Rehabilitation after cosmetic procedures: how to prolong the effect

Olga Koryakina, dermatocosmetologist, Master of Science, expert in hardware and injection cosmetology, member of UALDVK, UADV, NOM, MAEKM

Any surgical intervention has a kind of prologue and epilogue - preoperative and postoperative periods. In aesthetic surgery, as in any other surgical field, the success of the operation depends not only on the surgeon’s tactics and the quality of the work performed, but also on the correct preparation of the patient for the operation, as well as on its correct management in the postoperative period.

The issue of joint work of doctors who specialize in certain narrow areas of aesthetic medicine is especially relevant at the present time. Particularly important is the joint work of plastic surgeons and cosmetologists, who can offer optimal rehabilitation options. Rehabilitation is the most important touch, without which the work done cannot be completed. Due to damage to the epidermal barrier, transepidermal water loss significantly increases, which leads to disruption of the water-electrolyte balance in the skin and its dehydration.

Rehabilitation involves the patient visiting physiotherapy and cosmetology rooms, where he will undergo procedures. Unfortunately, despite the availability and widespread availability of information, some patients refuse or even immediately “brush off” rehabilitation after plastic surgery, saying that everything is healing well on them anyway. To some extent, they are right, because the regeneration of the body allows us not to die from damage, but the process without additional help can continue for a long time, and does not exclude the possibility of complications.

Stage I. Preoperative period

The purpose of this stage is:

• reduction of congestion;
• improvement of lymphatic and venous flow in tissues:
• acceleration of rehabilitation processes due to rapid tissue regeneration and return to normal lifestyle after a short period of time;
• minimization and elimination of such characteristic postoperative complications as pain, discomfort, loss of sensitivity, tissue swelling, prevention of the formation of rough scars, persistent hyperemia and desquamation, post-inflammatory hyperpigmentation, seborrhea, exacerbation of herpetic infection, etc.;
• preventing the occurrence of postoperative scars and smoothing the skin in those areas where it was injured during surgery;
• consolidation and improvement of the results obtained;
• restoration of psycho-emotional balance before surgery (reduction of anxiety, normalization of sleep), selection of cosmetic preparations that improve metabolic processes in the skin of the face and neck.

Depending on the nature of the damage, measures in the preoperative period may differ significantly from those during external therapy, but the main focus will be maintained. The main task of the preparatory stage is to restore the regenerative potential of the skin, that is, those structures that ensure restoration. These include blood vessels, fibroblasts, the concentration of HA and antioxidants, and Marchionini’s hydrolipid mantle. Also, to prepare for damage, we need to adapt the skin to aggressive influences using long-term low-intensity stimulation.

External therapy

For low-intensity stimulation, external products (creams, gels) containing glycolic acid or a combination of glycolic acid with other alpha and beta hydroxy acids are most often used. If the damage is superficial, then preparation may take from 5 to 10 days. For moderate and deep levels of damage, preparation must be carried out for 1 month or more. The concentration of glycolic acid (if a combination, then the total concentration of all acids taken together is indicated) can range from 4% to 30%, pH - from normal 5.5 to highly acidic 3.5 (pH 3.5 is the minimum allowed pH for external use at home). Such products are prescribed once or twice a day, depending on the type of skin and its reaction to acid exposure. If the skin is dry or sensitive, then acidic products are used only once a day, in the evening. At the adaptation stage, they can be prescribed even every other day.

In my practice, I always try to prepare the skin for exposure, since I work a lot with thermal treatment devices. Before active thermal exposure, I use hardware hydrodermabrasion technology - for those patients who are not ready for injection preparation or prefer an integrated approach. Due to the combined effects of diamond dermabrasion, hydromechanical peeling and chemical peeling, I get excellent results: exfoliation, hydration, stimulation of metabolic processes. Recovery, and even the period of rehabilitation of prepared skin before thermal procedures, is significantly reduced and is better tolerated by the patient.

Injection therapy

To restore the regenerative resource, biorevitalization is primarily used - it allows you to change the skin at the morphological level. Biorevitalizants, after being introduced into the skin, are destroyed by hyaluronidase with the formation of active metabolites - short chains of hyaluronic acid and oligosaccharides. These metabolites bind to fibroblast and vascular receptors, stimulating proliferation processes. As a result of this action, the number of young active fibroblasts and microcirculatory vessels in the skin increases, which leads to the activation of metabolic processes and morphological restoration of the skin. In the dermis, the production of hyaluronic acid and its concentration increases.

Hyaluronic acid is the “conductor” of skin regeneration processes. It allows you to quickly limit the alteration phase, minimize swelling in the exudation phase and most effectively restore the skin after damage in the proliferation phase. It is the high concentration of HA that allows fibroblasts to properly cross-link collagen fibers into a strong and elastic mesh.

Naturally, after the biorevitalization procedure, the skin will recover much faster and give a better aesthetic result. In addition, the risk of complications such as post-inflammatory hyperpigmentation, dryness and skin hypotrophy will be significantly reduced.

Depending on the initial condition of the skin and the planned depth of damage, different therapeutic protocols are required.

Before menopause, to perform a median lesion on skin that does not have significant photodamage, one biorevitalization procedure will be sufficient. To do this, you can use drugs based on both native hyaluronic acid and PDNR (polydeoxyribonucleotides). The procedure is carried out 2-3 weeks before the planned damage.

After menopause, skin preparation needs to be carried out more intensively. To do this, we can use two procedures two weeks apart, so that the second procedure is performed two weeks before the injury. Or one procedure using two drugs at once (native HA and PDNR) 3-4 weeks before the planned damage.

To carry out biorevitalization, as a rule, in this case we use micropapular or tubercular techniques. The entire surface of the face is processed, but we treat each area with different densities. We treat those areas of the face that will be subjected to more intense treatment with a step between injections of 3-5 mm. We will include wrinkles, hyperpigmentation, post-acne, lifting surfaces, and surgical sites as such areas. We treat all other areas with a step between injections of 1 cm.

Today, the method of intradermal injection of autologous platelet-rich plasma (PRP) is becoming widespread in Ukraine. Your own blood is collected and centrifuged using a special apparatus to obtain PRP. Platelets contain substances with high biological activity - cellular growth factors: platelet-derived growth factor (PDGF-aa, PDGF-bb, PDGF-ab), transforming growth factor (TGF-b1, TGF-b2), vascular endothelial growth factor (VEGF) and epithelial growth factor (EGF). We inject the resulting PRP into the deep layers of the skin using a syringe using the microinjection technique.

General therapy

We include general therapy as prescriptions related to lifestyle, diet, oral medications, and physical therapy.

Changing your lifestyle in this case means avoiding excessive UV exposure, refusing to visit solariums, and tanning. It is necessary to limit toxic loads (alcohol, tobacco). A month before the procedure, it is recommended to conduct a course of general detoxification of the body (lymphatic drainage, diet, ozone therapy, etc.). For persons prone to edema, intensive decongestant therapy is necessary. It is advisable to prescribe multivitamins, omega-3 PUFAs, and squalene internally. If you are planning damage to a deep level, then you need to undergo a general clinical examination to exclude concomitant pathology.

Stage II. Rehabilitation period

Aesthetic operations can be divided into “small” and “large”.

In “small” operations, the projection department of the lymph nodes of the lateral parts of the face and neck is not affected, and “large” operations are operations with a wide detachment of the skin-fat flap of the neck and lateral parts of the face. For “small” operations, the rehabilitation period is sometimes limited only to the period of early rehabilitation, for large ones - to the period of early and late rehabilitation.

The period of early rehabilitation lasts up to two weeks, late - up to 1-1.5 months.

The purpose of the rehabilitation stage is:

• restoration of microcirculation and skin sensitivity in the operated and adjacent areas;
• promoting the formation of normotrophic scars;
• reduction of pain;
• acceleration of hematoma resorption;
• correction of color irregularities, texture, superficial wrinkles, enlarged pores;
• restoration of postoperative psycho-emotional state.

During the first 24 hours, periodic cooling of the procedure area with ice is necessary. Further, it is possible to apply external agents that promote faster resorption of minor hemorrhages (heparin ointment, Lyoton 1000, Gepatrombin, Troxevasin, Traumeel). It should be noted that all external agents must be applied strictly in the direction indicated by the doctor, depending on the specifics of the procedure being performed. Moderate pain is possible in the manipulation area. If necessary, the patient can use painkillers (Analgin, Pentalgin, Ketanov, etc.).

An important condition for the successful restoration of skin after damage is the use of products that provide the protective function of the skin during the regeneration period. The loss of fluid from the surface of damaged skin leads to dryness, tightening and itching. Dehydration, in turn, interferes with normal healing, since this process occurs faster in a humid environment.

Not so long ago, recommendations included the use of medical petroleum jelly in the early stages of epithelization, which, by creating a moisture-proof barrier on the surface of the skin, stops transepidermal water loss, thereby maintaining the necessary water balance. However, this property of blocking TEWL also inhibits the response aimed at restoring the skin. In addition, according to electron microscopy, petroleum jelly penetrates the upper layers of the epidermis and disrupts the structure of lamellar bodies. The latest generation of protective external products - moisturizing restorative gels - create a physiological “breathable” film on the surface of the skin, which not only prevents water loss from the skin and retains moisture in the upper layers of the epidermis, but also does not disrupt the natural processes of skin restoration.

If we are talking about procedures such as laser resurfacing or medium and deep peels, then immediately after the procedure in my practice I use a special Sheald Recovery balm. This balm has an antimicrobial, softening effect, soothes the skin, promotes its regeneration, while at the same time deeply moisturizes even very dry skin, helps prevent the appearance of scars and improve results after the procedure. Creams with a high degree of occlusion completely block the loss of moisture from the surface of the skin, which leads to maceration of the crust. This makes it possible to soften it and also stimulate lysis processes, which helps with faster and gentler exfoliation. This management allows you to shorten the time of re-epithelialization by 1-2 days. Occlusive creams can be applied only until the majority of the skin surface is exfoliated (4-5 days). After re-epithelialization of the skin, their application, on the contrary, inhibits further regeneration, macerating the young epidermis and having a pronounced comedogenic effect.

You should be especially careful with the consequences of continuous laser resurfacing and deep phenol peeling, which is similar in its mechanism of action. After these procedures, the skin is inflamed and hyperemic for a very long time, and the risk of post-inflammatory hyperpigmentation is high. But even when these signs disappear, it still remains very thin, like parchment, and loses its elasticity

Early rehabilitation period

This stage includes dressings, examination and other medical procedures and takes from 2 to 10 days, depending on the complexity of the operation and the patient’s condition. It is necessary to continue to observe the restrictions of the first period, with the exception of temperature ones (you can wash in a hot shower). Rehabilitation cosmetic procedures are prescribed 2-4 days after the operation. This allows you to significantly reduce the pain that occurs in the first days after surgery in the affected areas. In addition, thanks to a properly selected course, swelling is relieved faster and other postoperative complications are prevented.

In the first 3-5 days, we most often use the same occlusive creams with a pronounced anti-inflammatory effect, since we need to prevent the skin from drying out through occlusion. Wet management of the wound surface gives the best aesthetic result. Among the active ingredients needed: hyaluronic acid, peptides, panthenol, squalene.

The state of microcirculation plays a huge role in the existence of the whole organism, but there are situations when this state acquires almost primary importance. Such situations include restoration of the face and neck after anti-aging plastic surgery: post-traumatic swelling due to tissue damage is added to the already existing metabolic disorder before surgery. Post-traumatic edema, with its large volume, creates pressure on vessels that do not cope well with their functions, further disrupting microcirculation, especially venous and lymphatic outflows.

The wound healing process is a cascade of reactions and intercellular interactions that begin with the release of blood cells directly into the wound (Fig. 1). And if the stage of edema was very pronounced and prolonged, then the edema, turning into stagnation (lymphostasis), disrupts the mobility of subcutaneous structures and starts the process of tissue damage (scarring) according to the mechanism: edema (inflammation) → formation of granulation tissue → its contraction and subsequent remodeling in scar tissue.

One of the main tasks of the early postoperative period is to help form a new system of blood and lymph flow using “bypass routes” (the so-called collateral circulation).

On days 10-14 after injury, it is necessary to recommend biorevitalization with preparations based on native hyaluronic acid. Particular care must be taken in treating areas prone to hyperpigmentation. Postoperative scars need to be treated around, retreating 0.5-1 cm from their edge. We use the micropapules technique. We can also use OTP at the same time.

To achieve this task, physiotherapeutic procedures are actively used. First of all, microcurrents and magnetic therapy are prescribed, and low-intensity infrared laser therapy is prescribed for 2-4 days. From about 3-5 days you can add ozone therapy, quantum therapy, UHF, ultrasound. After the sutures have healed, iontophoresis and lymphatic drainage with movable electrodes can be added.

During the early recovery period, you should not use cosmetics containing glycolic acid, as this can lead to deeper damage to the skin.

What does your skin need after cosmetic surgery?

• Drugs and procedures that promote collagen synthesis. The most common among them are preparations containing L-ascorbic acid. Procedures include ultrasound therapy and infrared laser.
• Iontophoresis with biologically active drugs that are injected into the skin of the face, neck and décolleté.
• Procedures that stimulate microcirculation (microcurrents, ultrasound, etc.). Their consequence is an increase in oxygen content in tissues, activation of metabolism, stimulation of the synthesis of collagen and elastin.
• Lymphatic drainage - thanks to it, lymph outflow improves, bags under the eyes and swelling on the face disappear.
• Drugs that promote the healing of postoperative sutures (Solcoseryl and the like).
• Moisturizing and stimulating masks. Post-operative skin responds especially well to algae-based masks and sublimated collagen masks, as well as enzymatic masks. Gels with hyaluronic acid are ideal for hardware procedures.
• Acupressure of the skin - as a method it is both delicate and effective at the same time.

What is prohibited in the first month after surgery and facial plastic surgery?

• Solarium - Ural irradiation, being an additional load on the skin, spends energy resources on melanogenesis and, thereby, reduces immunity. After a UVB session, even normal skin is in a state of micro-edema. In addition, the risk of hyperpigmentation is high.
• Sauna and hot shower, which increase swelling by expanding the vascular bed.
• Methods involving tissue displacement: manual massage, myostimulation, vibration massage and vacuum massage.

To prevent the development of pigmentation, it is recommended to avoid exposure to the open sun throughout the entire course of procedures and completely avoid visiting solariums. It is necessary to use sunscreen products with a protection level of at least 30 every day, regardless of the season. In the case of damaged skin, the best option for protection from sun rays is products with inorganic filters based on zinc oxide and titanium dioxide. These substances do not penetrate the skin, are chemically inert, practically do not cause allergic reactions and are able to effectively reflect ultraviolet radiation. Also on the market there is now a product that, using the Extremozyme technology (Extreme protect SPF 30 Innovative skincare), protects and restores collagen at the cell DNA level, and also contains zinc oxide and encapsulated organic octinoxate.

In order to prevent hyperpigmentation, it is better to exclude from everyday skin care products cosmetics containing photosensitizing components: oils of bergamot, orange, lemon, orange, cinnamon, lavender, licorice, St. John's wort and clover extracts. Do not forget that personal hygiene products (deodorants) or perfumed sprays may have photosensitizing properties.

Possible side effects

The first problem that is observed after procedures that violate the integrity of the skin is inflammation. Remember: redness, swelling, heat, pain and dysfunction. To reduce the severity of these reactions, restorative care should include:

• hydration;
• restoration of the epidermal barrier;
• prevention of infection.

In the first days, external medications are prescribed in the form of solutions, liquids, foams, antiseptic dyes, lotions. As soon as epithelization occurs and weeping and erosion disappear, we switch to cosmetic preparations in the form of cream.

To quickly restore the skin after laser exposure, creams based on silicones and glycerin are traditionally used, which reduce TEWL, antibiotics to prevent infectious complications, glucocorticoids to combat inflammation and substances that promote skin regeneration (vitamins A, E, C, B3, provitamin B5, wild rose seed oil, etc.).

It is important to remember that the bioavailability of any topical agents during this period will be significantly higher.

Only ions or substances that are lipophilic, have a low molecular weight, or are polar molecules can overcome the intact skin barrier. After laser exposure, the penetration of drugs increases both through the intercellular route and through the additional route (through sweat glands and hair follicles). The high bioavailability of the drugs allows for rapid restoration of skin integrity and reduces the patient’s rehabilitation time after the procedure.

In practice, corneotherapeutic preparations Dermaviduals were used: a base cream corresponding to the patient’s skin, enriched with flax seed oil in nanoparticles, provitamin B5 and boswellia extract in nanoparticles. Patients were advised to apply the cream at least 3 times a day (morning, lunch and evening). If during the day they experienced discomfort, tightness, or itching, then they applied the cream as many times as necessary. In addition, patients used serum with beta-glucans 2 times a day (morning and evening).

Often, if you neglect to carry out an allergy test before peeling, you can get a complication in the form of an allergic reaction. In such cases, antihistamines, calcium preparations, sorbents, external lotions and steroid ointments are prescribed.

If asepsis and antisepsis are violated, wounds may become infected with pathogenic microbes. To solve such complications, drugs containing antibiotics are prescribed internally and externally.

Hardware methods and massage during the rehabilitation period

1. Laser therapy. Penetrating into tissues, laser radiation activates various photophysical and photochemical processes in them. As a result, cascades of reactions are launched in the body, the results of which are:

• strengthening metabolic processes;
• accelerating the healing of wounds and erosions;
• stimulation of blood and lymph circulation;
• relief of pain;
• activation of immune cell functions;
• decreased blood clotting;
• reduction of inflammatory reactions;
• reduction of microbial contamination at the site of laser exposure.

Laser exposure activates the synthesis of collagen and elastin, which allows the skin to recover faster without rough scars. In red mode it has anti-inflammatory activity and stimulates tissue regeneration.

2. Physical impact: mechanical vibrations

Massage. This is a mechanical effect on body tissues by the hands of a specialist, often with the help of additional devices or devices. Massage:

• Relieves pain, swelling;
• restores local metabolism;
• improves blood circulation in the problem area;
• removes toxins;
• gives a modeling and lifting effect;
• increases muscle tone;
• improves complexion.

One of the important advantages of this technique is its relaxing effect. The rhythm and lightness of pressure characteristic of massage promote relaxation not only of the face, but also of the whole body. Recommended as a basic technique for recovery after plastic surgery. Any invasive intervention is stressful for the body. Relaxing procedures such as lymphatic drainage and classical massage, various SPA techniques, and stone therapy help overcome feelings of anxiety, loneliness, and insecurity that can accompany plastic surgery and deep peelings.

Ultrasound. Ultrasound therapy increases the elasticity of tissues, produces micromassage and warms them up at the internal level. Using similar procedures, it is also possible to introduce cosmetic preparations for their deeper and local effects. Under the influence of high-frequency sound vibrations, local tissue heating occurs, which causes an acceleration of metabolic processes. This provides an anti-inflammatory and analgesic effect, improves peripheral circulation and resolves scars.

Ultraphonophoresis. This is a method of treatment with physical factors, based on the combined action of ultrasound in combination with medicinal substances. Glycerin, lanolin or its mixture with petroleum jelly are used as bases for contact media. With their help, rapid release of the drug is achieved. For example, Hydrocortisone 1% ointment, emulsion with petroleum jelly and lanolin is prescribed for anti-inflammatory purposes.

Ultrasound potentiates (strengthens) the effect of antimicrobial, vasodilating, immune system suppressing, and anti-inflammatory drugs. However, it should be remembered that it reduces the activity of morphine, B vitamins, atropine, novocaine, etc. It is used for infiltrates after operations, injections, the postoperative period, adhesive disease.

To influence the body, constant or alternating magnetic fields, pulsating and running, are used. There are various forms of magnetic inductors for more convenient use on different areas of the human body.

Pressotherapy (lymphatic drainage) is a hardware intervention that stimulates the circulation of lymph through the vessels, which helps combat the ineffective functioning of the vascular system and get rid of edema.

Vacuum massage is carried out using various vacuum cans - this is a highly effective effect aimed at combating cellulite, fat folds, and impaired blood and lymph circulation. Vacuum procedures are also used in the facial area to cleanse it of comedones. This therapy has a lymphatic drainage effect, reduces puffiness under the eyes and rejuvenates the skin.

One type of effective massage is LPG (Endermology) - the combined effect of vacuum and rollers on the skin. This method is often used after liposuction. You can also use a vacuum to work with acupuncture points in the body.

3. Light therapy/chromotherapy. Therapeutic effects of visible radiation:

• improvement of blood supply and tissue trophism;
• stabilization of the functioning of irradiated organs;
• metabolic effect;
• photodestruction;
• normalization of the functioning of the nervous system and the psycho-emotional state of the patient.

Ultraviolet radiation. UV rays have a bactericidal and bacteriostatic effect, causing the production of melanin as a protective factor of tissues.

Infrared radiation. Infrared therapy has the following properties:

• anti-inflammatory;
• antispasmodic;
• trophic;
• stimulating blood flow;
• awakening the reserve functions of the body;
• detoxification;
• pronounced biostimulating effect.

Visible radiation.

• Blue light - 420 nm, visible light. Therapeutic effect: anti-inflammatory, soothing, anti-edematous effect.
• Red light - 624 nm, visible spectrum. Therapeutic effect: improvement of tissue trophism, acceleration of regeneration, resorption of infiltrates, muscle relaxation.

4. Climatotherapy. This type of therapy is known as aerotherapy; improves skin permeability. Ions penetrate through damaged and undamaged surfaces of the skin and reduce pain sensitivity. With aeroiontophoresis of analgesics, this therapeutic effect is enhanced.

5. Electrotherapy.

Electrophoresis (ionotherapy), galvanization. Medicinal electrophoresis is a physiotherapeutic method of electrotherapy, which consists of a combined effect on the body of galvanization (direct current of low strength and voltage) and medications. General effect: activation of immune, metabolic and physico-chemical processes.

Therapeutic effects depend on the dominant electrode at the time of the procedure.

Cathode (negative electrode):

• dilation of blood and lymphatic vessels;
• relaxation;
• normalization of metabolism;
• improvement of cell metabolism;
• stimulation of the secretion of biologically active substances.

Anode (positive electrode):

• removal of excess fluid from the body;
• reduction of inflammatory processes;
• anesthesia;
• sedation

Application in surgery:

• cicatricial and adhesive tissue changes;
• contractures;
• burns;
• postoperative rehabilitation.

It is advisable to supplement the procedure of galvanization and electrophoresis with other physiotherapeutic effects : laser therapy, magnetotherapy , light therapy, ultrasound, etc. to enhance the therapeutic effect, comprehensive effects on the body and the prevention of many diseases.

Microcurrent therapy is in first place among hardware corrections. It has an anti-inflammatory, analgesic effect, improves metabolic processes. The technique is optimal for relieving postoperative pain and reducing swelling. Its essence lies in the complex effect on the body of ultra-low frequency electric current impulses.

Dermatocosmetologists recommend using microcurrent therapy after any plastic surgery, especially after a circular facelift or blepharoplasty, since in these cases manual massages are contraindicated. The main advantage of microcurrents is the ability to remove toxic substances and excess fluid from the skin. As a result, swelling and bruising decrease and disappear, and skin tightness disappears. Thanks to increased metabolism, the process of skin rejuvenation is activated and muscle tone improves. This accelerates tissue healing processes, improves metabolism, and restores the physiological activity of damaged cells.

Even a couple of such procedures can reduce the recovery period by about a third, but in general the course involves 7-15 sessions, the frequency of which is selected individually. The simplicity of the method and high efficiency have determined the widespread use and great popularity of microcurrent therapy in the field of aesthetic medicine.

Darsonvalization. Darsonval currents - high-frequency currents of weak strength - are one of the classical methods of physiotherapeutic treatment. In cosmetology, darsonvalization is used as a rejuvenating, regenerating procedure. Passing through facial tissues, Darsonval currents cause improved blood circulation and stimulation of metabolism. Darsonvalization in various areas of the head and neck can help reduce pain and also improve blood circulation. Typically, Darsonval currents are used in combination with other restorative procedures. In rehabilitation they are used to stimulate tissue repair and regeneration, as well as to prevent purulent inflammation.

Magnetotherapy . To influence the body, constant or alternating magnetic fields, pulsating and running, are used. There are various forms of magnetic inductors for more convenient use on different areas of the human body. Magnetotherapy has a gentle effect on tissue, having trophostimulating, increasing blood supply, analgesic and regenerating effects.

Consecutive or combined exposure to several physical factors enhances the therapeutic effect, the susceptibility of tissues to treatment, shortens the duration of the course of exposure, reduces the body’s addiction, and therefore reduces the likelihood of exceeding permissible dosages.

But hardware cosmetology should be treated with caution. There are quite useful and safe methods of influence, but progress, the desire to always look young and beautiful on the part of the client and to have more and more profits on the part of manufacturers and service providers sometimes reaches the point of absurdity. Then it is not only impossible to get a positive result from the procedure, but it can also cause harm to health.

Late postoperative period

In the late postoperative period, the following tasks are solved: the formation of an aesthetically acceptable scar and a return to the usual skin care regimen.

Normally, scarring begins approximately 7-8 days after surgery and is most active from the 3rd to the 8th week. At this time, intensive collagen synthesis processes take place in the scar under the influence of growth factors that were released during skin dissection during surgery. After about a month, the scar becomes intensely pink and more noticeable than immediately after the stitches were removed. This may increase the patient's depression. By 3-6 months, the scar gradually fades, and the process of its formation is completed.

During the period of restoration of barrier functions, it is necessary to change the texture of the cream; it is better to use softer creams with high emollient qualities. For oily skin, an emulsion will be sufficient. Creams must completely protect the functions of the horny barrier. At this stage, it is necessary to add active components that will penetrate well into the skin and have a more pronounced effect, since the permeability of the epidermis during this period is very high. You can add aloe extracts, rose moschetta, vitamin C, E, A, and omega-3 PUFAs to the active ingredients. For the entire rehabilitation period, it is necessary to exclude irritating, stimulating and scrubbing agents.

Injection methods

2-4 weeks after radical aesthetic procedures, the time comes for more global restoration of the skin using mesotherapy and biorevitalization. Injections of vitamin cocktails and preparations based on hyaluronic acid are needed for rapid tissue regeneration. The required effect is achieved not only through the pharmacological effects of the components, but also through stimulation of the skin through mechanical action with a needle.

At the final stage of rehabilitation, questions arise such as correction of scar elements after surgical plastic surgery, removal of skin formations, laser resurfacing, complications after deep peels. It is very important to understand that it is unacceptable to pick off the scabs, as this can lead to the formation of a rough scar.

In case of formation of a keloid and hypertrophic scar, it is recommended:

• cryotherapy - cryodestruction, which can effectively reduce the volume of scar tissue;
• triamcinolone injections, which are carried out once every 10-14 days;
• use of silicone patches, laser correction.

In practice, at the moment, to work with already formed scars, I use innovative technology of thermomechanical ablation, which allows me to work with minimal rehabilitation periods, which gives ample opportunities to work on the face, without falling out of social life.

The importance of psychological preparation

And finally, perhaps the most important point of rehabilitation is psychological preparation and support. Of course, the success of a rapid recovery depends on the technique, the volume of intervention, the constitutional characteristics of the person, the general condition of the body and preoperative preparation, during which it is possible to correct, reduce and, possibly, prevent various unpleasant components of the rehabilitation period.

Psychotherapeutic preparation must be given special attention, since any traumatic procedure causes stress, and in most cases, patients are not ready to see themselves after large-scale interventions. Positive attitudes, information support, paying attention to positive dynamics, results, efficiency, wishes for a good day and mood - and miracles of transformation will not keep you waiting.

What would happen without all of the above?

Without an individual rehabilitation course of procedures, complete restoration of damaged tissue can take up to six months. Thus, the blood supply to the problem area remains disrupted for quite a long time, which can become a serious risk of the formation of rough scars.

To avoid infections and inflammations, the incision sites are carefully treated with antiseptics, which, in turn, dry the skin. Properly selected cosmetological techniques can eliminate this dryness and other unpleasant consequences.

Painful sensations are relieved after the first procedure of the rehabilitation program. If nothing is done, the pain may persist for several weeks.

In addition, an individually selected course will eliminate and prevent other possible complications.

Special preparation for invasive intervention and timely initiation of restorative treatment can reduce rehabilitation time by more than half and consolidate the results of a job well done. Supportive procedures can significantly improve the aesthetic result of plastic surgery without resorting to additional surgical interventions.

Rice. 1

Literature: Cosmetologist No. 1, 2017