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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 7 of 28

Figure 3. Skincare regimen, pulsed-dye laser resurfacing [intense pulsed light (IPL)], high-intensity focused ultrasound (Ultherapy), and
recurrent Botox injections to the glabella, forehead, and crow’s feet. 43 yo Caucasian Fitzpatrick II presented with effects of long-term
sun damage including dyschromia, rhytids, and mild skin laxity. The patient was initiated on a skincare regimen consisting of topical
retinoid, vitamin C, and hydroquinone for four weeks prior to undergoing two sessions of full-face and neck high-intensity focused
ultrasound followed by three treatments of pulsed-laser phototherapy (IPL), and recurrent neuromodulator injections to the glabella,
forehead, and crow’s feet at 3-4 month intervals. Total treatment time was approximately 19 months

increase transdermal delivery of active skincare ingredients when these modalities are combined. The
main advantage of microdermabrasion is that, unlike lasers and chemical peels, it is safe in most patients
including patients with higher Fitzpatrick types or who are otherwise at higher risk of pigmentary changes
[27]
or scarring .

The procedure begins with facial cleansing and degreasing, followed by three passes in different directions
over the treated skin. The degree of dermabrasion depends on the rate of handpiece movement and
strength of flow. No anesthetic is required. Following treatment, sunscreen is applied, and there is typically
no social downtime. Patients are advised that they will likely undergo multiple treatments. Complications
[26]
are mostly self-limiting and include erythema, irritation, and petechiae .