Everything you need before, after, and in between your treatments.
Client Care Guide
CO2 Laser treatment is designed to renew, tighten and improve the texture of the facial skin. It is an aggressive procedure and requires strict adherence to these aftercare instructions. Immediate and very visible benefits can be seen in the form of reduction in laxity (tightening), reduction in wrinkles, removal of sun damage, increase in elasticity and improvement in collagen density and thickness.
It is a procedure that is also used to improve acne scarring by causing contraction of the skin, a degree of direct physical vaporization of the acne scars and remodelling of the collagen within the deeper layer of skin (dermis).
What you will experience following the treatment:
∙ You will experience a burning sensation following treatment and mild to moderate swelling of the face over the next 24-48 hours. The burning sensation usually resolves within 24-48 hours.
∙ Over the next three to four days the face will feel tight and swollen. There can be weeping of yellowish fluid for up to 5 days after the procedure.
∙ Crusting may develop over the first few days post procedure and must not be removed. They will heal and resolve leaving fresh new skin as healing continues.
∙ It is not unusual to experience some degree of itching between 4-6days following the treatment.
∙ At the end of 5-10 days post treatment, the skin will have largely healed. There should be no further crusted areas. The skin will remain pink. This will settle progressively over the following weeks.
Never pick or remove skin or crusts. Allow them to shed naturally. Picking will increase the likelihood of scarring.
Please note the time periods above may vary according to the strength of treatment. For example the duration of crusting may be longer in more aggressive treatments.
You will be given complete post op instructions and advised on what products to use on the treated area during the healing period. These are the only things that should be used to maintain the healing skin over the next 7-14 days. This may be adjusted by your clinician as your healing time goes on.
Post OP Day 1 to 4
Morning:Gentle cleanser and topical such as, Oxygenetix, Biafine. Wash 4-6 times daily with cleanser. Reapply topical to keep dirt and bacteria from entering treatment laser holes in skin. Use gloves and non woven gauze when cleansing so there is no chance of scratching or irritating the sensitive skin
Evening: Same as above. Holes from treatment should be closed on day 4. The purpose of washing the face throughout the day is to remove residue that builds on the face as it slowly oozes serous fluid (healing). This serous fluid tends to drip from the skin and crystallizes into a yellow crust/residue. Face washing removes this residue and reduces any microbial build up on the face. Face washing is important to minimize the risk of infection after the laser treatment.
How do I wash my face?
Face washing should be performed wearing the supplies gloves and gauze under running lukewarm water. The water must not be hot. Test it on the back of your hand. Rinse the face using copious amounts of water. Then apply about a tablespoon of face wash and massage all over the face. Leave on the face for 1-2minutes. It could sting and this is normal. Rinse off the wash with plenty of lukewarm water. Use adequate pressure to the treatment area to adequately remove the crystalline residue.
Drying the face
Use the non woven gauze to gently dry the treatment area. Do not use a regular towel as this can irritate or scratch the treatment area.
Hair Washing
Many patients naturally feel that washing hair should be avoided. Failure to wash hair allows build up of potentially infective debris along the hairline. This will increase the risk of infection after the procedure. Hair can be washed while standing in the shower. With your back to the shower tilt your head backwards and rinse the hair with copious amounts of lukewarm shower water. Then apply shampoo taking care to minimize shampoo foam application to the face but to also ensure that the hairline adjacent to the face is cleaned appropriately. Rinse shampoo backwards. This can be done by tilting the head backwards as if you were having your hair washed at a hairdresser.
Application of Dermal Revival Serum or Aquaphor
The only substance that should be applied to your skin after your laser treatment for the first 3-4 days is Aquaphor OR Biafine. This product is safe and the risk of irritation, inflammation and delayed healing is minimal. They create an occlusive barrier over the face that stops it from drying out. This moist occlusive environment favours regeneration and healing of the skin. Aquaphor is less greasy than Vaseline and contains an anti inflammatory calledBisobolo. One percent of patients may suffer with a contact allergy to Aquaphor. The patient usually notice this when there is persistent stinging, burning and discomfort after application. Normally Aquaphor should soothe the skin. In this case the office and we will recommend switching to something else. Remember that Aquaphor is to be used until the clinician tells you to discontinue it. Application of any other moisturisers or healing balms is strictly forbidden. Enough Aquaphor should be applied to the face to ensure good coverage of all lasered areas including the eyelids. It is unnecessary to apply overly thick layers. As it is normal for your face to ooze and be greasy as a result of Aquaphor, you should use a clean towel over your pillow case when you sleep. Change this towel daily for the first 3-4 days post laser surgery.
Sunblock / SPF
Laser procedures and application of sunblock following any laser procedure usually go hand in hand. CO2 laser is an exception to this. This is because the outer barrier layer (epidermis) has been entirely removed. Sunblocks only are designed to be applied to healthy intact skin with an epidermal layer, as are most over the counter creams. Having lost this natural barrier temporarily after laser resurfacing, your skin will react adversely if sunblock is applied too early. It will cause contact irritant dermatitis (a harmful inflammatory reaction to the skin). If this occurs your healing will be delayed.
In darker skin patients, early application of sunblock is more likely to cause inflammation and hyperpigmentation. It should therefore be avoided until your clinician advises you to start applying. Excessive sun should be avoided. If you are going to develop hyperpigmentation after laser it will occur irrespective of sunblock application. You cannot prevent this from happening. However sticking rigidly to your aftercare instructions will ensure a quicker recovery. Remember sun avoidance NOT sunblock.
Common Misconceptions
Patients often ask about special healing creams such as Cicalfate, Bio oil, Sudocrem, Bepanthen, Flammazine or Silicone based gels. These are all strictly to be avoided after surgery unless your clinician advises you to use them. CO2 laser resurfacing is a very specific type of laser procedure.Use of these products before your skin is healed and ready will increase the chances of developing permanent scarring. It is imperative that you adhere closely to instructions without experimentation. Silicone based dressings such as kelocote or Stratacel will cause scarring if applied in the first 7 days after laser treatment.
Mask Wear (Covid masks)
Masks for protection against Covid transmission are strictly NOT to be worn for 3 months after the procedure. It may seem like a good idea as it hides the embarrassing redness after surgery.Use of masks in this 3 month period will lead to inflammation, folliculitis and a fine web like scarring on the face (cicatricial scarring). This type of scarring is permanent if untreated. DON’T WEAR A MASK FOR THREE MONTHS. The doctor can provide the patient with mask exemption letter if necessary. Please note it is now not a legal requirement to wear a mask in most countries.
Shaving
Shaving with a razor should be strictly avoided within the 7-10 days after laser resurfacing . Electric shavers that rub against the skin with rotary or oscillating heads should also be avoided. Your clinician will let you know when it is safe to shave again.
Post OP Day 4-7
Wash:
Wash face with a face wash such as Cetaphil Gentle Cleanser. Warm water (not hot) should be used otherwise you will increase redness after washing.
Moisturizer
Apply a non acid, gentle moisturizer (as directed by your clinician) such as CeraVe, Neutrogena etc immediately after washing the treatment area. It is important to hydrate the skin even though you may not have used a moisturiser prior to the procedure. Failure to do this will increase inflammation and redness. Skin sensitivity is still high during this period and it is entirely possible to develop sensitivity/allergy/contact irritant dermatitis to moisturisers and sunblocks. You will be able to tell if this is the case as your skin will become red, itchy, bumpy and a burning or stinging sensation will be felt. If the treatment area is still very dry, contact our office so we can recommend switching you to something else more hydrating.
Sunblock
You may tentatively (if cleared to use this by your clinician) start to use sunblock at days 4-7 depending on your healing process. Be prepared to stop using it if you develop irritation or allergy. There is no gain from protecting against the sun by invoking an allergic reaction. If you are a darker skin type, hyperpigmentation is in fact more likely in this case. If the sunblock irritates the treatment area, stop applying it and contact our office immediately. If you can tolerate the sunblock, apply it in the morning after your moisturizer.Foundation/Tinted moisturizer/Anti-redness creams It is usual at this stage to become concerned if you still have some redness or in darker skin types, to feel self-conscious because of post inflammatory hyperpigmentation. It is normal for patients to wish to cover this up. The risk and benefit of any product must be assessed. If a product is used and the product irritates the skin, redness and post inflammatory hyperpigmentation will be prolonged by its use. So the short term gain that is won through camouflage is lost by prolonging the pigmentation or redness issue. The patient should still be under close supervision for this condition and should make sure to alert the office if he/she believes that he/she experiences a problem when using these types of products.
Foundation – Lycogel Camouflage Foundation (requires colour matching) Contains SPF 50 or Oxygenetix Foundation
Tinted SPF – Skin Revival SPF UV 50
Anti-redness – Alchimie Forever anti inflammatory topical products
Day 14-30
In over 95% of cases, patients will be able to return to their normal face skincare routine at this point. Actives such as retinol/tretinoin can be cautiously re-introduced under advisement of the clinician. Glycolic or salicylic acid exfoliators can be re-introduced when cleared by the office. Niacinamide and anti-oxidants such as Vitamin C can also be re-introduced when cleared by the office. The office should conduct a 3 month clinic, post op appointment. Photos will usually be taken at each visit as healing should be complete by this time. Before and after results/assessment will be conducted. The clinician will review the next step regarding your skin care routine and can make appropriate recommendations. Then schedule your 3 month follow up appointment.
CO2 Laser Treatment
- Avoid facials and saunas the day of treatment. This can cause migration of the product.
- Try to use the injected muscles for the first 1-2 hours after treatment: practice frowning, raising your eyebrows and squinting. This helps work the neuromodulators into your muscles. Although this is thought to help, this will not impact your treatment negatively if you forget.
- The results of the treatment can take up to 14 days to take full effect. Usually patients notice a change in 4-5 days. It takes time for the muscles to lose strength and the lines to fade following treatment. Please wait until 14 days have passed before assessing if you are pleased with the results.
- Do not touch or rub injected site for 2-4 hours following treatment. Avoid exercise and sweating for the remainder of the day and no lying down or leaning forward for 2-4 hours after treatment.
- There can be a slight chance of bruising at the treated site, this is temporary. Be assured that any tiny bumps or marks will go away within a few hours of treatment.
- Avoid any type of facial, microdermabrasion, eyebrow waxing, or massage for 14 days after treatment. Receiving any of the listed services could result in migration of the product.
- Tylenol is acceptable to take if experiencing discomfort ( if not contraindicated ). Ibuprofen/ Advil/ Motrin can increase risk of bruising post-injections.
- Botox/ Xeomin/ Dysport is a temporary procedure and at first you may find that your treatment results will last approximately 3-4 months.
- Your satisfaction is important to Me! I would like you to return to the office in 2 weeks for a follow up assessment appointment, especially after your first treatment. This will ensure we are able to see how your facial muscles react to your treatment. If you require additional Botox/ Xeomin/ Dysport to fine-tune/ adjust your treatment results there may be additional charges at the regular rate.
- Avoid exercise for 48 hours post treatment.
- Keep your head up elevated.
Botox
- Stay cool! Heating internally can cause hyperpigmentation.
- Do not put the treated area directly into a hot shower spray.
- Do not use hot tubs, steam rooms or saunas.
- Do not go swimming.
- Do not participate in activities that would cause excessive perspiration.
- Do not use loofahs or other means of mechanical exfoliation.
- Do not direct a hair dryer onto the treated area.
- Do not apply ice or ice water to the treated area.
- Stay cool! Heating internally can cause hyperpigmentation.
- Do not put the treated area directly into a hot shower spray.
- Do not use hot tubs, steam rooms or saunas.
- Do not go swimming.
- Do not participate in activities that would cause excessive perspiration.
- Do not use loofahs or other means of mechanical exfoliation.
- Do not direct a hair dryer onto the treated area.
- Do not apply ice or ice water to the treated area.
Chemical Peels
- After receiving a professional treatment, your should not necessarily expect to “peel”. However, light flaking in a few localized areas for several days is typical. Most patients who undergo these treatments have residual redness for approximately one to twelve hours post-procedure.
- As with all peels and treatments, it is recommended that makeup is not applied the day of treatment, as it is ideal to allow the skin to stabilize and rest overnight. You are to sleep with chemical peel and not wash your face till next morning.
- To minimize side effects and maximize results use the Post Procedure Products for three to five days or until flaking has resolved.
- If the skin feels tight, apply Post Peel Hydrator as needed.
- It is recommended that other topical, over the counter medications or alpha hydroxy acid products not be applied to the skin seven days post procedure, as they may cause irritation.
- It is recommended to delay use of tretinoin, Retin-A, Differin, Renova, Tazorac, Avage EpiDuo or Ziana five days post-procedure.
- Avoid direct sun exposure and excessive heat. Use SPF every day.
- Do not go to a tanning bed for at least two weeks post procedure. This practice should be discontinued due to increased risk of skin cancer and signs of aging
- Do not pick or pull on any loosening or peeling skin. This could potentially cause hyperpigmentation.
- Do not have electrolysis, facial waxing or use depilatories for approximately seven days.
- After receiving a professional treatment, your should not necessarily expect to “peel”. However, light flaking in a few localized areas for several days is typical. Most patients who undergo these treatments have residual redness for approximately one to twelve hours post-procedure.
- As with all peels and treatments, it is recommended that makeup is not applied the day of treatment, as it is ideal to allow the skin to stabilize and rest overnight. You are to sleep with chemical peel and not wash your face till next morning.
- To minimize side effects and maximize results use the Post Procedure Products for three to five days or until flaking has resolved.
- If the skin feels tight, apply Post Peel Hydrator as needed.
- It is recommended that other topical, over the counter medications or alpha hydroxy acid products not be applied to the skin seven days post procedure, as they may cause irritation.
- It is recommended to delay use of tretinoin, Retin-A, Differin, Renova, Tazorac, Avage EpiDuo or Ziana five days post-procedure.
- Avoid direct sun exposure and excessive heat. Use SPF every day.
- Do not go to a tanning bed for at least two weeks post procedure. This practice should be discontinued due to increased risk of skin cancer and signs of aging
- Do not pick or pull on any loosening or peeling skin. This could potentially cause hyperpigmentation.
- Do not have electrolysis, facial waxing or use depilatories for approximately seven days.
- Stay cool! Heating internally can cause hyperpigmentation.
- Do not put the treated area directly into a hot shower spray.
- Do not use hot tubs, steam rooms or saunas.
- Do not go swimming.
- Do not participate in activities that would cause excessive perspiration.
- Do not use loofahs or other means of mechanical exfoliation.
- Do not direct a hair dryer onto the treated area.
- Do not apply ice or ice water to the treated area.
- Schedule your injection at a time when minor swelling or bruising will not disrupt your social obligations. Each time you are treated, outcomes may vary.
- To lessen the likelihood of bleeding or bruising, discontinue use of blood thinning products for 10 days prior to treatment, if approved by your primary care provider. This includes: aspirin, ibuprofen (Motrin or Advil), naproxen, Aleve, fish oil, St. John’s Wort, flax, Vitamin E, Vitamin D, garlic, Ginkgo Biloba, ginseng, etc. Alcohol is also to be avoided 24 hours pre- or post-injectable treatment, as it is also a blood thinner. You can consider taking Arnica Montana natural supplement to help bruising (take 5 tablets three times per day starting one week prior to treatment).
- Please notify your provider if you have any history of cold sores, as we will consider pre-medicating with an antiviral prescription prior to injections. Cancel your appointment if you have any open sores in the treatment area. It is important that you alert us of any medical conditions you may have and/or any prescribed medications you are taking prior to your treatment.
- Any injection introduces the risk for infection. For this reason, the following is taken into consideration when proceeding with injections. We will delay injectables if you:
- Have had any infection, cold, virus, or flu in the past 30 days.
- Have had any dental procedures in the past 30 days or are anticipating dental procedures or cleanings in the next 30 days.
- Have had a surgical procedure in the past 30 days or are anticipating a surgery or procedure.
- Have had any immunizations in the past 30 days or if you’re anticipating immunizations.
- Have had any tattooing or permanent makeup within the past 30 days.
- Take any immunosuppressive/injectable medications (ex: Biologics such as Humira, Skyrizi, Stelara, Enbrel, Taltz, Cosentyx, Tremfya).
- Additional contraindications: Pregnancy, breastfeeding, allergies to components of dermal fillers, open sores in areas to be treated.
Dermal Filler
- Swelling, bruising, tenderness, numbness, and areas of firm nodules may occur.
- Avoid straws, water bottle, or pursing of the lips for 2 weeks.
- Cosmetic fillers are long lasting, but not permanent. Longevity depends on the areas treated and your body’s metabolism.
- DO NOT APPLY ANYTHING TO THE SKIN UNTIL THE DAY AFTER TREATMENT: No cleanser, moisturizer, or makeup!
- DO NOT massage, touch, or manipulate the injection site. Avoid heavy exercise the day of your treatment.
- Ice packs may be used to the treated area during the first 12 hours. Ice for 15 minutes on every hour.
- Avoid dental work for 30 days after filler injections.
- Avoid sleeping on your side or stomach for 24 hours post-treatment to prevent dispersing the product. We recommend you sleep elevated on your back and use pillows to stabilize yourself.
- If experiencing swelling, sleep with head elevated for 2-3 days to decrease swelling.
- You may take acetaminophen/Tylenol if you experience any mild tenderness or discomfort.
- Wait a minimum of four weeks (or as directed by your provider) before receiving any skin care or laser treatments or additional filler.
- For most patients, the benefits of dermal fillers can be enhanced by using a medical-grade skincare system. Please contact your provider or a member of the staff for product recommendations.
- If you experience bruising, Arnica Montana natural supplement can be taken to help bruising to resolve at a faster rate; take 5 tablets three times per day (this can be started 1 week prior to injections).
- After receiving a professional treatment, your should not necessarily expect to “peel”. However, light flaking in a few localized areas for several days is typical. Most patients who undergo these treatments have residual redness for approximately one to twelve hours post-procedure.
- As with all peels and treatments, it is recommended that makeup is not applied the day of treatment, as it is ideal to allow the skin to stabilize and rest overnight. You are to sleep with chemical peel and not wash your face till next morning.
- To minimize side effects and maximize results use the Post Procedure Products for three to five days or until flaking has resolved.
- If the skin feels tight, apply Post Peel Hydrator as needed.
- It is recommended that other topical, over the counter medications or alpha hydroxy acid products not be applied to the skin seven days post procedure, as they may cause irritation.
- It is recommended to delay use of tretinoin, Retin-A, Differin, Renova, Tazorac, Avage EpiDuo or Ziana five days post-procedure.
- Avoid direct sun exposure and excessive heat. Use SPF every day.
- Do not go to a tanning bed for at least two weeks post procedure. This practice should be discontinued due to increased risk of skin cancer and signs of aging
- Do not pick or pull on any loosening or peeling skin. This could potentially cause hyperpigmentation.
- Do not have electrolysis, facial waxing or use depilatories for approximately seven days.
If you experience any of the following symptoms, contact our office immediately:
Dusky or white discoloration of injected areas, mottling or unusual bruising, severe or increasing pain, redness, increasing warmth or coolness to touch, severe swelling, itching, blisters, difficulty swallowing or smiling, fever, or chills. If you notice onset of any of these symptoms, call our office immediately at 302-540-9400 to speak with a provider.
After hours, you will be connected directly with Valerie at DripNeedle.
- Your lips will be swollen after the produce. You may also notice some redness or bruising at the injection sites, which is normal. Most side effects will be minor and you will be able to resume most activities once the procedure is done.
- Apply ice to your lips afterward using an ice pack of ice cube covered in cloth ( so it doesn’t stick to the lip and cause pain). This will help ease swelling, itching, bruising, and any other pain.
- Avoid strenuous exercise for 48 hours after you get lip filler. Elevated blood pressure and heart rate from exercise may make swelling or bruising worse. You can take Arnica for bruising if your provider approves. It’s fine to engage in light activity like walking.
- Stay hydrated. Drinking plenty of water will help your body heal.
- Eat plenty of hydrating fruits and vegetables and try to avoid excess sodium, which may worsen swelling.
- Avoid high temperatures like steam rooms, saunas, or heated exercise classes for 48 hours after treatment. High heat can make swelling more pronounced.
- Ask your provider which painkiller are OK to take in the days after treatments. Normally Tylenol will be fine, but not blood-thinning medications like Ibuprofen.
- If you’re getting lip fillers for a specific event, make sure you provide at least 6 weeks before event to allow your lips to properly recover.
- Try to sleep with your head elevated on pillows to reduce swelling. Do not sleep on your face.
- Avoid makeup on your lips for up to 24 hours after.
- Avoid straws and water bottles for 2 weeks post lip filler.
- Lumps and Bumps are normal. You can lightly massage them. If they persist after 6 weeks notify us as you may need spot dissolution.
- Wait 4-6 weeks before adding more lip filler.
- Notify your provider immediately if you’re experiencing any color change in the lip tissue or surrounding tissues. (302) 540-9400
Lip Filler
1. Wash your face with Clear Defense Cleanser. Dry your face with a clean towel.
2. Use one Clear Defense Exfoliating Pad.
3. Use 1-2 pumps of Clear Defense Hydrator.
4. Use 1-2 pumps of Clear Defense SPF
DayTime
DripNeedle Skin Care Routine
Your at-home routines to maintain and enhance results.
Night Time
1. Wash your face with Clear Defense Cleanser. Dry your face with a clean towel.
2. Use one Clear Defense Exfoliating Pad (only once you’ve built up to twice a day).
3. Use Clear Defense Retinol.
4. Use 1-2 pumps of Clear Defense Hydrator.
Clear Defense
DripNeedle Skin Care Routine
Your at-home routines to maintain and enhance results.
1. Wash your face with Skin Revive Cleanser. Dry your face with a clean towel.
2. Use 3-5 drops of Skin Revive Serum. Allow serum to dry.
3. Use 1-2 drops of Skin Revive Peptide.
4. Use 1-2 pumps of Clear Defense Hydrator.
5. Use Skin Revive SPF.
DayTime
Night Time
1. Wash your face with Clear Defense Cleanser. Dry your face with a clean towel.
2. Use 3-5 drops of Skin Revive Serum. Allow serum to dry.
3. Allow 1-2 pumps of Skin Revive Retinol.
4. Allow 1-2 pumps of Skin Revive Peptide.
5. Allow 1-2 pumps of Skin Revive Hydrator.
