AHAs have been the most misused and misunderstood molecules in skin rejuvenation. Very largely they are simply exfoliants and should mainly be used as penetrant enhancers. In patients with thick rough skin, AHAs have a place to help refine the skin. Once the natural qualities of the horny layer have been restored, then the use of AHAs should fall away. Care should be taken because they do impair the natural protection from the sun and they should always be used in conjunction with vitamin A. Lactic acid is an exception because it has a particularly useful effect on restoring natural moisturising factors and is less irritating than glycolic acid.
Your patient should use a "cocktail" of vitamin A, vitamin C, other antioxidants and active ingredients such as palmitoyl pentapeptide every morning and evening for a minimum of 3 weeks prior to surgery. Remind them to use these products on the areas where incisions are planned. This will ensure that the skin
Fig. 62.4. a Acne-scarred skin with photoageing prior to topical vitamin A, vitamin C and antioxidants. b After 52 treatments of iontophoresis and low-frequency sonophoresis (The Environ DF IONZYME machine for pulsed iontophoresis and low-frequency sonophoresis was used. The products used were Environ Crystal Masque and Environ C-Quel. Home skin care was with Environ) of vitamin A, vitamin C and continuous home skin care. No surgery was between the a and b
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