Patient Care

Dysport | Wrinkle Relaxer Care

This is the most critical window to prevent the product from moving to unintended muscles.
• DO NOT lie down, recline, or bend over for at least 4-6 hours after your injections. WHY? We want to use gravity to our advantage and keep the Dysport exactly where it was placed. Lying down can increase the risk of the product migrating, which could lead to temporary eyelid or brow drooping (ptosis).
• DO NOT rub, massage, or apply firm pressure to the injection sites. WHY? This is the most common way to move the product. This includes: No facials, facial massages, facial rollers (like jade or quartz), or microdermabrasion for 7 days.
• DO NOT wear tight hats, headbands, helmets, or goggles that put pressure on the treated areas (especially the forehead or brow) for the rest of the day.
• DO NOT engage in any heavy or strenuous exercise (running, hot yoga, heavy lifting, HIIT) for at least 24 hours. WHY? Increased blood flow and sweat can increase swelling, bruising, and (theoretically) dilute or spread the product. Light walking is fine.
• DO NOT use saunas, hot tubs, steam rooms, or take very hot showers for 24 hours. WHY? Heat increases blood flow (vasodilation), which can increase your risk of bruising.
• DO NOT drink alcohol for 24 hours. WHY? Alcohol is a blood thinner, which significantly increases your risk of bruising at the injection sites.
• DO NOT rub your face while cleansing. DO gently wash your face with a mild cleanser and lukewarm water. Pat dry.
• DO NOT use any harsh or "active" skincare products (like retinoids, glycolic/salicylic acids, or exfoliants) on the treated areas for 24-48 hours.
• DO NOT take over-the-counter blood thinners like Aspirin, Ibuprofen (Advil, Motrin), and Naproxen (Aleve) for 24 hours to minimize bruising. If you need pain relief for a mild headache, Acetaminophen (Tylenol) is the best choice.
IMPORTANT: If you are on a prescribed blood thinner (like Warfarin, Plavix, or Eliquis) for a medical condition, DO NOT stop taking it unless instructed by your doctor.
Common (and Normal) Side Effects
• Bumps & Redness: Small, mosquito-bite-like bumps or redness at the injection sites are very common and should resolve within 30-60 minutes.
• Mild Bruising: You may develop small, pinpoint bruises. This is normal and can be covered with makeup after the first 24 hours. They will resolve in 3-7 days.
• Mild Headache: A slight headache on the day of injection is also common and can be treated with Acetaminophen (Tylenol).
• "Heavy" Sensation: As the product begins to work, you may feel a "heavy" or "tight" sensation in your brows or forehead. This is normal and will fade as you get used to the feeling.
Your Results Timeline
• Dysport is NOT instant. It takes time for the product to bind to the nerve receptors and relax the muscle.
• Days 2-4: You will likely begin to see the first signs of relaxation. Dysport is known to "kick in" slightly faster than other toxins.
• Day 7: You should see a significant, noticeable improvement.
• Day 14 (2 Weeks): Your results are considered final and complete. This is the point at which you can fully assess the outcome.
2-Week Follow-Up:
Sometimes we may schedule a follow-up appointment with you around the 2-week mark, especially if this is your first treatment with us. This is not for more injections but to assess your final results, take "after" photos, and determine if any small "touch-ups" are needed.
• Duration: Dysport results typically last 3-4 months.
• Maintenance: To maintain your results, it's best to schedule your next appointment before the product completely wears off (usually around the 3-4 month mark).
While serious complications are rare, you should contact our clinic immediately if you experience any of the following:
• Signs of Eyelid or Brow Droop (Ptosis): A new, significant heaviness or drooping of your eyelid or eyebrow. (This is rare and temporary, but Dr. Bonato can help).
• Vision Changes: Any blurred vision, double vision, or difficulty seeing.
• Allergic Reaction: (Very Rare): Hives, severe itching, difficulty breathing, or swelling of the face, lips, or tongue. This is a medical emergency.
• Systemic Issues: Any difficulty swallowing, speaking, or breathing. This is a medical emergency

Microneedling Care

The goal is to protect your skin's open channels from infection and irritation while providing a clean, hydrated environment for healing.
• DO NOT Touch: Avoid touching your face with unwashed hands for the first 24-48 hours. This is the #1 way to avoid infection.
• DO NOT Use "Actives": For at least 5-7 days, STOP all "active" ingredients. This includes:
o Retinoids (Retin-A, tretinoin, retinol)
o Vitamin C
o Acids (AHA/BHA, like glycolic, lactic, and salicylic acid)
o Benzoyl Peroxide
o Harsh scrubs or exfoliating products
• DO NOT Use Makeup: Avoid all makeup for at least 24 hours (48-72 hours is even better) to prevent "clogging" the micro-channels and causing breakouts or infection.
• DO NOT Sweat: For 48-72 hours, avoid strenuous exercise, saunas, steam rooms, jacuzzis, and hot showers. Sweat and heat can cause significant irritation and inflammation.
• DO NOT Sunbathe: Your skin is extremely vulnerable to UV damage. Avoid all direct sun exposure for 3-5 days. After that, be vigilant with sunscreen.
• DO NOT Pick: You may experience dryness or flaking around day 3-5. Do not pick, peel, or scrub this skin. Let it shed naturally. Picking can lead to scarring and hyperpigmentation.
• DO NOT Take Anti-Inflammatories: The inflammation is part of the healing process you want. Avoid NSAIDs like Ibuprofen (Advil, Motrin) and Naproxen (Aleve). If you need pain relief, Acetaminophen (Tylenol) is generally considered safe as it is not an anti-inflammatory.
The Immediate 24 Hours (The "Open" Phase)
• What to Expect: Your skin will be red, tight, and feel like a moderate sunburn. You may see some pinpoint bleeding or mild swelling. This is a normal inflammatory response.
• Your Job: Keep it clean and calm.
o Cleansing: Do not wash your face or apply any products for at least 4-6 hours (or as instructed by Dr. Bonato). For your first wash (evening of Day 1 or morning of Day 2), use only lukewarm water and your clean hands. Pat dry gently with a clean, soft cloth.
o Products: Only use the specific post-procedure serum/cream Dr. Bonato gave you. Do not use your regular skincare.
o Pain/Itching: A cool compress (a clean cloth with cool water) can be used to soothe the skin.
o Sleep: Use a clean pillowcase tonight.
Days 2-3 (The "Healing" Phase)
• What to Expect: The redness will begin to fade, turning into a pinkish tone. Your skin will feel extremely dry, tight, and may have a "sandpapery" texture.
• Your Job: Hydrate and Protect.
o Cleansing: You can now use a gentle, non-medicated, non-foaming cleanser (like CeraVe Gentle Cleanser or Cetaphil) and lukewarm water. Wash 2x daily (AM/PM).
o Hydration: This is the most important step. Apply a simple Hyaluronic Acid serum to damp skin. This will pull moisture into the skin and aid healing.
o Moisturize: Apply a bland, gentle moisturizer (like CeraVe Moisturizing Cream or your provider's recommendation) over the hyaluronic acid to "seal" it in.
o Sun Protection: You must now start using sunscreen. It must be a mineral/physical sunscreen (containing Zinc Oxide and/or Titanium Dioxide) with SPF 30 or higher. Chemical sunscreens (oxybenzone, avobenzone) can be too irritating for new skin. Reapply if you are near windows or outside.
Days 3-7 (The "Shedding" Phase)
• What to Expect: This is when peeling and flaking often begin, especially around the mouth and nose. Your skin may feel itchy. This is normal.
• Your Job: Gently support the shedding.
o Cleanse, Hydrate, Moisturize, Protect: Continue your routine from Day 2. You may need to apply moisturizer multiple times a day to manage the dryness and flakiness.
o DO NOT EXFOLIATE. The flaking skin is protecting the new skin underneath. Do not use a washcloth, facial brush, or scrub to remove it. Let it fall off on its own.
Week 2 and Beyond (The "New Skin" Phase)
• What to Expect: The flaking should be complete. Your skin may look pink, fresh, and noticeably smoother. You are now seeing the initial "glow."
• Your Job: Slowly re-introduce your normal routine.
After Day 7-10 (and once all flaking and sensitivity are gone):
o You can gently re-introduce your other products.
o Start with Vitamin C serum first in the mornings.
o Wait at least 10-14 days before re-starting retinoids or strong acids. Start them slowly (every 3rd night) to see how your new skin tolerates them.
Sunscreen: This is non-negotiable. Protecting your new collagen from UV damage is the #1 way to maintain your results.
While your skin will be red and sensitive, certain signs are not normal. Contact our clinic immediately if you experience any of the following:
• Signs of Infection: Increasing pain (instead of decreasing), fever, pus or yellowish/greenish drainage, or excessive, warm-to-the-touch swelling.
• Allergic Reaction: Any rash, hives, or severe, unmanageable itching.
• Herpes Outbreak: If you are prone to cold sores (herpes simplex virus), microneedling can trigger an outbreak. Dr Bonato can prescribe an antiviral for you to take. Contact us if you see any blisters.
• Prolonged Redness: If your "sunburn" look hasn't faded significantly after 3 days.

Dermal Filler Care

Your primary goals are to reduce swelling, minimize bruising, and allow the filler to settle without disturbance.
Things to avoid:
• DO NOT touch, rub, massage, or apply pressure to the treated areas. This is the #1 way to prevent irritation, infection, or displacing the filler before it has settled.
• DO NOT drink alcohol for at least 24 hours. Alcohol thins the blood and can significantly worsen bruising and swelling.
• DO NOT take Blood Thinners: Avoid over-the-counter medications and supplements that thin the blood for 24-48 hours (unless medically necessary—always check with your doctor).
• DO NOT take: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Aspirin, Vitamin E, Fish Oil, St. John's Wort, and Ginkgo Biloba. SAFE TO TAKE: Acetaminophen (Tylenol) is the recommended choice for any mild discomfort, as it is not a blood thinner.
• DO NOT engage in strenuous exercise, jogging, yoga, or any activity that significantly raises your heart rate or blood pressure for 24-48 hours.
• DO NOT expose the area to intense heat for 24 hours. This includes saunas, steam rooms, hot tubs, and very hot showers.
• DO NOT get direct, prolonged sun exposure
• DO NOT apply makeup on the treated areas for at least 12-24 hours to keep the injection sites clean.
• AVOID "active" skincare products (retinoids, vitamin C, glycolic/salicylic acids) on the area for 24-48 hours to prevent irritation.
Tips to Minimize Swelling & Bruising:
• Ice: Apply a cold compress or ice pack to the treated area for 10 minutes on, 10 minutes off, as needed for the first 24-48 hours. Do not apply ice directly to the skin; wrap it in a thin, clean cloth.
• Elevate: Sleep on your back with your head slightly elevated on an extra pillow for the first 1-2 nights. This helps gravity drain fluid and reduce morning swelling.
Your Healing & Results Timeline
Day 1-3: The "Swelling" Phase
• What to Expect: Swelling, redness, tenderness, and bruising are all normal and to be expected. Swelling is often most noticeable the morning after your procedure. For lip fillers, this swelling can be significant.
• Your Job: Continue to ice as needed, sleep elevated, and be gentle. Trust the process.
Day 4-7: The "Settling" Phase
• What to Expect: Swelling and redness will rapidly decrease. Bruising may become more colorful (yellow/green) as it begins to heal. You may feel small "lumps" or firmness; this is the filler integrating with your tissue.
• Your Job: You can typically resume normal exercise and your regular skincare routine. DO NOT try to massage any lumps unless specifically instructed to do so by your provider.
Week 2-4: The "Final Result" Phase
• What to Expect: This is when your final result truly appears! The filler has fully settled, softened, and integrated. Any remaining swelling, bruising, or lumps should be gone. Your skin will look and feel smooth and natural.
• Your Job: This is the perfect time for a possible follow-up appointment, if needed. Dr Bonato will assess your results, take "after" photos, and determine if any small "touch-ups" are needed to perfect the outcome.
The lips are highly vascular and prone to swelling. Follow these additional tips:
• Avoid Straws: Do not drink through a straw for the first 24-48 hours. The puckering motion can be uncomfortable and place pressure on the filler.
• Avoid Kissing: Avoid passionate kissing for 24-48 hours.
• Soft Foods: You may want to stick to softer, easy-to-eat foods for the first day to avoid excessive chewing or opening your mouth wide.
• Stay Hydrated: Drink plenty of water. Hyaluronic acid (the main ingredient in Juvéderm and Restylane) loves water and will use it to plump and hydrate your lips.
While serious complications are rare, it is crucial to know the signs. Contact your provider's office immediately if you experience any of the following:
• Signs of Vascular Occlusion (a blocked blood vessel): This is a medical emergency.
o Increasing or Severe Pain: Pain that is getting worse instead of better, or is disproportionate to what you'd expect.
o Skin Blanching: The skin near the injection site turns pale, white, or has a blotchy, purplish, lace-like pattern.
o Coolness: The affected area feels unusually cool to the touch.
o Vision Changes: Any blurred vision, vision loss, or pain in your eyes (this is extremely rare but requires immediate emergency care).
• Signs of Infection (usually appear 3-7 days later):
o Increasing redness, swelling, or warmth at the injection site.
o Pus or drainage from any injection point.
o Fever or feeling generally unwell.
• Signs of Allergic Reaction (usually immediate):
o Severe itching, rash, or hives.
o Swelling of the face, tongue, or throat; difficulty breathing (this is a medical emergency).

Sculptra | Biostimulator Care

This is the most important part of your post-treatment care. Failure to follow this step can lead to the formation of small bumps or nodules under the skin.
• WHAT IT IS: Massage the treated areas for 5 minutes, 5 times a day, for 5 days in a row. To make life easier and more manageable you can perform the massage for 2 minutes, 2 times per day for 2 weeks (2-2-2 Protocol).
• WHY? Sculptra particles are suspended in sterile water (which is absorbed in 1-2 days). This massage ensures the poly-L-lactic acid particles are distributed evenly throughout the tissue, preventing them from clustering together and promoting a uniform collagen response.
• HOW TO MASSAGE:
o Wash your hands thoroughly with soap and water. Apply a simple moisturizer or clean facial oil to your fingertips to prevent friction on the skin. Using firm but gentle pressure, massage the treated areas in a deep, circular motion. You are not just rubbing the skin; you are moving the tissue underneath. Your provider can show you the exact technique before you leave the office. Set reminders on your phone to stay consistent!
What to AVOID After Treatment
• AVOID Anti-Inflammatories (if possible): For 24-48 hours, avoid Ibuprofen (Advil, Motrin), Aspirin, Naproxen (Aleve), and fish oil. These are blood thinners and will significantly increase your risk of bruising.
• AVOID Strenuous Exercise: No heavy workouts, hot yoga, or activities that cause heavy sweating for at least 24-48 hours. This can worsen swelling and bruising.
• AVOID Alcohol: Do not drink alcohol for at least 24 hours after treatment, as it increases your risk of bruising.
• AVOID Excessive Heat & Sun: For 2-3 days, avoid saunas, steam rooms, hot tubs, and prolonged direct sun exposure. Your skin is sensitive.
• AVOID "Active" Skincare: For 5-7 days, avoid harsh or "active" ingredients on the treated areas. This includes retinoids (Retin-A, tretinoin), glycolic/salicylic acids (AHA/BHA), and harsh scrubs.
• AVOID Other Facial Treatments: Do not get facials, facial massages (other than your 5-5-5 or 2-2-2), laser treatments, chemical peels, or microneedling in the treated area for at least 2-3 weeks. Ask your provider for their specific timeline.
The Immediate 24-48 Hours
• Swelling & "Fullness": You will likely see immediate "plumpness" in the treated areas. This is not the final result. It is mostly due to the sterile water in the Sculptra suspension and temporary swelling from the injections. This "fullness" will subside over the next 2-3 days, and your face will return to its pre-treatment appearance.
• Bruising & Redness: Bruising, redness, and tenderness at the injection sites are all very common and normal.
• Your Job:
o Ice: Apply a cold compress or ice pack to the treated areas for 10-15 minutes at a time, several times throughout the first 24 hours. Do not apply ice directly to the skin; wrap it in a clean, thin cloth.
o Pain Relief: If you have any discomfort or a mild headache, you may take Acetaminophen (Tylenol).
o Massage: Begin your 5-5-5 (or 2-2-2) Massage as instructed.
The First Week (Days 3-7)
• What to Expect: The initial swelling will be gone. You may have resolving bruises that turn yellowish or greenish. Your skin will likely look as it did before the treatment. This is normal. The collagen-building process is just beginning.
• Your Job:
o Massage: Complete your 5-5-5 (or 2-2-2) massage protocol.
o Skincare: You can typically resume gentle cleansing and moisturizing.
o Makeup: You can usually apply makeup a few hours after your treatment, but it's often best to wait 24 hours to ensure all injection sites are closed. Be very gentle when applying and removing makeup.
The "Waiting" Phase (Weeks 2-6)
• What to Expect: You will be in a "waiting" period. You will not see any dramatic changes during this time. Be patient. The Sculptra particles are now signaling your body to start producing new collagen.
• Your Job:
o Live Normally: You can resume all normal activities.
o Check for Lumps: After your 5-day or 2 week massage is complete, you can gently feel the treated areas (when washing your face, for example). If you feel any new, small, firm "pea-sized" bumps developing, contact your provider. They may instruct you to resume massage in that specific spot.
Sculptra is a marathon, not a sprint. The results are your own collagen, so they are gradual, natural, and long-lasting.
• The "Series": Sculptra is always done as a series of treatments, typically 2-3 sessions spaced 6-8 weeks apart.
• First Signs (6-8 Weeks): You may start to notice the first subtle improvements in skin texture and volume about 6-8 weeks after your first treatment.
• Full Results (4-6 Months): The most significant results are visible about 4-6 months after your last treatment session. This is how long it takes for the new collagen framework to be fully built.
• Maintenance: Results are long-lasting (often 2+ years). A "touch-up" treatment of one vial is typically recommended every 12-24 months to maintain your results.
While serious complications are rare, it is crucial to be vigilant. Contact your provider's office immediately if you experience any of the following:
• Signs of Vascular Occlusion (a blocked blood vessel): This is a medical emergency.
o Increasing or severe pain that is getting worse.
o Skin turning pale, white, or having a dusky, purplish, lace-like pattern.
o Any changes to your vision.
• Signs of Infection (usually appear 3-7 days later):
o Increasing redness, warmth, or swelling at an injection site.
o Pus or drainage.
o Fever or feeling generally unwell.
•Nodules: If you feel a distinct, persistent lump or bump developing, especially after your 5-day or 2-week massage period is over.

PRP Care

• DO NOT touch, press, rub, or manipulate the treated area (s) until the day after your treatment. If you have any questions or concerns about lumps or bumps, please call your providers office before taking matters into your own hands.
• AVOID the treatment area for the first 24 hours in order to minimize the risk of infection. You may wash or take a shower 6 hours post treatment, but do not wash the treated area.
• AVOID vigorous scrubs, exfoliation or facial treatment in the area of treatment for at least 2 weeks.
• AVOID Aspirin, Motrin, Ibuprofen, Aleve (all non-steroidal and steroidal anti-inflammatory agents), Gingko Biloba, Garlic, Flax Oil, Cod liver Oil, Vitamin A, Vitamin E, or any other essential fatty acids at least 3 days - 1week prior to and after your treatment. If you experience discomfort or pain, you may take Tylenol or other Acetaminophen products if you are not allergic to them.
• AVOID intense exercise, sauna, or swimming for at least 48 hours.
• AVOID icing post injection. The inflammation from the procedure is necessary to produce the results we are looking for.
• AVOID applying makeup until the day after your treatment in order to minimize the risk of infection at the injection sites.
• DO sleep on your back with your head elevated for two days.
• DO apply bacitracin as provided by Dr. Bonato to the injection sites before bed for 2 nights. You are able to cleanse your face the morning after treatment and resume all other skincare.
If you have any areas that are increasing in pain and redness after 24 hours, please contact Dr. Bonato immediately. Swelling and tenderness are normal, but should get progressively better. If anything is getting worse or extreme, it may be a sign of infection or occlusion, and must be dealt with immediately.

PRP Hair Care

The entire goal of PRP is to trigger a mild, controlled inflammatory response. This "healing cascade" is what summons growth factors to the area.
DO NOT take any anti-inflammatory medications (NSAIDs) for at least 3-7 days before and after your procedure, unless specifically instructed by your doctor for another medical reason.
• AVOID: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Aspirin, and other NSAIDs. WHY? These medications will stop the very process you are trying to stimulate, effectively counteracting your treatment.
• WHAT TO TAKE INSTEAD: If you experience pain or a headache, you can typically take Acetaminophen (Tylenol), as it is a pain reliever but not an anti-inflammatory.
The Immediate 24 Hours
This is the most critical period for preventing infection and managing initial side effects.
• Pain & Tenderness: Your scalp will likely feel tender, tight, or slightly swollen, similar to a sunburn. This is normal.
• Pain Relief: Use Acetaminophen (Tylenol) as needed.
• Swelling: To minimize swelling (which can sometimes travel down to the forehead), apply a cold compress or ice pack to your forehead or the back of your neck for 10-15 minutes at a time. DO NOT apply ice directly to the injection sites.
• Sleep: Try to sleep with your head slightly elevated on an extra pillow for the first night.
• DO NOT Wash Your Hair: Do not shower, wet, or shampoo your hair for at least 12-24 hours.
• DO NOT Touch: Avoid touching, rubbing, or scratching the treated areas to prevent irritation and infection. If you must touch your head, ensure your hands are freshly washed.
• Activity: No strenuous exercise, saunas, steam rooms, or jacuzzis. Avoid any activity that causes heavy sweating.
• Substances: Avoid alcohol and smoking, as they can impair the healing process.
• Hats: You can wear a clean hat if you need to for sun protection or to conceal redness.
The First Few Days (Days 1-3)
You are now in the initial healing phase. Gentleness is key.
• Washing Your Hair: You can now (usually after 24 hours) wash your hair.
o Use lukewarm water, not hot.
o Use a gentle, sulfate-free shampoo.
o Be very gentle. Use your fingertips (not nails) to lightly massage the scalp. Do not scrub.
o Rinse thoroughly and pat dry with a clean, soft towel.
o Avoid using a high-heat setting on your blow dryer.
• Activity: You can resume light to moderate exercise. Continue to avoid strenuous workouts or heavy sweating for at least 48-72 hours.
• Topical Treatments: Pause all other topical hair treatments like Minoxidil (Rogaine) or other medicated foams/serums for 72 hours unless directed by Dr. Bonato.
• Sun Exposure: Protect your scalp from direct, prolonged sun exposure. Wear a hat if you will be outside for an extended period.
The First Week (Days 4-7)
You should be feeling mostly back to normal.
• Resuming Normalcy: You can typically return to your normal hair washing routine and products.
• Exercise: You can usually resume all normal exercise and activities.
• Topical Treatments: You can typically restart Minoxidil (Rogaine) and any other treatments as approved by your provider.
• Itching: Some mild itching or flakiness can occur as the micro-wounds heal. Do not scratch. You can use a gentle, moisturizing conditioner or a light scalp tap to relieve it.
• Hair Coloring & Chemicals: WAIT at least 1-2 weeks after your procedure before dyeing, bleaching, perming, or using any harsh chemical treatments on your hair. Your scalp is sensitive and needs time to fully heal.
• Sun Protection: Continued sun protection is always a good idea for scalp health.
• Healthy Lifestyle: Support your treatment's success from the inside out. Focus on a balanced diet rich in vitamins and minerals, stay well-hydrated, and manage stress.
This is the most important part: Be patient. PRP is a biological process, not an instant fix.
• It's a Series: PRP is not a one-time treatment. Results are built over a series of sessions, typically 3-4 treatments spaced 4-6 weeks apart.
• Initial Shedding: Don't be alarmed if you notice some mild shedding in the first few weeks. This can be a normal part of the hair follicle's response as it prepares to enter a new growth phase.
• First Signs (2-3 Months): The first thing most patients notice is a decrease in hair shedding.
• Visible Growth (4-6 Months): You may start to see new, fine "baby hairs" and an increase in thickness.
• Full Results (6-12 Months): The most significant results are typically seen 6-12 months after starting your full series of treatments.
• Maintenance: To maintain your results, Dr. Bonato will likely recommend a "touch-up" session once every 6-12 months, or to consider exosome based daily fortification serum.
While complications are rare, it's important to be vigilant. Contact your provider's office immediately if you experience any of the following:
• Signs of Infection: Increasing pain, persistent warmth, pus or drainage from any site, or a fever.
• Excessive Bleeding: Any bleeding that is more than pinpoint droplets and does not stop with light pressure.
• Severe Pain: Pain that is not relieved by Acetaminophen (Tylenol) or is getting progressively worse instead of better.
• Allergic Reaction: Any signs of a severe rash, hives, or swelling.

VIPeel | Chemical Peel Care

• DO NOT Pick, Peel, or Pull! This is the most important rule. Picking at flaking skin before it's ready can lead to severe irritation, hyperpigmentation (dark spots), and permanent scarring. Let the skin shed on its own.
• NO Sun Exposure: Your new skin is extremely vulnerable. Avoid direct sun completely. A single bad sunburn can reverse your results and cause serious damage.
• NO Strenuous Exercise or Heat: For the first 3-5 days (or until peeling subsides), avoid any activity that causes heavy sweating. This includes strenuous workouts, saunas, steam rooms, and hot tubs. Sweat can trap moisture and heat, leading to irritation and blistering.
• NO Other Actives: Stop all other "active" skincare. Do not use retinoids (Retin-A, tretinoin), vitamin C, alpha-hydroxy acids (glycolic, lactic), or beta-hydroxy acids (salicylic acid) for at least 7-10 days after you finish peeling.
This is the typical healing timeline. Your experience may vary slightly.
Day 1: The Day of Your Peel
• Immediately After: Your skin will look "tanned," yellow, or reddish. This is the peel solution and is perfectly normal.
• The 4-Hour Rule: You must leave the peel solution on your skin for a minimum of 4 hours.
o Do not wash, touch, or apply anything to your face during this time.
o Avoid sun exposure.
• Evening (Before Bed):
1. Gently cleanse your face using the VI Derm Gentle Cleanser (or another provider-approved, mild, non-medicated cleanser) and cool water.
2. Pat your skin dry with a clean, soft towel. Do not rub.
3. Open the Post-Peel Towelette (Towelette #1) from your kit and apply it to your skin as instructed. This is a crucial step that enhances the peel. It may tingle slightly.
4. Do not apply any moisturizer on top unless you are extremely sensitive or dry. It's best to let the towelette work on its own.
Day 2: The "Calm Before the Peel"
• Morning:
1. Gently wash your face with the gentle cleanser and cool water. Pat dry.
2. Apply a thin layer of the Post-Peel Protectant (the moisturizer from your kit) or 1% Hydrocortisone cream.
3. Apply VI Derm SPF 50+ Sunscreen (or a similar broad-spectrum mineral SPF 30+).
4. You can apply makeup if you wish.
• Throughout the Day: Reapply moisturizer and SPF as needed. Your skin will feel tight and dry.
• Evening (Before Bed):
1. Gently cleanse your face. Pat dry.
2. Apply the Post-Peel Towelette (Towelette #2) from your kit.
3. (If your kit included a third towelette, you would use it here. Follow your kit's instructions.)
4. You can apply the Post-Peel Protectant or Hydrocortisone cream after 30 minutes if you feel uncomfortably dry or itchy.
Day 3: Peeling Begins!
• What to Expect: This is when the "social downtime" typically starts. You will likely see flaking and peeling, usually beginning around your mouth, nose, and chin.
• Your Job:
1. Cleanse: Continue to wash your face 2x daily (AM and PM) with the gentle cleanser and cool water.
2. Moisturize: This is your new full-time job. Apply the Post-Peel Protectant and/or 1% Hydrocortisone (for itching) generously and frequently throughout the day. Keeping the peeling skin hydrated will make it less noticeable and less tempting to pick.
3. Protect: SPF 30-50+ is mandatory. Reapply often. A wide-brimmed hat is your best friend if you must be outside.
Days 4, 5 & 6: The Peak of Peeling
• What to Expect: These are typically the heaviest peeling days. Your entire face, including the forehead and cheeks, will be shedding. You will look flaky, and your skin may be pink and sensitive underneath.
• Your Job: Repeat your Day 3 routine.
o Gentle cleansing AM and PM.
o DO NOT PICK. If you have a large piece of skin hanging, you may carefully trim it with small, sterile scissors. But do not pull.
o Moisturize, moisturize, moisturize.
o Protect with SPF.
Day 7-10: Finishing Up
• What to Expect: The peeling should be mostly finished, though you may have some residual flakiness around the hairline or jaw. Your new skin will look bright, smooth, and pink.
• Your Job:
o Continue the gentle cleanser, moisturizer, and SPF routine.
o Your skin is still sensitive. Treat it like baby skin.
o You can slowly re-introduce your normal skincare routine only after all peeling and sensitivity have completely resolved. Start with your most basic products first.
o Wait at least 10-14 days before re-introducing active ingredients like retinoids, vitamin C, or acids.
While some irritation is normal, contact your provider immediately if you experience any of the following:
• Severe or increasing pain (not just itching or stinging)
• Blistering, oozing, or crusting
• Signs of infection, such as pus, extreme redness, or heat
• Severe swelling (especially around the eyes)
• Any allergic reaction (hives, difficulty breathing)

NOUVADerm | Laser Skin Care Pre-Treatment Protocol

This is the most critical phase for preventing PIH and achieving superior results for pigmentation.
1. Topical Regimen (The "Priming Trio"):
This regimen should be started 2-6 weeks before the laser appointment.
• Tyrosinase Inhibitor (Melanin Suppressant) NOT needed in every case:
o Gold Standard: Prescription Hydroquinone 4%. Apply a pea-sized amount to the entire treatment area once or twice daily as tolerated. This actively suppresses the melanin-producing cells (melanocytes), making them less likely to overreact to the laser's thermal energy. Dr. Bonato will prescribe this if he feels it to be necessary for your specific skin type and concerns.
o Non-Hydroquinone Alternatives: For patients with hydroquinone allergies or for long-term "break" periods, we may consider agents like Cysteamine (Cyspera), Azelaic Acid 15-20%, or a high-quality Kojic Acid/Arbutin formulation.
• Retinoid (For Cellular Turnover and Collagen Stimulation):
o Prescription: Tretinoin (0.025% - 0.05%). Start application 3 nights a week, gradually increasing to nightly as tolerated. Tretinoin normalizes cell turnover, helps shed existing superficial pigment, and stimulates collagen, which complements the laser's effects on fine lines and texture. Dr. Bonato will prescribe this if he feels it to be necessary for your specific skin type and concerns.
• Sunscreen (Non-Negotiable):
o A broad-spectrum, mineral-based sunscreen with SPF 50+. Mineral sunscreens (Zinc Oxide, Titanium Dioxide) are preferred as they are generally less irritating and provide excellent physical protection. AVOID chemical based sunscreens. Must be applied every single morning, regardless of weather or indoor plans. Reapply every 2 hours if outdoors. Strict sun avoidance is mandatory.
2. Supportive Skincare Routine:
The rest of the skin routine should be simple and supportive to avoid irritation.
• Cleanser: A gentle, soap-free, hydrating cleanser.
• Moisturizer: A bland, non-comedogenic moisturizer that supports the skin barrier (e.g., containing ceramides, hyaluronic acid).
Sample Priming Routine (2-6 weeks out):
• AM: Gentle Cleanser -> Hydroquinone 4% -> Moisturizer -> SPF 50+ Mineral Sunscreen.
• PM: Gentle Cleanser -> Wait 20-30 min -> Tretinoin (pea-sized amount) -> Moisturizer.
Objective: To reduce potential inflammation and procedural risks.
• Discontinue All Exfoliants: Stop use of all other exfoliating products, including:
o Alpha-hydroxy acids (AHAs) like glycolic and lactic acid.
o Beta-hydroxy acids (BHAs) like salicylic acid.
o Physical scrubs and brushes.
• Halt Other Procedures: Cease all other professional treatments in the area, such as chemical peels, facials, microneedling, or waxing.
• Review Medications: Stop taking any medications or supplements that can increase bleeding or bruising, after consulting with their prescribing physician. This includes:
o Aspirin and NSAIDs (Ibuprofen, Naproxen)
o Fish Oil / Omega-3s
o Vitamin E
o Ginkgo Biloba, Garlic supplements
• Lifestyle: Avoid excessive alcohol and to stop smoking, as both can significantly impair healing.
Objective: To ensure the skin is calm and non-irritated on treatment day.
• Stop Active Topicals: This is the most important step in this phase. The patient should discontinue the use of their Tretinoin and Hydroquinone (if prescribed). 7 days is a standard "washout" period for retinoids to prevent over-sensitivity during the laser treatment.
• Initiate Antiviral Prophylaxis: For any patient with a history of cold sores, an antiviral medication will be prescribed. Valacyclovir 500mg twice daily, starting 1-2 days before the procedure and continuing for 5-7 days after. This prevents a laser-induced herpetic outbreak, which can lead to severe complications. Dr. Bonato will prescribe this if you have had 2 or more cold sore outbreaks in the last year.
• Simplify Skincare: The skincare routine should now be extremely basic:
o Gentle cleanser
o Simple, bland moisturizer
o SPF 50+ sunscreen
Morning Routine: Wash your face with your gentle cleanser and apply NO other products — no moisturizer, no sunscreen, and absolutely no makeup. Your clinic will cleanse and prep the skin before the procedure.
Comfort: Wear comfortable, loose-fitting clothing.
By implementing this comprehensive pre-treatment protocol, you will set the stage for a safer procedure, a smoother recovery, and ultimately, more impressive and satisfying clinical outcomes.

NOUVADerm | Post Procedure Protocol

CLEANSING: Cleanse the skin twice a day with plain, lukewarm water and a gentle cleanser, beginning the morning after the treatment. Use clean hands and gentle patting motions. DO NOT rub, scrub, or use an exfoliant or skin care sponge or brush such as a Clarisonic on the treated area.
MOISTURIZER: After treatment, keep skin moisturized by using RE|PAIR Post-Treatment Skincare Serum 2 times daily, or as needed for 7 days. In addition, post-procedure healing cream/moisturizer may be recommended by your provider. Apply moisturizer as needed throughout the day to combat dryness and flaking. After 7 days, you may continue recovery support by using the 30ml take-home D|TOX Daily Hydrating Serum for morning hydration and 30ml take-home RE|PAIR Daily Restoring Serum for daily recovery & restoration. DO NOT apply any other products that were not instructed by your provider - eg. essential oils, coconut oil, etc.
SUNSCREEN: Sunscreen is a MUST and should be used daily beginning the day after treatment and used consistently for up to 3 months post-procedure. Use a physical (mineral based) sunscreen with Broadband UVA and UVB protection and a SPF of 30 or higher. Look for SPF’s containing Zinc oxide, & titanium dioxide, and avoid any with fragrances or chemical sunscreen. Ensure to reapply during sun exposure.
DISCOMFORT: For general post-treatment discomfort, an over-the counter oral pain reliever, i.e. Extra Strength Tylenol might be prescribed by your doctor. If an anti-viral was prescribed, continue to take as directed. Avoid scratching and itching, as scarring and pigmentation complications can occur. Itching can be relieved by oral Benadryl but may cause drowsiness.
FEELING OF WARMTH: The treated area may be extremely warm (like a sunburn) and red for 1-2 hours after the treatment. You may feel this sensation for up to 12-24 hours after the treatment. Applying cold compresses may provide comfort during this time. If this persists more than 24 hours, please call the office for further evaluation.
REDNESS (ERYTHEMA): Redness is normal and expected. Redness generally persists for the first 24 hours and may last for up to 7 days depending on the intensity of the treatment. Use gentle cleansers and keep your skin moisturized and out of the sun which will allow your skin to heal and limit further damage & stress on your skin.
MENDS/MICRO CRUSTS: MENDS (microscopic epidermal necrotic debris) or Micro Crusts will appear on the 2nd or 3rd day after treatment as tiny dark spots and bronzed appearance to the treated skin. These Micro Crusts are part of the healing process where treated tissue is working its way out of your body as brand new fresh skin is regenerated. During this time, your skin will be very dry and may feel like sandpaper before flaking off. Keep your skin well moisturized with RE|PAIR Post-Treatment Skincare Serum to support the healing process. Do not pick at your skin.
o NO sun exposure. A wide-brimmed hat is recommended when outdoors.
o NO picking, scratching, or rubbing the treated skin.
o NO makeup.
o NO active ingredients like retinoids, alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), or vitamin C for 7 days post-treatment
o NO hot water, saunas, or strenuous exercise that causes sweating.
o Antioxidants: A gentle vitamin C serum can be introduced to help protect against environmental damage and further improve skin tone. Start with a lower concentration and use it in the morning under sunscreen.
o Niacinamide: This is an excellent ingredient to introduce as it helps with skin barrier function and has anti-inflammatory properties.
o Retinoids: These can typically be restarted around 4-6 weeks post-procedure, or as tolerated. Start slowly (a few times a week) and with a lower concentration to minimize irritation.
o Hydroquinone (if needed): For patients with a high risk of post-inflammatory hyperpigmentation, a hydroquinone regimen may be restarted once the skin has fully healed.
Cold compresses can be used to alleviate the feeling of warmth & swelling
Use clean pillowcase and clean towels
Use soft cloth and soft towels to avoid any scrubbing
Make-up can typically be worn once the peeling process is complete
Wear a wide-brimmed hat or protective clothing for 2 months post treatment to avoid blistering, scarring, hyperpigmentation and hypopigmentation
When showering, avoid getting shampoo directly on the treated area
Avoid strenuous exercise and sweating until after skin has healed