Preparing The Skin For Cosmetic Surgery

Posted Thursday, September 13, 2007 to MARKETSPACE > Skin Care

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Laura Leroy RN, BSN discusses ways to prepare the skin for surgery.

Today many cosmetic and plastic surgeons recommend pre and post operative skin care by a licensed esthetician.

Physicians have found that by adding the esthetic component to their practice, it has been a "win-win" situation for the doctor and the patient. This service can increase the patient's satisfaction with results as well as compliment the surgeon's technique. It is also a good marketing tool that pays for itself.

Most importantly, physicians have found skin heals better when it is thoroughly cleansed and hydrated. It is less susceptible to redness and bruising and there is a decreased risk of postoperative infections.

Assessing the Skin

The foundation of a successful skin care program begins with an individual skin analysis.

An understanding of the Fitzpatrick Classification of sun-reactive skin types, along with Glogau's Classification of photoaging groups can be very beneficial when analyzing the skin. It is important for the skin care specialist to have an understanding of the aging process, and put together a treatment plan that would address these conditions using a scientific approach.

The esthetician's goal should be to design a pre-treatment program to cleanse, rejuvenate, exfoliate, hydrate, and protect the skin before cosmetic surgery.

There are two components of the aging process that lead to cutaneous changes, intrinsic aging and extrinsic aging. Hereditary factors and constant environmental changes can effect the skin. Some of these changes are caused by aging, genetic factors, state of health, the environment, stress, pollution, alcohol, photo-aging, prescription medications, and hormones.

Intrinsic aging occurs naturally with the passage of time. Extrinsic aging is caused by external conditions, such as, exposure to ultraviolet rays, which can cause 90% of extrinsic aging.

Clinical signs of cutaneous aging can be decreased elasticity, dryness, fine lines, wrinkles, elastosis, and uneven pigmentation.

Characteristics of Skin

When examining the patient's skin, it is best to divide the face into thirds. As the face ages, changes occur with each third that can be addressed individually. The upper third is from the hairline to the glabella. The middle third of the face includes the peri-orbital region, the cheeks, and nose. The lower third of the face can show dramatic changes over time. These areas include the mandible, the maxilla, and the peri-oral areas.

By dividing the face into thirds, the esthetician will be able to take into consideration an objective framework for her evaluation of the skin's condition in each of the areas.The goal for the esthetician will be to design a basic skin care system that will address cleansing, rejuvenation, exfoliation, hydration, and protection.

With the proper ingredients, tools, and a documented framework of practice, the esthetician will be able to accomplish this goal.

Skin Types

When selecting the correct product to address the skin's condition, first the esthetician must determine how dry or oily the surface of the patient's skin appears.

Dry skin appears to lack moisture, the skin feels tight and shows signs of fine lines and wrinkles.

Oily skin can have whiteheads, blackheads, pimples, and enlarged pores. The skin appears shiny due to the oil that is sitting on the surface.

Combination skin is oily in the t-zone area forehead, nose and chin and usually I has clogged pores across the nose and chin area.

With these various types, the options for pre treatment and conditioning of the skin will vary. The treatment chosen should take into consideration the patient's chronological age, and the aggressiveness of the proposed cosmetic surgery treatment.

Skin Conditions

Normal skin is smooth, supple and hydrated.

Oily skin is usually shiny, especially in the t-zone area and pores can appear large.

Asphyxiated skin is rough and thick in appearance with visible blackheads.

Keratinized skin has an abnormal build-up of dead cells; the skin appears dull and thick.

Acne can range from occasional blemishes, to mild acne to severe acne. Due to the activity of the sebaceous glands, the skin can appear thick, and oily with large pores and pustules.

Dry skin can often be very fine and delicate showing signs of flakiness and blotches. Dry skin lacks the normal oil production, so it lacks suppleness and elasticity.

Dehydrated skin lacks moisture, especially water. Dehydrated skin can feel rough and show signs of fine lines and wrinkles. Blotchy skin appears red, congested, and have capillary fragility.

Pigmented spots can be a characteristic of any skin type, due to excessive sun exposure, Chemotherapy and hereditary factors.

To ensure the best clinical outcome for facial rejuvenation before cosmetic surgery, estheticians must be instrumental in providing proper education on the skin care regime chosen. By the esthetician explaining the benefits of each treatment program, it will enhance the patient's compliance with their skin care regime.

Conclusion

Estheticians providing skin care services within a cosmetic practice can enhance the surgical outcome. An understanding of the factors related to various skin conditions is of utmost importance in order to compile a framework of practice. With proper education and commitment on the patient's part, the esthetician will be able to bring the skin to optimum health before cosmetic surgery.

Glogau's Classification

Group I Mild (usually 25-35)

No keratoses
Little wrinkling
No scarring
Little or no makeup

Group II Moderate (usually 35-50)

Early actinic ketatoses; slight yellow skin discoloration
Early wrinkling: parallel smile lines
Mild scarring
Little makeup

Group III Advanced (usually 50-60)

Actin keratoses; obvious yellow skin discoloration with telangiectasia
Wrinkling; present at rest
Moderate acne scarring
Always wears makeup

Group IV Severe (usually 60-75)

Actin keratoses and skin cancers have occurred
Wrinkling; much cutis laxa of actinic, gravitational and dynamic origin
Severe acne scarring
Wears makeup that cakes on the skin

Fitzpatrick Classification of Skin Type
Type	Skin Color	Reaction to Sun
I	Light, very white or freckled	Always burns, never tans
II	Light, white	Usually burns, tans with difficulty
III	Medium, white to olive	Sometimes burns, tans average
IV	Moderate brown	Rarely burns, tans very easily
V	Dark brown	Very rarely burns, tans very easily
VI	Black	Never burns, tans very easily