prepare the skin four weeks prior to surgery to improve the health of the skin barrier. Professionals can incorporate microcurrent once a week for four weeks prior the procedure, along with homecare-based on corneotherapy compounds that include fatty acids, ceramides, and cholesterol. This protocol greatly influences the skin prior to surgery and supports the results and enhanced healing post-surgery.


Adjuvant Care in Health-Compromised Skin
The growing trend for health-challenged skin requires specialized care. Patients undergoing chemotherapy and radiation treatment for cancer may display severe skin barrier dysfunction, including peeling, cystic lesions, and inflammation; the immune system becomes compromised. The skin requires a very gentle approach to care that is anti-inflammatory and restorative. Agents may include D-panthenol; essential omega-3 and omega-6 fatty acids, such as linseed oil, kiwi seed oil, rose hip seed oil, and evening primrose oil, combined with phosphatidylcholine. Oncology skin care requires specialized training in order to understand the consequences of the disease on the skin. Post-recovery care also requires an understanding.

The integration of professional aesthetic care within a medical practice provides a more integrative approach to patient care. It is essential that all skin care professionals be well-educated in procedures, ingredient chemistry, and its relationship with the histological factors involving the skin. They must also be well-versed in skin types and conditions, especially in the understanding of the skin in a diverse population. They should also understand the complexities surrounding the development of a total concept of services, addressing the needs of aging skin, acne, rosacea, pre- and post-surgical care, wound healing, skin peels, machine therapy, and other modalities.

Professionals may have the best products and treatments, however, the clients' results are solely dependent upon the professionals' expertise and precision, as well as the client. In-service training of new and existing personnel mitigates the possibility of mistakes and provides a thorough understanding of what they are doing. Following protocols is mandatory.

There is also a growing trend to place adjuvant practices into hospital programs to address pre- and post-surgical care, oncology care, and dermatological conditions. This concept is far-reaching, supporting patient education and awareness of preventive and long-term care. Furthermore, the growing $1.9 trillion world market for a total, integrative approach to wellness and prevention predicts a very proliferative future in services and revenues.

1. Adjuvant and Neoadjuvant Therapy in Breast Cancer: www.cancer.gov/types/breast/adjuvant-fact-sheet
2. Barrett-Hill, Florence (2015), Cell differentiation
3. Currin, Morag (2014) Oncology Esthetics: A Practitioner's Guide Revised and Expanded.
4. Horrobin, David F. (2000), Essential fatty acid metabolism and its modification in atopic eczema. A J Clin Nutrition; 71 (supplement): 367S-72S
5. International Association of Applied Corneotherapy, 2016 Global Conference proceedings, Cologne, Germany.
6. Lautenschläger, H. (2005), History and current aspects of corneotherapy. Kosmetische Medizin 26 (2) 58-60
7. Lautenschläger, H. (2005), Skin care before and after surgery. Medical beauty Forum (1), 34-37
8. Zani, AJ (May 1, 2005) Skincare product selection important to medspas. Cosmetic Surgery times, Special Edition and Modern Medicine. Avanstar Communications.
9. Zani, A (2013), What is microcurrent?

Alexandria-ZaniAlexandra J. Zani is an international educator, researcher, and author with a background in cell biology and medical. Her passion for education resulted in receiving numerous advanced certifications in the United States and abroad. Zani earned an instructor license for aesthetics/cosmetology, is NCEA certified, Oncology Esthetics® certified, and certified in the Pastiche Method® of skin analysis. She is a member of the International Association for Applied Corneotherapy (IAC). Zani presents education for advanced aesthetic technology, including microcurrent, LED, and non-ablative laser. She is a specialist in the anti-aging sciences, including the effects of nutrition, lifestyle, and the mind-body connection.


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