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Farber et al. Plast Aesthet Res 2020;7:72 I http://dx.doi.org/10.20517/2347-9264.2020.152 Page 3 of 28

Figure 1. Skincare regimen. 53-year-old Hispanic female treated with a skincare regimen which includes topical retinoid, vitamin C, and
hydroquinone. Before (top) and following 5 weeks (bottom) of daily skincare treatment

remains the gold standard retinoid for skin rejuvenation and should be recommended as an adjunct to
other aesthetic treatments.

An example of a patient treated with a combination regimen of a retinoid, vitamin C, and hydroquinone is
included in Figure 1.

Acids
Alpha hydroxy acids, such as glycolic, lactic, and citric acids, work to exfoliate the skin and interfere with
epidermal cohesion, creating a more youthful skin appearance. One study demonstrated an increase in
skin thickness with improved elastin quality and collagen density in patients using a combined alpha
[13]
hydroxy acid formulation . Another study showed a dose-dependent improvement in skin smoothness
[14]
and reduction in rhytids with use of topical lactic acid . Patient should be encouraged to use the topical
alpha hydroxy acid with the highest effective concentration that they can tolerate without significant
redness or desquamation. They should be instructed that acids should not be used with antioxidants as the
[15]
combination can destabilize vitamin C and reduce its efficacy .
Medical facials
Ò
Dermal infusion facials (such as those offered by HydraFacialÔ, Diamond GlowÔ, and SilkPeel ) include
a combination of mechanical exfoliation, suction-based extraction, and active ingredient infusion. The
exfoliation technique associated with dermal infusion facials is termed hydradermabrasion and combines
microdermabrasion with pressurized application of an ingredient-containing serum. In one study
comparing combined hydradermabrasion and antioxidant serum infusion with topical application of the
same antioxidant serum, the treatment group was found to have increased epidermal and dermal thickness,
[16]
increased antioxidant levels, decreased fine lines, decreased pore size, and decreased hyperpigmentation .