Care instructions

Seven days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil all increase bruising.
• Stop alcohol. It dilates blood vessels and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Three days before

• Avoid vigorous facial massage and facial treatments, including microcurrent and gua sha.

Tell us before your appointment

• Any new medications, particularly muscle relaxants and aminoglycoside antibiotics, which can potentiate the effect.
• If you are pregnant or breastfeeding. This treatment is not performed during pregnancy.
• Your previous treatment history: when, where, how many units, and anything that did not go as expected.
• For migraine: your current frequency, what you have already tried, and any previous treatment.
• For masseter: whether the goal is slimming, relief from clenching, or both. It changes placement and dosing.

The day itself

• Arrive with a clean face, nothing on the treatment area.
• Eat something beforehand. Low blood sugar makes people lightheaded.
• Bring a list of your current medications.

This window matters more than anything else afterwards.

• Stay upright. Do not lie down for four hours. This keeps the product where it was placed.
• Do not touch, rub or massage the treated areas. That includes facials, facial massage devices, and resting your face in your hands.
• No tight headband, hat or helmet over the treated area.
• No vigorous exercise for the rest of the day.
• Avoid heat. Hot showers, saunas and steam rooms.
• No alcohol for the rest of the day.

Days 1 to 3

• Mild tenderness, swelling or small bumps at the injection sites are normal and settle within 24 to 48 hours.
• Bruising can appear, particularly around the crow's feet and lower face, and resolves within 5 to 10 days. Arnica can help.
• Do not massage the area even if it feels uneven. The product is still settling.
• Gentle skincare is fine. Avoid aggressive exfoliation and actives on the area for 24 hours.
• Slight asymmetry at this stage is normal and usually resolves.

Days 3 to 14

• Results keep developing. Most people see significant change by day five to seven.
• Avoid facials, chemical peels and microneedling for two weeks.
• If at day fourteen the result is uneven, weaker than expected, or an area has not responded, contact us. Touch-ups are assessed at two weeks.

• Some jaw soreness or fatigue in the first few days is normal while the muscle adjusts.
• Avoid very hard foods for a few days if the jaw is tender.
• The slimming effect appears gradually over four to six weeks as the muscle softens, with full results at six to eight weeks. It is not immediate.
• For clenching and bruxism, a noticeable reduction in clenching and morning jaw pain is typical within two weeks.
• Results last about three months, with retreatment on a consistent three-month schedule.

• A temporary headache or mild neck soreness in the first 24 to 48 hours is common and settles on its own.
• Preventive effect builds over two to four weeks as the treatment takes full effect across all injection sites.
• Keep a simple headache diary in the weeks afterwards. It is what allows dosing to be adjusted properly at the next session.
• Full effect is typically reached by week four. Retreatment is every three months.

Seven days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil all increase bruising.
• Stop alcohol. It dilates blood vessels and increases both bruising and swelling.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Speak to the doctor who prescribed them. Contact us and we will plan around them.

Two weeks before

• No dental work. Dental procedures can introduce bacteria into the bloodstream and raise infection risk. Schedule dental work well before or well after.
• No facial waxing, threading or laser hair removal on the area.
• No chemical peels, microneedling or microcurrent.

Tell us before your appointment

• Any history of cold sores. Lip filler in particular can trigger an outbreak, and we will prescribe a preventive antiviral to take beforehand.
• Your previous filler history: what product, where, when, and anything that did not go as expected.
• Any autoimmune or connective tissue conditions.
• If you are pregnant or breastfeeding. Filler is not placed during pregnancy.
• Any allergies, particularly to lidocaine, which most hyaluronic acid fillers contain.

The day itself

• Arrive with a clean face, no makeup on the area.
• Eat something beforehand.
• If you are having lip filler and have a cold sore history, confirm you have taken the antiviral as prescribed.
• For temples, remove glasses or anything pressing on the area.

• Swelling is expected, especially with lips. Day one swelling is not your result.
• Bruising can appear, particularly around the lips, and resolves within 5 to 14 days. Arnica can help.
• Ice gently, wrapped in a cloth. Never directly on the skin.
• Keep the area elevated. Sleep on an extra pillow the first night.
• Do not touch, press or massage the area.
• Avoid heat: hot showers, saunas, steam rooms, hot yoga.
• No alcohol, no strenuous exercise, no makeup on the area.

Days 2 to 7

• Swelling starts to subside. Bruising may darken before it fades, which is normal.
• The product is still integrating. Some unevenness or firmness in this window is expected.
• Do not massage or manipulate the area.
• Gentle skincare is fine. No actives on the area for 48 hours.
• No facials, peels or laser for two weeks.

Day 14 onwards

• Swelling should be fully resolved and the result clearly visible. This is when it is assessed.
• If you have any concern about symmetry or volume at the two-week mark, contact us.
• Retinoids and actives can resume from day seven.

Lips

• Swelling peaks at 24 to 48 hours and can be significant. Your lips will look larger than the final result during that window.
• Avoid pursing, puckering or stretching the lips for 48 hours.
• Avoid very hot food and drink for 24 hours.
• If you have a cold sore history, take the antiviral as prescribed and contact us at the first sign of tingling.
• Results settle and soften over two to four weeks. Final result at four weeks.

Chin

• Mild swelling and firmness for three to five days.
• Sleep on your back the first few nights to keep pressure off it.
• Visible immediately, refines over two to four weeks.

Jaw

• Firmness and swelling along the jawline for five to seven days.
• Avoid hard or chewy food for a few days if tender.
• Definition becomes clearer as swelling resolves. Final result at three to four weeks.

Temples

• Mild swelling and tenderness for 24 to 48 hours.
• Avoid anything pressing on the temples, including sunglasses and headbands, for 48 hours.
• Visible immediately, refines over one to two weeks.

Seven days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil all increase bruising.
• Stop alcohol. It increases bruising and swelling.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Two weeks before

• No dental procedures. Dental work can introduce bacteria and raises infection risk around injected material.
• No aggressive treatments on the area, including peels, microneedling and laser.

Tell us before your appointment

• Any history of keloid or hypertrophic scarring. These treatments work by driving collagen production, which can behave unpredictably in skin prone to abnormal scarring.
• Any previous filler or biostimulator: what was used, when, and anything that did not go as expected.
• Any autoimmune or connective tissue condition.
• Any known allergy, particularly to lidocaine.
• If you are pregnant or breastfeeding. Biostimulators are not performed during pregnancy.

The day itself

• Arrive with the treatment area clean.
• Eat something beforehand.
• For Radiesse on the hands, remove rings and jewelry before you arrive.

After every Sculptra session: five minutes, five times a day, for five days.

• The massage distributes the product evenly through the tissue and substantially reduces the risk of nodules forming.
• It is not optional, and it is the main thing that determines whether the result is even.
• The technique is demonstrated before you leave the clinic.
• Set five reminders on your phone on the day of treatment. People miss sessions on day three and four, not day one.
• Massage only the areas that were treated with Sculptra. If anything else was done at the same visit, you will be told exactly which areas to leave alone.

This applies to Sculptra. Radiesse does not require it.

The first 24 to 48 hours

• Noticeable swelling and puffiness is normal. It comes from the solution the product is delivered in, not the product, and it settles within two to three days.
• Ice gently, wrapped in a cloth.
• Do not press or touch the area other than the prescribed massage.
• Avoid heat: saunas, hot showers and steam rooms.
• No strenuous exercise for 24 hours.

Days 3 to 14

• As the swelling resolves you will look close to how you looked before treatment. This is expected. It is not a sign the treatment did not work.
• Continue the massage through day five.
• Gentle skincare is fine. Avoid active treatments on the area for two weeks.
• Retinoids and other actives can resume after day seven. They support collagen production rather than interfering with it.

Hands

• Swelling and bruising for three to five days is normal. The hands can look quite puffy immediately afterwards.
• Keep hands elevated when resting for the first 24 hours.
• Wear loose gloves or keep the hands protected during any activity.
• No long baths, and no dishwashing without gloves, for 24 hours.
• Avoid strenuous hand activity for 24 hours.
• The volume improvement is visible straight away. The collagen builds over the following three to four months.

Décolletage

• Mild redness and swelling for 24 to 48 hours is normal.
• Avoid tight, abrasive or synthetic fabric over the area for 24 hours.
• SPF 50 on the chest every day from here on. This area takes more UV than people expect, and sun exposure is what undoes the result.
• The result builds over three to four months as collagen is produced.

• Collagen building starts at around four weeks. Most people notice change between four and eight weeks, in the mirror rather than in photographs.
• The full result from a three-session Sculptra series is read at six months, not before.
• Drink water consistently through the series. Sculptra performs better in well hydrated tissue.
• Daily SPF 50. UV degrades collagen, which is the entire thing you are paying to build.
• Sculptra sessions are spaced four to six weeks apart, three in the initial series, then annual maintenance.
• Radiesse is repeated every 12 to 18 months.

Seven days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil all increase bruising.
• Stop alcohol. It dilates blood vessels and increases both bruising and swelling.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Speak to the doctor who prescribed them. Contact us and we will plan around them.

Two weeks before

• No dental work. Dental procedures can introduce bacteria into the bloodstream and raise infection risk. Schedule dental work well before or well after.
• No waxing, threading or laser hair removal on the area.
• No chemical peels, microneedling or resurfacing on the area.

Tell us before your appointment

• Any allergy to lidocaine. The gel contains it.
• Your previous injectable history: what product, where, when, and anything that did not go as expected.
• Any autoimmune or connective tissue condition, and any history of keloid or hypertrophic scarring.
• If you are pregnant or breastfeeding. This is not given during either.

The day itself

• Arrive with a clean face and neck, no makeup on the area.
• Eat something beforehand.
• Allow time for numbing before the injections start.

• Small raised points at each injection site are expected. They settle over a day or two as the gel disperses.
• Redness, mild swelling and tenderness are normal. Bruising can appear and usually fades within a week.
• Do not rub, press or massage the area.
• Ice gently if it helps, wrapped in a cloth, never directly on the skin.
• Avoid heat: hot showers, saunas, steam rooms, hot yoga.
• No alcohol, no strenuous exercise, no makeup on the area.
• For the neck, avoid anything tight against it, including high collars and scarves.

Days 2 to 7

• The injection points flatten and any bruising fades, sometimes darkening before it does.
• Makeup is fine once the skin is unbroken, usually after the first day.
• Gentle skincare only. No retinoids, acids or other actives on the area for 48 hours.
• No facials, peels, microneedling or laser on the area for two weeks.
• Sunscreen daily. Recently treated skin marks more easily.

Day 14 onwards

• Actives can resume from day seven.
• Change in smoothness and hydration is usually visible by now and continues to settle.
• The result is assessed at one month, not in the first fortnight.

Three days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. These reduce platelet activity and directly undermine the treatment. This is the most important instruction on this page.
• Stop alcohol. It affects platelet function and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Tell us before your appointment

• Any clotting disorder or platelet condition.
• Any history of blood cancer, or any active cancer. PRP is not performed in either case.
• Any active infection, rash or open wound in the treatment area.
• Your current medications, particularly corticosteroids and immunosuppressants, which affect platelet function and healing.
• For scalp treatment, any scalp condition such as psoriasis, seborrheic dermatitis or a fungal infection. These are treated first.
• If you are pregnant or breastfeeding.
• Any known allergies.

The day itself

• Drink water and eat something. Hydration measurably affects the quality of the plasma drawn.
• Arrive with the treatment area clean and no products on it.
• For scalp treatment, wash your hair that morning with a gentle shampoo and use no styling product.
• Wear something comfortable. A button-front top is easier for facial treatment.

• No anti-inflammatories for three days. No ibuprofen, no naproxen. The inflammatory response after treatment is part of how PRP works, and suppressing it reduces the result. If you need something for discomfort, ask us what to take instead.
• No ice directly on the skin. It constricts vessels and dampens the same response. A gentle cool compress is fine if swelling is marked.
• Swelling, redness and small bumps at the injection sites are normal, particularly under the eye and on the scalp.
• Do not touch, rub or massage the injection sites.
• No vigorous exercise for 24 hours.
• Avoid heat: saunas, steam rooms and very hot showers.
• No alcohol for 24 hours.
• Gentle skincare is fine on the face from the evening: cleanser and a fragrance-free moisturizer. SPF 50 the next morning.

Days 2 to 7

• Bruising may appear, most of all under the eye. Swelling at the injection sites starts to settle.
• No retinoids, acids or active ingredients on the treated area for five days.
• No facials, peels or laser on the area for two weeks.
• Continue gentle skincare and daily SPF 50.

Day 7 onwards

• Reintroduce retinoids and actives gradually, every other night for the first week.
• On the face, a temporary worsening of fine lines or texture in the first week or two is normal while the tissue remodels.
• Keep up daily SPF 50. It protects the collagen you are building.
• Most people see change at four to six weeks. The result from a full series is read at three to six months.

Three days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. These reduce platelet activity and directly undermine the treatment. This is the most important instruction on this page.
• Stop alcohol. It affects platelet function and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Tell us before your appointment

• Any clotting disorder or platelet condition.
• Any history of blood cancer, or any active cancer. PRP is not performed in either case.
• Any active infection, rash or open wound in the treatment area.
• Your current medications, particularly corticosteroids and immunosuppressants, which affect platelet function and healing.
• For scalp treatment, any scalp condition such as psoriasis, seborrheic dermatitis or a fungal infection. These are treated first.
• If you are pregnant or breastfeeding.
• Any known allergies.

The day itself

• Drink water and eat something. Hydration measurably affects the quality of the plasma drawn.
• Arrive with the treatment area clean and no products on it.
• For scalp treatment, wash your hair that morning with a gentle shampoo and use no styling product.
• Wear something comfortable. A button-front top is easier for facial treatment.

• No anti-inflammatories for three days. No ibuprofen, no naproxen. The inflammatory response after treatment is part of how PRP works, and suppressing it reduces the result. If you need something for discomfort, ask us what to take instead.
• No ice directly on the skin. It constricts vessels and dampens the same response. A gentle cool compress is fine if swelling is marked.
• Swelling, redness and small bumps at the injection sites are normal, particularly under the eye and on the scalp.
• Do not touch, rub or massage the injection sites.
• No vigorous exercise for 24 hours.
• Avoid heat: saunas, steam rooms and very hot showers.
• No alcohol for 24 hours.
• Gentle skincare is fine on the face from the evening: cleanser and a fragrance-free moisturizer. SPF 50 the next morning.

This area needs more care than the rest of the face, and the recovery is longer.

• Bruising can be significant and can take 10 to 14 days to clear. The skin here is the thinnest on the body. Plan around anything important.
• Marked swelling in the first 24 to 48 hours is normal. Sleep with your head raised on an extra pillow.
• Do not rub the area, even if it feels itchy.
• Arnica gel applied gently can speed bruising along.
• Wear sunglasses outdoors while any bruising is present. Sun on bruised tissue can darken it temporarily.
• Results, meaning better hydration, less hollowing and a brighter look, are typically visible at four to six weeks.

Days 2 to 7

• Bruising may appear, most of all under the eye. Swelling at the injection sites starts to settle.
• No retinoids, acids or active ingredients on the treated area for five days.
• No facials, peels or laser on the area for two weeks.
• Continue gentle skincare and daily SPF 50.

Day 7 onwards

• Reintroduce retinoids and actives gradually, every other night for the first week.
• On the face, a temporary worsening of fine lines or texture in the first week or two is normal while the tissue remodels.
• Keep up daily SPF 50. It protects the collagen you are building.
• Most people see change at four to six weeks. The result from a full series is read at three to six months.

Three days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. These reduce platelet activity and directly undermine the treatment. This is the most important instruction on this page.
• Stop alcohol. It affects platelet function and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Tell us before your appointment

• Any clotting disorder or platelet condition.
• Any history of blood cancer, or any active cancer. PRP is not performed in either case.
• Any active infection, rash or open wound in the treatment area.
• Your current medications, particularly corticosteroids and immunosuppressants, which affect platelet function and healing.
• For scalp treatment, any scalp condition such as psoriasis, seborrheic dermatitis or a fungal infection. These are treated first.
• If you are pregnant or breastfeeding.
• Any known allergies.

The day itself

• Drink water and eat something. Hydration measurably affects the quality of the plasma drawn.
• Arrive with the treatment area clean and no products on it.
• For scalp treatment, wash your hair that morning with a gentle shampoo and use no styling product.
• Wear something comfortable. A button-front top is easier for facial treatment.

• No anti-inflammatories for three days. No ibuprofen, no naproxen. The inflammatory response after treatment is part of how PRP works, and suppressing it reduces the result. If you need something for discomfort, ask us what to take instead.
• No ice directly on the skin. It constricts vessels and dampens the same response. A gentle cool compress is fine if swelling is marked.
• Swelling, redness and small bumps at the injection sites are normal, particularly under the eye and on the scalp.
• Do not touch, rub or massage the injection sites.
• No vigorous exercise for 24 hours.
• Avoid heat: saunas, steam rooms and very hot showers.
• No alcohol for 24 hours.
• Gentle skincare is fine on the face from the evening: cleanser and a fragrance-free moisturizer. SPF 50 the next morning.

• Do not wash your hair for 24 hours. The growth factors need that time to absorb.
• Tenderness, tightness or itching for 24 to 48 hours is normal.
• After 24 hours, wash with a gentle sulfate-free shampoo. No vigorous scalp massage and no scratching.
• No styling product, dry shampoo or hair treatment for 48 hours.
• Avoid heat on the scalp for 48 hours: hot hair dryers, hot yoga, saunas.
• Shedding may increase for the first two to four weeks. This is a normal hair cycle response, not a sign of failure.
• New growth typically begins to appear at three to six months.
• Three to four sessions four weeks apart, then maintenance every three to six months.

Three days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. These reduce platelet activity and directly undermine the treatment. This is the most important instruction on this page.
• Stop alcohol. It affects platelet function and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Tell us before your appointment

• Any clotting disorder or platelet condition.
• Any history of blood cancer, or any active cancer. PRP is not performed in either case.
• Any active infection, rash or open wound in the treatment area.
• Your current medications, particularly corticosteroids and immunosuppressants, which affect platelet function and healing.
• For scalp treatment, any scalp condition such as psoriasis, seborrheic dermatitis or a fungal infection. These are treated first.
• If you are pregnant or breastfeeding.
• Any known allergies.

The day itself

• Drink water and eat something. Hydration measurably affects the quality of the plasma drawn.
• Arrive with the treatment area clean and no products on it.
• For scalp treatment, wash your hair that morning with a gentle shampoo and use no styling product.
• Wear something comfortable. A button-front top is easier for facial treatment.

• No anti-inflammatories for three days. No ibuprofen, no naproxen. The inflammatory response after treatment is part of how PRP works, and suppressing it reduces the result. If you need something for discomfort, ask us what to take instead.
• No ice directly on the skin. It constricts vessels and dampens the same response. A gentle cool compress is fine if swelling is marked.
• Swelling, redness and small bumps at the injection sites are normal, particularly under the eye and on the scalp.
• Do not touch, rub or massage the injection sites.
• No vigorous exercise for 24 hours.
• Avoid heat: saunas, steam rooms and very hot showers.
• No alcohol for 24 hours.
• Gentle skincare is fine on the face from the evening: cleanser and a fragrance-free moisturizer. SPF 50 the next morning.

Days 2 to 7

• Bruising may appear, most of all under the eye. Swelling at the injection sites starts to settle.
• No retinoids, acids or active ingredients on the treated area for five days.
• No facials, peels or laser on the area for two weeks.
• Continue gentle skincare and daily SPF 50.

Day 7 onwards

• Reintroduce retinoids and actives gradually, every other night for the first week.
• On the face, a temporary worsening of fine lines or texture in the first week or two is normal while the tissue remodels.
• Keep up daily SPF 50. It protects the collagen you are building.
• Most people see change at four to six weeks. The result from a full series is read at three to six months.

Two weeks before each session

• Stop all retinoids. Tretinoin, retinol, retinaldehyde, adapalene. Any vitamin A derivative increases photosensitivity and raises the risk of a reaction.
• Stop hydroquinone and kojic acid. Both are photosensitizing and can interfere with even treatment results.
• Stop exfoliating acids. AHAs such as glycolic and lactic, BHAs such as salicylic. These thin the skin barrier.

Four weeks before the first session, and throughout the course

• No tanning of any kind, including sun, beds and self-tanner. Uneven tone leads to uneven treatment, and for Fitzpatrick IV to VI a tan raises the risk of post-inflammatory hyperpigmentation considerably.
• No waxing or laser hair removal on the area being treated.

Start now if you have not already

• SPF 50 every morning, rain or shine. This is not negotiable before laser. It pre-conditions the skin and reduces the risk of pigmentation afterwards, particularly for Fitzpatrick III to VI.

Tell us before your appointment

• Any new medications, especially antibiotics. Doxycycline and minocycline are photosensitizing.
• Any cosmetic treatment in the last two weeks, including peels, microneedling or facials.
• If you are pregnant or breastfeeding. This treatment is not performed during pregnancy.
• Any history of cold sores. We may prescribe a preventive antiviral before facial treatment.

The day itself

• Arrive with clean skin and nothing on the treatment area. No moisturizer, SPF or makeup.
• Skip caffeine that morning if you flush easily.

• Expect mild to moderate redness, warmth and slight swelling. This usually peaks around four to six hours afterwards and then settles.
• Moisturize as soon as you get home, with something gentle and fragrance-free. Keep the skin hydrated.
• SPF 50 the next morning and every morning after. Sun exposure without protection is the single biggest cause of pigmentation after laser in Fitzpatrick III to VI.
• Avoid heat. Hot showers, saunas, steam rooms and hard exercise all increase inflammation and can worsen redness.
• No makeup on the treated area for 24 hours.
• No retinoids or acids for five days.

• Redness should be visibly improving by day two or three.
• Treated spots may darken before they fade. This is called peppering and it is a sign the treatment is working, not a problem.
• Those darkened spots shed on their own over 7 to 14 days. Do not pick, scratch or exfoliate them.
• Gentle moisturizer morning and evening. SPF 50 every morning without exception.
• By day seven the skin should look and feel close to normal, with pigmentation starting to fade.

• Resume retinoids and actives after day seven. Between sessions they improve the result rather than interfere with it.
• Continue SPF 50 daily throughout the course and afterwards. It is the most effective thing you can do to protect the result.
• Avoid sun exposure on the treated area. Even brief unprotected exposure during a course can undo progress on pigmentation.
• Avoid other lasers, peels or microneedling between sessions unless we have discussed it.

Skin of color responds well to this laser. It is designed for deeper tones, and the 650-microsecond pulse makes it meaningfully safer than other systems for Fitzpatrick III to VI. What matters more here than in any other patient group is the preparation. The work done before a session largely determines the outcome.

Four weeks before the first session

• Calm the barrier first. Inflamed or compromised skin going into laser treatment raises the risk of pigmentation afterwards. Switch to bland, fragrance-free moisturizers with ceramides, use a gentle non-stripping cleanser, and stop irritating acids and retinoids early. No scrubs, exfoliating devices or anything creating friction.
• Consider a tyrosinase inhibitor. Starting one two to four weeks before treatment primes pigment cells to resist overproducing in response to heat. This is among the highest-yield things a Fitzpatrick IV to VI patient can do. Options include hydroquinone, cysteamine, azelaic acid, tranexamic acid, kojic acid and arbutin. Which one depends on your skin and sensitivity, and it is a prescription decision made at consultation.
• SPF 50 starting now, not after. For deeper tones this is pre-conditioning rather than aftercare. Ultraviolet exposure in the weeks before treatment raises background pigment activity and increases risk during the course.
• Antiviral cover if you have any history of cold sores. In deeper skin an outbreak can trigger pigmentation out of proportion to the outbreak itself, and it is preventable.

How treatment is adapted

• Lower energy settings to begin with, adjusted as we see how your skin responds across the course.
• Conservative endpoints. The goal is the right amount of stimulation, not the maximum.
• Longer gaps between sessions, at least five to six weeks for Fitzpatrick V and VI, so inflammation resolves completely before retreating.

Afterwards

• SPF 50 every single morning. The most important instruction on this page.
• Do not pick at darkened spots. Removing them early breaks the barrier and raises pigmentation risk sharply.
• Resume your tyrosinase inhibitor at day seven to hold the gains and prevent rebound between sessions.
• Tell us if you see new darkening after day seven. It may mean adjusting the topical, lengthening the interval or lowering the energy. Caught early, this is very manageable.

Treating pigment from more than one direction

For deeper skin tones targeting hyperpigmentation, the laser is one layer rather than the whole plan. The second is topical: a tyrosinase inhibitor slowing new pigment production at skin level, preventing recurrence and protecting the result between sessions. Daily SPF 50 ties the layers together, because without it ultraviolet exposure continuously re-triggers pigment production and undermines everything else at once.

How the layers are timed and sequenced is decided at consultation, based on your imaging, your history and what you are already using.

XERF has the lightest pre-treatment requirements on the menu. No numbing, no needles, and nothing to stop beforehand.

Tell us before your appointment

• Any metal implants, surgical hardware, pacemaker or implanted electronic device. Radiofrequency energy cannot be used over or near these.
• Any filler or implants in the area, so treatment can be mapped around them.
• If you are pregnant or breastfeeding. This treatment is not performed during pregnancy.
• Any active skin infection, open wound or significant rash on the area.
• Recent significant weight loss, including on GLP-1 medication. It changes what to expect.
• Any previous radiofrequency, ultrasound tightening or surgical lifting.

Hydration

Radiofrequency heats the skin by driving current through the water in your tissue, so how hydrated you are changes how evenly that energy spreads. Arriving well hydrated rather than dry is worth the attention.

• Drink normally and steadily over the days before, rather than loading up on the morning of. Tissue hydration builds over days, and a glass on the way in does not undo a dry week.
• Skip alcohol the night before. It is the most common reason skin arrives dry.
• Heavy caffeine the morning of has a similar effect. Your usual coffee is fine.
• If you have been given a fluid restriction, follow it. Tell us and we will work around it. Heart, kidney and liver conditions are the common reasons, and the restriction takes priority over anything on this page.

The day itself

• Clean skin on the area, no thick creams, oils or makeup.
• Loose comfortable clothing, particularly for body treatment.

• Mild redness and warmth immediately afterwards is expected and settles within a few hours.
• Avoid intense heat for the rest of the day: saunas, steam rooms, very hot showers.
• Avoid vigorous exercise for the rest of the day.
• Gentle fragrance-free moisturizer. SPF 50 if you are going outside.
• Normal skincare is fine from that evening. There are no restrictions on retinoids or actives after XERF.

• Skin should look and feel close to normal by day one or two, though some warmth and slight sensitivity can persist.
• Some people notice a subtle tightening sensation in the first week. That is the initial collagen response beginning.
• Resume all normal activity, including exercise, from day two.
• Continue daily SPF 50. It protects collagen and sustains the result.
• No conflict with other treatments. XERF has no post-treatment window that rules out other services.

• Results build gradually as new collagen is produced and existing collagen contracts.
• Most people notice tightening and firmness at four to eight weeks.
• Full results from a series of three to four sessions are typically visible at three to six months.
• Continue daily SPF 50 throughout. Ultraviolet damage degrades collagen and undermines the result over time.
• Annual maintenance sustains it as aging continues.

Body areas

• Mild redness and warmth for a few hours.
• Loose clothing for the rest of the day.
• Normal exercise from day two.
• Firmness and texture improvement at four to eight weeks, full results at three to six months.

XERF is among the most skin-tone-agnostic treatments available. Radiofrequency energy is not absorbed by melanin, so there is no mechanism here equivalent to the pigmentation risk that exists with laser and peel treatments.

• No extended pre-conditioning is required specifically for XERF, at any Fitzpatrick type.
• If you are also in a laser or microneedling series, the preparation protocol for those treatments still applies. XERF does not affect or override it.

Five days before

• Stop all retinoids. Tretinoin, retinol, retinaldehyde, adapalene. They thin the barrier and raise irritation risk during needling.
• Stop exfoliating acids. AHAs such as glycolic and lactic, BHAs such as salicylic. No exfoliating toners, serums or masks.
• Stop benzoyl peroxide.

Three days before, for PRP

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil reduce platelet activity, which directly undermines PRP. This matters more here than for any other treatment.
• Do not stop prescribed blood thinners or anticoagulants. Speak to the doctor who prescribed them and contact us so we can plan around them.

Two weeks before

• No waxing, threading, laser hair removal or dermaplaning on the area.
• No peels, laser or other microneedling.

Tell us before your appointment

• Any active breakout, open wound, rash or skin infection on the area. Microneedling is not performed over active inflammation or broken skin.
• Any history of keloid or hypertrophic scarring.
• Any clotting or platelet condition, for PRP.
• If you are pregnant or breastfeeding. This treatment is not performed during pregnancy.
• Recent sun exposure or an active tan, which raises sensitivity and pigmentation risk.
• Current medications, particularly immunosuppressants or corticosteroids, which affect healing.
• Any history of cold sores. A preventive antiviral will be prescribed. In deeper skin an outbreak after needling can cause pigmentation out of proportion to the outbreak itself.

The day itself

• Clean, product-free skin. No moisturizer, SPF or makeup on the area.
• Eat beforehand, particularly for PRP, since blood is drawn first.
• Be well hydrated. It improves PRP quality and supports healing.

The micro-channels created by needling are open. That is why the infusion works, and it is also why what touches your skin in this window matters more than usual.

• Redness and warmth are normal. Expect it to look like a mild to moderate sunburn.
• Apply nothing except what we have given you or approved for the first 24 hours.
• Do not touch, rub or press the skin.
• No exercise or anything that makes you sweat for 24 hours. Sweat introduces bacteria into open channels.
• No makeup for 24 hours, 48 preferred.
• Avoid heat: hot showers, saunas, steam rooms, hot yoga.
• Avoid direct sun. In the first 24 hours a hat or scarf is better than putting SPF over open channels.
• Sleep on a clean pillowcase. Bacteria on fabric cause breakouts when the channels are open.

Days 2 to 3

• Redness begins to subside. Mild peeling or flaking is normal as the skin regenerates.
• A gentle fragrance-free moisturizer is now safe, morning and evening.
• SPF 50 every morning from day two. Essential for protecting new skin and preventing pigmentation.
• Small breakouts in the days afterwards are a normal purging response and resolve on their own.
• No retinoids, acids or actives.

Days 4 to 7

• Skin should feel close to normal by day four or five.
• Normal gentle skincare resumes. No actives until day seven.
• From day seven, reintroduce retinoids and actives gradually, every other night for the first week. They enhance collagen remodeling and complement the treatment.
• No facials, peels or laser for two weeks.

Weeks 2 to 12

• Collagen remodeling continues. Results build over weeks and months.
• Most people see texture and pore improvement at four to six weeks. Acne scarring generally needs a series of three before the change is clear.
• Daily SPF 50 throughout the series and afterwards.

PRP

Platelet-rich plasma concentrates your own growth factors from a small blood draw. Because it comes from your own blood, allergic reaction is not possible.

• The healing response is more robust than serum, so expect slightly more redness and warmth in the first 24 hours.
• Avoid anti-inflammatories for three days afterwards as well. They blunt the inflammatory response PRP relies on to stimulate collagen.
• Stay well hydrated in the days after.
• Initial glow at one to two weeks. Texture and collagen change at four to eight weeks. Full results from a series of three at three to six months.

Serums

Serum infusion targets a specific concern. Which one is chosen depends on what we are treating.

• Hyaluronic acid for hydration, plumping and barrier support.
• Vitamin C for brightening, antioxidant protection and collagen support.
• Growth factor serums for collagen and elastin stimulation.
• Brightening serums with niacinamide, kojic acid or tranexamic acid, for uneven tone and post-inflammatory darkening.

• Recovery is similar to or milder than PRP.
• Immediate glow from hydrating serums. Brightening and texture at two to four weeks. Full results from a series at six to eight weeks.
• Reactions are rare. If you get unusual burning, itching or a rash after the initial redness has settled, contact us.

For deeper skin tones the single biggest factor in the outcome is not the treatment, it is what happens before it. Inflammation going into the session is the main driver of pigmentation afterwards. The goal is calm, well-prepared skin on the day.

Four weeks before the first session

• Calm the barrier first. Bland fragrance-free moisturizers with ceramides and niacinamide, a gentle non-stripping cleanser, no scrubs or exfoliating devices. Stop acids and retinoids early, two weeks out rather than five days.
• Consider a tyrosinase inhibitor. Starting two to four weeks beforehand primes the skin to resist pigmentation afterwards, and it is the highest-yield preparation for Fitzpatrick IV to VI. Options include hydroquinone, cysteamine, azelaic acid, tranexamic acid, kojic acid and arbutin. Which one is a prescription decision made at consultation.
• A low-inflammation preparatory treatment before the first session improves the starting point without adding inflammatory burden. A hydrating facial, a calming enzyme facial, red light therapy or an oxygen facial.
• Active acne is treated first. Needling through inflamed acne markedly worsens pigmentation in deeper skin. Options include the Aerolase in acne mode, a gentle mandelic or lactic acid peel, or topical treatment.
• Antiviral cover if you have any cold sore history.

How treatment is adapted

• Shallower initial depth, adjusted as we see how your skin responds.
• Fewer passes. The goal is stimulation, not maximum trauma.
• No chasing pinpoint bleeding. Bleeding as an endpoint indicates more inflammation than is needed and raises pigmentation risk.
• Longer intervals, at least six weeks between sessions for Fitzpatrick V and VI, so healing and inflammation resolve completely.

Five to seven days before

• Stop all retinoids. Tretinoin, retinol, retinaldehyde, adapalene. These thin the barrier and raise peel sensitivity.
• Stop all exfoliating acids. Glycolic, lactic, salicylic and PHA, including toners, serums and masks.
• Stop benzoyl peroxide.

Two weeks before

• No waxing, threading, laser hair removal or dermaplaning on the treatment area.
• No other peels, microneedling or laser treatment.

Tell us before your appointment

• Any history of cold sores. A peel can trigger an outbreak, and a preventive antiviral is prescribed beforehand.
• Any isotretinoin in the last twelve months. A peel is not performed within that window.
• Any recent sun exposure or an active tan. Peeling tanned skin markedly raises the risk of pigmentation, and the appointment is better rescheduled.
• If you are pregnant or breastfeeding. Peels are not performed during pregnancy.
• Any known allergy, particularly to salicylic acid or retinoic acid.
• Your current skincare routine, so anything else that needs pausing can be identified.

The day itself

• Arrive with clean, product-free skin. No moisturizer, no SPF, no makeup.
• Skip caffeine that morning if you flush easily.
• Wear a button-front top so nothing has to come over your face afterwards.

For Fitzpatrick III and above, preparation starts about four weeks before the peel. Arriving with calm, well conditioned skin is what decides both how well the peel works and how safely it heals.

Calm the barrier first

• Switch to bland, fragrance-free moisturizers. Ceramides and gentle humectants.
• Use a gentle, non-stripping cleanser only.
• Stop retinoids and exfoliating acids two weeks before rather than the standard five to seven days, so the barrier has longer to recover.
• No scrubs, exfoliating devices, or anything that creates friction or inflammation.

Slow melanin production before the peel

• Starting a melanin-inhibiting topical two to four weeks beforehand primes the skin to resist pigmentation through the inflammatory phase. It is one of the highest yield things available for Fitzpatrick IV to VI.
• Which agent depends on your skin and is chosen at consultation. Options include hydroquinone, cysteamine, azelaic acid, topical or oral tranexamic acid, and gentler choices such as kojic acid or arbutin.

SPF 50 from four weeks out

• Not just afterwards. UV exposure in the weeks before a peel raises background melanin activity and increases the risk during the peeling window.

Settle the skin before you start

• For a first peel, or particularly reactive skin, a calming treatment one to two weeks beforehand lowers the starting level of inflammation. A Hydrafacial beforehand is one option for that.
• Any active inflammatory acne is treated first. Peeling over inflamed acne is one of the most reliable ways to produce pigmentation in deeper skin.
• Any history of cold sores means a preventive antiviral. An outbreak during healing can leave pigmentation far out of proportion to the flare.

The peel stays on after you leave and keeps working. You remove it at home, at the time you are given in the clinic, usually four to six hours later.

• Do not wash it off early. Leave it on for the full time. Early removal shortens the treatment.
• Do not touch, rub or pick at the skin.
• Do not exercise or do anything that makes you sweat. Sweat can make the peel work unevenly.
• Put nothing on your skin until after the peel is washed off.
• When it is time, use cool or lukewarm water and a gentle fragrance-free cleanser. Pat dry, do not rub.
• Then apply the post-peel protectant from your kit. It is formulated for the barrier at this stage.

Pink, red and tight-feeling skin at this point is expected.

Days 1 to 2, before anything visible happens

• Skin looks pink, feels tight and may be sensitive. Normal.
• Peeling has not started yet. Do not try to speed it up.
• Apply the post-peel protectant morning and evening.
• SPF 50 every morning without exception, even indoors. UV during the peel process sharply raises the risk of pigmentation, most of all in Fitzpatrick III to VI.
• No retinoids, no acids, no actives.
• No makeup for the first 24 hours. Mineral makeup is fine after that.

Days 3 to 5, the visible phase

• Peeling begins, usually around the mouth and chin, then spreads. It looks worse before it looks better, and that is the treatment working.
• Do not pick or pull at peeling skin. This is the most important instruction of the whole protocol. Removing skin before it is ready breaks the barrier and raises the risk of scarring and pigmentation, particularly in Fitzpatrick IV to VI.
• Apply the protectant generously. It makes the flaking more manageable and keeps the barrier covered.
• SPF 50 every single morning.
• Plan around this window socially rather than hoping it passes quickly.
• No facial treatments, no exfoliants, no actives.
• Drink water. Hydration helps the shedding process.

Days 6 to 7

• Peeling should be mostly or fully finished by the end of day seven. The new skin looks brighter and more even.
• Some dryness or mild sensitivity can linger. Keep using the protectant until it settles.
• SPF 50 stays essential. New skin is especially vulnerable to UV.
• Do not restart retinoids or actives before day seven, and only if the skin feels fully healed.

Day 7 onwards

• Reintroduce retinoids and actives gradually, every other night for the first week back.
• If you were using a melanin-inhibiting topical before the peel, resume it at day seven. This is what holds the result and prevents pigment rebounding.
• Avoid direct sun on the treated area for at least four weeks. Outdoors, SPF 50 plus a hat.
• Daily SPF 50 from here on is not aftercare, it is what protects the result long term.
• In a series, the next session is scheduled four to six weeks after peeling finishes, and six weeks minimum for Fitzpatrick V and VI.

There is genuinely very little to do for this one.

Three to five days before

• Stop retinoids. Tretinoin, retinol, retinaldehyde. They raise sensitivity and make the treatment more irritating than it needs to be.
• Stop high-strength exfoliating acids. Strong AHAs and BHAs. Gentle toners are fine to continue.

Tell us before your appointment

• Any active inflammatory acne, open wound, rash or skin infection on the area. A Hydrafacial cannot be performed over broken skin or significant inflammation.
• Any laser, peel or microneedling in the last two weeks.
• Any allergy or sensitivity, particularly to salicylic acid, which is used in the clarifying step.
• If you are pregnant. Some boosters are not used during pregnancy and the protocol is adjusted.
• Any active rosacea flare. Settings are adjusted and a calming booster is used.

The day itself

• Arrive with a clean face. No makeup, no heavy moisturizer, no SPF.
• Nothing else.

1. Cleanse and exfoliate

A vortex tip lifts surface dead cells and sebum, using a mild glycolic and salicylic blend that is far gentler than a standalone peel. Most people feel a light tingle or nothing.

2. Extract

Vacuum suction clears congestion, blackheads and debris from the pores. This is the step you feel, a pulling sensation strongest around the nose. It is not painful.

3. Hydrate

Hyaluronic acid, peptides and antioxidants are infused under light pressure into skin that has just been cleared, which is when it absorbs best.

4. Boost

A targeted booster chosen for your skin. Brightening where pigmentation is a concern, or calming peptides and growth factors for reactive skin and rosacea.

Your pores have just been cleared. The aim for the rest of the day is to keep them that way.

• No heavy makeup. Mineral makeup is fine if you need something.
• No vigorous exercise. Sweat over freshly cleared pores is a reliable way to cause breakouts.
• Avoid heat. Saunas, steam rooms and very hot showers.
• SPF 50 if you are going outside, which applies always but particularly now.
• This is the best window of the month for a good serum. Skin absorbs more right after treatment than at any other time.

• Back to your normal routine from the next morning. Cleanser, moisturizer, SPF.
• If you stopped retinoids before the appointment, restart them after three days.
• SPF 50 every morning.
• A mild purge is common. Small breakouts in the days after extraction are congestion coming to the surface. It is temporary and resolves on its own within about a week.
• As maintenance, sessions every four to six weeks hold the result.

Three days before

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. These reduce platelet activity and directly undermine the treatment. This is the most important instruction on this page.
• Stop alcohol. It affects platelet function and increases bruising.
• Stop high-dose vitamin C above 1,000 mg a day.
• Do not stop prescribed blood thinners or anticoagulants such as aspirin taken for cardiac reasons, apixaban, rivaroxaban, warfarin or clopidogrel. Do not stop any of these without speaking to the doctor who prescribed them. Contact us instead and we will plan around them.

Tell us before your appointment

• Any clotting disorder or platelet condition.
• Any history of blood cancer, or any active cancer. PRP is not performed in either case.
• Any active infection, rash or open wound in the treatment area.
• Your current medications, particularly corticosteroids and immunosuppressants, which affect platelet function and healing.
• For scalp treatment, any scalp condition such as psoriasis, seborrheic dermatitis or a fungal infection. These are treated first.
• If you are pregnant or breastfeeding.
• Any known allergies.

The day itself

• Drink water and eat something. Hydration measurably affects the quality of the plasma drawn.
• Arrive with the treatment area clean and no products on it.
• For scalp treatment, wash your hair that morning with a gentle shampoo and use no styling product.
• Wear something comfortable. A button-front top is easier for facial treatment.

• No anti-inflammatories for three days. No ibuprofen, no naproxen. The inflammatory response after treatment is part of how PRP works, and suppressing it reduces the result. If you need something for discomfort, ask us what to take instead.
• No ice directly on the skin. It constricts vessels and dampens the same response. A gentle cool compress is fine if swelling is marked.
• Swelling, redness and small bumps at the injection sites are normal, particularly under the eye and on the scalp.
• Do not touch, rub or massage the injection sites.
• No vigorous exercise for 24 hours.
• Avoid heat: saunas, steam rooms and very hot showers.
• No alcohol for 24 hours.
• Gentle skincare is fine on the face from the evening: cleanser and a fragrance-free moisturizer. SPF 50 the next morning.

What we check

• Your full medical history, with particular attention to thyroid cancer in the family, pancreatitis, gallbladder disease, gastrointestinal conditions and any history of an eating disorder.
• Every medication and supplement you take. Several interact with how a GLP-1 affects you, and diabetes medication in particular usually needs adjusting.
• Whether you are pregnant, breastfeeding or planning a pregnancy.
• What you have already tried, including any GLP-1, at what dose, and how you tolerated it.

Baseline labs

• Comprehensive metabolic panel, including kidney and liver function.
• A1c, which tells us where glucose has been sitting over months rather than on the day.
• A lipid panel.
• Thyroid function.
• Anything else your history calls for.

Bring to your first visit

• A list of your current medications and doses.
• Any recent lab work you already have.
• Your insurance information, so coverage can be checked before you are surprised at the pharmacy.

Dosing starts low deliberately. The starting dose is not a treatment dose, it is there to let your body adjust, and going up faster than the schedule is the usual reason people have a bad time.

What is common

• Nausea, usually strongest in the day or two after a dose and after each increase.
• Reflux and early fullness. Food sits longer than you are used to.
• Constipation. Very common, and easier to prevent than to fix. Water and fiber from the start.
• Fatigue, often tied to eating far less than you did.

What helps

• Smaller meals, eaten slowly, and stopping at the first sign of fullness rather than pushing through it.
• Keeping fluid up. Dehydration makes almost every side effect worse.
• Staying at a dose longer rather than moving up on schedule if you are struggling. Tell us instead of quietly enduring it.

Tell us if

• You cannot keep fluids down.
• Nausea is not settling between doses.
• You are losing weight faster than about one to two percent of your body weight a week.

Appetite falls, which is the point. What you do with the smaller amount you eat is what determines how you feel and what you lose.

• Protein first at every meal. When total intake drops, protein is the thing most likely to fall short.
• Eat slowly and stop when full. Fullness arrives sooner and more suddenly than you are used to, and eating past it is what causes most of the nausea people report.
• Fluid throughout the day. Thirst signals get quieter along with hunger, and dehydration is behind a lot of the fatigue, headaches and constipation.
• Fiber daily. Constipation is easier to prevent than to treat.
• Go easy on very fatty and very large meals, particularly in the first day or two after a dose. They sit heavily.
• Alcohol hits differently. Less food, slower stomach emptying, and many people find their tolerance has changed.

Fat is lost from the face along with everywhere else. Nobody chooses where it comes off, and the face is where it shows first.

• What changes: temples flatten, cheeks lose fullness, the midface loses the support the skin above was resting on, and the lower face can start to look heavier by comparison.
• When: usually once meaningful weight has come off, so months rather than weeks.
• It is assessed at your follow-up visits rather than left for you to notice in a photograph.
• If it needs treating, the useful approach is rebuilding structure rather than filling the hollow that shows. Collagen stimulation works on the underlying support, and it takes months, which is why raising it early matters.
• Timing matters. Treating while weight is still changing quickly means treating a moving target. When in the course of your weight loss to do anything is part of the conversation.

• These medications work while they are taken. Appetite returns when they stop, and for most people so does weight. Plan for this rather than being surprised by it.
• Labs are repeated on a schedule. The point is whether the metabolic picture is improving, not only what the scale says.
• Maintenance dosing is a real option once you reach a weight you want to hold, and it is not always the highest dose.
• If you need to pause, for surgery, for pregnancy planning, or for cost, tell us and we will plan it. Stopping abruptly and restarting at your old dose is not safe.
• Before any procedure requiring sedation or general anesthesia, tell the anesthesia team you are on a GLP-1. These medications slow stomach emptying and that changes fasting instructions.

Before a PRP appointment, three days ahead

• Stop over-the-counter anti-inflammatories. Ibuprofen, naproxen, fish oil, vitamin E and flaxseed oil. They reduce platelet activity and work against the treatment.
• Stop alcohol. It affects platelet function and increases bruising.
• Do not stop prescribed blood thinners or anticoagulants. Contact us instead so treatment can be planned around them.
• Hydrate and eat before you come. Hydration affects the quality of the plasma drawn.

Before botulinum toxin, seven days ahead

• Stop over-the-counter anti-inflammatories, fish oil, vitamin E and high-dose vitamin C, all of which increase bruising.
• Stop alcohol.

Tell us before your appointment

• Every medication you take, including anything for erectile function, blood pressure or mood, and any nitrate. Nitrates matter.
• Any bleeding or clotting disorder.
• Any neuromuscular condition, such as myasthenia gravis, which changes whether botulinum toxin is safe.
• Any active infection, skin breakdown, or lesion in the area to be treated.
• For anal sphincter treatment: your bowel history, any known fissure, hemorrhoids, inflammatory bowel disease, or previous anal surgery.
• Any history of blood cancer or active cancer, which rules out PRP.
• Any previous treatment of this kind, what was used and how it went.

The day itself

• Shower beforehand. No topical products on the area.
• Trimming the area is helpful but not required.
• Wear loose, comfortable clothing. Supportive underwear is useful after scrotal treatment.
• Plan for a quiet evening rather than the gym.

The first 48 hours

• Swelling and bruising are expected and settle over several days.
• No anti-inflammatories for three days. The inflammatory response is part of how PRP works, and suppressing it reduces the result. Ask us what to take instead if you need something.
• No ice directly on the skin, for the same reason. A cool compress over clothing is fine.
• No strenuous exercise, cycling or heavy lifting for 48 hours.
• Avoid heat: saunas, steam rooms and very hot baths.
• No alcohol for 24 hours.

Sexual activity

• No sexual activity, including masturbation, for one week. The tissue needs to be left undisturbed while the platelets do their work.
• Resume normally after that. There is no need to be cautious once the week has passed.

The following weeks

• Change is reported over six to twelve weeks, not days.
• A series of three sessions is the usual protocol, spaced four to six weeks apart.
• Anything else being treated for erectile function continues unless you are told otherwise. This is not a replacement for it.

The first 48 hours

• Mild swelling, small bumps and bruising at the injection points are normal and settle within a few days.
• Supportive underwear helps with comfort.
• No strenuous exercise, cycling or hot baths for 48 hours.
• Do not massage or rub the area.
• No sexual activity for 48 hours.

The timeline

• The effect appears gradually over two to four weeks, not immediately. Do not judge it in the first week.
• Full effect lasts about three to four months, then returns to baseline.
• Cold, exercise and anxiety will still cause some contraction. The muscle is relaxed, not disabled.
• Repeat treatment is scheduled once the effect has clearly worn off rather than on a fixed date.

The first week

• Soreness at the injection sites for a few days is normal.
• Temporary difficulty controlling gas is the most common effect, and it resolves as the botulinum toxin wears off. Temporary leakage of stool is less common but possible. Both are expected findings rather than complications, and dosing here is deliberately conservative.
• Keep stool soft. Fiber, fluid, and a stool softener if needed. Straining works directly against the treatment.
• Warm baths help with soreness.
• No receptive anal sex for two weeks.

The timeline

• The effect builds over two to four weeks and lasts about three to four months.
• Where this is being used for a fissure, healing is assessed at follow-up. Keeping stool soft over the following weeks is what determines whether it stays healed.
• Repeat treatment is possible where the benefit was clear and has worn off.

What you will be asked

• Where the pain is, when it happens, whether it is at entry or deeper, and whether it lasts afterwards.
• Whether there is bleeding, and what it looks like.
• Your bowel habits, including constipation, straining and stool consistency.
• Your continence, including control of gas. This is asked of everyone and it matters here.
• What you do sexually and how often, in plain terms, because it changes what is likely.
• Your sexually transmitted infection testing history.
• Whether this has always been the case or started at some point.

The examination

• External inspection first, then a digital examination with lubricant and topical anesthetic.
• It stops if it is too painful. There is no version of this where you are expected to endure it.
• Testing for infection where the history or examination suggests it.

Preparing

• No special bowel preparation is needed. An ordinary shower is enough.
• Come at a time you are not rushed. This visit is 45 minutes.
• Bring a list of your medications.
• If you have had a recent flare of pain or bleeding, note when.

These are the factors the research identifies most consistently. For a meaningful number of people, addressing them is enough, and none of them requires a prescription.

• Lubricant, more than you think, reapplied. The rectum produces none of its own. Silicone-based lasts longer than water-based. Oil-based degrades latex condoms.
• Time before penetration. Arousal and gradual external and digital stimulation lower resting tone. Going in cold works against the anatomy.
• Graded dilation. Working up in size over sessions, rather than within one, is what the pelvic floor literature describes.
• Position and control. Being the one controlling depth and rate changes pain reports substantially.
• Stop when it hurts. Pushing through teaches the pelvic floor to brace, which is the loop that turns one painful experience into a pattern.
• Keep stool soft. Constipation and straining are behind a great deal of pain in this area, fissures above all.
• Pelvic floor rehabilitation. For an overactive pelvic floor this is the most evidence-supported approach there is, and it is worth doing whether or not anything else is added.

The first week

• Soreness at the injection sites for a few days is normal.
• Keep stool soft. Fiber, fluid, and a stool softener if needed. Straining works directly against the treatment.
• Warm baths help.
• No receptive anal sex for two weeks.
• Temporary difficulty controlling gas is the most common effect. Temporary leakage of stool is less common. Both resolve as the medication wears off.

The timeline

• The effect builds over two to four weeks, so nothing is judged in the first week.
• It lasts about three to four months and then returns to baseline.
• The window is the point. It is time in which penetration can be reintroduced gradually without the spasm, which is what may break the cycle. Using the window is what determines whether the benefit outlasts the medication.
• Everything in the previous panel still applies. This does not replace lubrication, preparation or pelvic floor work.

This is worth settling before any treatment that lowers sphincter tone.

• Fecal incontinence is more common in men who have frequent receptive anal intercourse, with reported prevalence between 8 and 30 percent depending on how often and which population was studied. Most of it is minor and involves control of gas rather than stool.
• Botulinum toxin lowers sphincter tone on purpose. That is the mechanism by which it helps, and it is also why baseline matters.
• You will be asked about it before anything is injected. Control of gas, urgency, any leakage, and whether you wear anything protective. There is no embarrassing answer, and an incomplete one leads to a worse decision.
• If your baseline is already marginal, lowering tone further may not be the right move, and other approaches take priority.
• Dosing here is conservative for this reason, and it can be increased at a later session more easily than it can be taken back.