“Daily acids, potent retinoids, at-home microneedling… the truth is, more is not more when it comes to getting results for your skin. When you go too far, which you can do even with over-the-counter skincare and gadgets, you set off inflammation," Dondos continues.
"This means not only are you ageing your skin, you’re risking it becoming unsuitable for the clinical treatments you may have been considering as the next step. Skin that has a damaged protective lipid barrier can be red and flaring or display angry breakouts. In other cases, the inflammation is under the radar and you hardly know you have it.”
Either way, she says, apply a powerful acid to skin that is in a state of red alert, and it can penetrate too far and cause burns. Needle or laser skin with weakened defences, and you can get permanent redness or hyperpigmentation.
Keep stripping weakened skin and you risk what sometimes happened in the early days of phenol peels and lasers: glossy, tight, ruddy skin that’s actually scar tissue, permanently damaged.
So when a clinician won’t treat you without a programme of strengthening skin prep, they’re not kidding.
Dr Sophie Shotter, Medical Director at Illuminate Skin Clinics, likes to prescribe oral supplements such as collagen drinks – she favours Zennii Skin Fusion, £85, for a month before and a month after any collagen-stimulating procedure.
“That way the skin is in good condition at the time of treatment, but also gets the nutrients needed to aid post-procedure healing,” she says. Dondos puts people on 4-6 weeks of a barrier-boosting regime involving prescription skincare before strong peels, lasers or SkinPen treatments.
“I also tell them to stop anything stimulating or resurfacing,” says Dondos. “That can be very hard for people who are desperate to ‘stop sagging’ and feel they need to keep those fibroblasts pumping out fresh cells!”
The art of the regenerative breakBut what those fibroblasts actually need is a rest. Apart from starting off with strong, structurally intact skin, it’s vital that doctor-prescribed breaks are taken between treatments.
“When we stimulate collagen production through controlled damage with acids or lasers, it is during the recuperation period that the magic happens and the extra collagen and elastin gets laid on,” says Dondos.
“Furthermore, the activity can plateau after two or three treatments, as with SkinPen needling, which is why we prescribe treatment courses and then many months of nothing. Much as it feels counter-intuitive to some, this actually maximises outcomes.”
Dondos likens it to weight training: it’s in rest that muscles grow. It is why she, and many clinicians with her, increasingly offer treatment plans comprising tweakments and skincare, carefully administered and monitored over the course of months or even years, for sustained, optimised results.
This also allows for further skin-compromising factors to be picked up on and mitigated. “Pollution, wayward hormones and acute stress all weaken the skin barrier in the same way irritating products can. Chronic stress, sleep deprivation, alcohol and smoking impair skin’s ability to heal and regenerate,” says Dr Sandra Gamper of Miriderma Skin Health Clinic in Bornemouth.
Inflammatory skin conditions such as eczema and psoriasis are often the result, she says, as is the potential of post-inflammatory hyperpigmentation and redness (i.e, more dark or red patches, as opposed to fewer ones) from something like a laser treatment or a deep peel.
So don’t be surprised when your doctor wants to address lifestyle factors before pushing ahead with treatment. “If we didn’t, we could end up going one step forward, two steps back with some skins – and that’s in nobody’s interest,” says Dondos.
Managing expectationsAnother thing your clinician will be keeping a beady eye on, and increasingly so, is psychological factors concerning your motivation for treatment.
“Of course, the vast majority of patients just want a beauty boost, or treatment of a skin condition that bothers them,” says Dondos. “It’s when we suspect someone is trying to ‘treat’ a much bigger trauma or issue in his or her life with facial or body tweaks that we become concerned.”
Picking up on signs of extremely low self-esteem sends red flags flying as well. “Improving your looks can be a wonderful confidence booster, but it won’t sort out your relationship, job prospects, depression or body dysmorphia,” says Miss Jonquille Chantrey of One Aesthetics Studio in Alderley Edge.
The prevalence of body dysmorphia in particular is high amongst people who seek procedures: “You’re looking at 7-15 per cent, or potentially one in ten patients” says Gamper.
If necessary, doctors like her can and will offer referrals to psychologists (sometimes they have one in-clinic) or things like hypnotherapy and guided meditation to help clients with self-doubt and stress and prevent them excessively ‘self-medicating’ with cosmetic treatment.
It means the all-important consultation with your clinician (don’t ever go for treatment without one!) comprises so much more than an assessment of your skin condition and wishes.
“Words such as ‘ugly, ‘not right’ and ‘deformed’ are red flags to me, as a is a tendency for a patient to constantly check their features, says Gamper. “If a patient flips from one area to another and is being really specific about tiny marks and perceived ‘flaws’, that can point to a problem with self-esteem,” agrees Chantrey.
If their motivation is to please someone else, that’s a concern, she adds, as is someone set on changing a facial feature because it’s a big trend.
“They could be prey to a sort of herd mentality, looking for group assurance or a sense of belonging in potentially the wrong place. It’s why we need to understand their social network and quality of life before proceeding – it’s not us as doctors being nosy, it’s essential if we want to manage patient’s expectations and achieve results that are both physically and psychologically satisfying.”
As it turns out, the majority of patients are open to a bit of ‘prying’: “people like that you care about how they feel, and understand that having a mutually emphatic relationship built on trust is important,” says Chantrey.
Approaching your cosmetic treatments as a collaborative effort with ongoing no-holds-barred exchange of information: it truly is the way forward for the very best results.
Sandra Gamper, Aesthetic Doctor
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