Caring for your skin before and after surgery: what is stopped, when it is resumed and what about the sun

They are two moments with two different jobs. Before surgery, what matters is that the skin arrives in good condition and that the factors which make healing harder are removed. Afterwards, what matters is protecting it and not putting actives on a wound that is still closing.

And there is one detail that surprises almost everyone: with retinoids, what decides the outcome is not the product, it is the timing. Used beforehand, the available evidence suggests the wound closes better. Applied on top of an open wound, they delay it.

This page is about the skin. The treatment of the scar — silicone, laser, schedule — has a protocol of its own and is in the scar protocol after surgery.

Before: prepare and simplify

What does help

Arriving with the skin in good condition. Skin that is well hydrated, with an intact barrier and no active irritation, is a better starting point than skin battered by a run of actives. In the preceding weeks that means a simple, sustained routine: gentle cleansing, moisturising and daily sun protection.

Stopping smoking, which is the best-supported measure in this whole section and is explained below.

What is worth simplifying

In general the advice is to withdraw, before the operation, the products that irritate or that can leave the skin more reactive: retinoids, exfoliating acids at high concentration, mechanical exfoliants and any treatment that is producing flaking or redness.

🔑 And how far in advance has an answer that surprises people: less settled than it looks. The most recent systematic review on skincare around aesthetic procedures brought together 104 publications and found that what is known about pre-procedure care rests on a low level of evidence, with very few trials comparing a specific regimen against doing nothing. The timings that circulate are custom, not results.

And the underlying fear — that an active leaves the skin “thin” and delays healing — was tested in a randomised trial with tretinoin on one arm and placebo on the other before CO₂ laser: there was no difference in re-epithelialisation, in collagen, or in the settling of the redness.

⚠️ So the useful criterion is not a date, it is a state: how your skin is on the day of surgery. Irritated, red or flaking, it is postponed even if you have gone ten days without using anything. Calm, and it does not become a problem because of an acid used on the Tuesday.

The exception that is supported is about pigmentation, not healing: if you have a high skin phototype and what you are having is a peel, retinoids are stopped one or two weeks beforehand. It is set out on the exfoliating acids page.

🔑 And with all that in front of you, the final instruction still belongs to whoever is operating on you, who is the one who knows what technique will be used and on what area.

And what is not a good idea

• Starting a new active in the preceding weeks. If it is going to irritate, it will irritate at exactly the worst moment.
• Having a peel or an aggressive treatment “to arrive in better shape”. This is the moment to stabilise, not to work on the skin.
• Waxing the area in the days beforehand.
• Sunbathing. Freshly tanned or sun-irritated skin is a worse starting point, and a tan also has a bearing on some later treatments.

The retinoid paradox: it is not the product, it is the timing

This is the counter-intuitive part and it deserves telling properly, because contradictory advice comes out of it everywhere.

Applied to an open wound, a retinoid delays closure. In a classic experimental model, the continued application of tretinoin to partial-thickness wounds delayed re-epithelialisation, with persistent inflammation and epithelial changes on histology.

Used beforehand, as preparation, the effect appears to be the opposite. In that same work, pre-treatment accelerated epithelial healing. And in a small later clinical study, after 16 weeks of pre-treatment with tretinoin, the wound areas were between 35% and 37% smaller on days 1 to 4 and between 47% and 50% smaller on days 6 to 11 compared with the controls.

⚠️ And now the reservation, which is a large one and has to be stated: the first study is a porcine model and the second was done with four elderly men. They are consistent signals pointing the same way, not a basis for promising anything. What they do support solidly is the negative half — not applying retinoids to a wound — which is also the half that matters for safety.

🔑 The practical conclusion is simple: what decides the outcome is not whether the product is good, but when it is used. And that timing is set by whoever knows the wound.

Smoking: the factor with figures

Of everything a person can do for their own healing, stopping smoking is the one with numbers behind it.

A scoping review on facial procedures screened 129 records and included 9 observational studies, with formal methodological appraisal. Active smoking was consistently associated with worse healing, with complication risks between 1.8 and 12 times higher in smokers. The most frequent adverse effects were flap necrosis, infection and wound dehiscence.

Two qualifications the review itself notes, and which are worth not hiding: several studies found no statistically significant association in specific settings, and the risk range is wide precisely because the studies and the procedures are heterogeneous. The authors stress the importance of stopping smoking in the perioperative period.

🔑 And here there is a concrete figure: a month before and a month after.

Note the second half, which is the one that gets forgotten. Almost everyone understands that you have to stop beforehand; far fewer people know that the month afterwards matters just as much, and it is exactly when the wound is healing. Stopping only to start again on leaving theatre throws away half the benefit.

⚠️ Confirm it with your surgeon anyway, because some operations call for a longer margin. But a month before and a month after is the starting point.

Isotretinoin: what the consensus says, not what custom says

For years it was repeated that you had to wait between six months and a year after oral isotretinoin before any procedure. A consensus published in JAMA Dermatology reviewed the evidence and concluded otherwise:

• There is not sufficient evidence to delay manual dermabrasion, superficial chemical peels, skin surgery, laser hair removal or fractional lasers, ablative or non-ablative.
• What is advised against is mechanical dermabrasion and fully ablative laser during treatment with systemic isotretinoin.

This matters at this clinic because the CO₂ laser used here is always fractional, not full-field, as explained on the fractional CO₂ laser page. Even so, if you are taking or have taken isotretinoin, say so at the consultation: it is not an automatic bar, but it is information the surgeon needs.

Afterwards: protect, and don’t jump ahead

The principle is the same for every operation, although the timings change: while the wound is closing, nothing goes on it that the person who operated has not prescribed.

Once the wound has closed, the return to the routine is stepped, and this is the order that makes sense:

1. Gentle cleansing and moisturising. The first thing to come back and the one with the least risk.
2. Sun protection. It is the most important item on this list and the most neglected. How to choose it is in how to choose a facial sunscreen.
3. Actives, last and one at a time. Retinoids, acids and depigmenting agents are the last to come back, and they are reintroduced the same way they are introduced for the first time: slowly. It is in how to start with retinol.

⚠️ The timing of each step depends on the surgery and on how the wound is doing, and it is given by whoever operates on you. Any generic schedule you find published is talking about somebody else.

And an important boundary

Scar treatment is not this. Silicone, sun protection specific to the scar, laser and pulsed light, and the schedule that orders them, are in the scar protocol after surgery, which is the page that sets all of it out. This page is about the skin; that one is about the scar.

What you can do in the meantime

For anyone waiting to get back to their routine, three things that can be done and that count:

• Keep up sun protection without missing a day. It is what weighs most on the medium-term result.
• Keep the skin hydrated and the barrier calm, which is exactly what makes the later reintroduction of actives tolerable.
• Don’t smoke. It still counts afterwards, not only before.

The products for each phase are in the dermocosmetics shop. Which ones apply and when is set by your surgeon at the follow-up, because it depends on the technique and on how the healing is going.

Frequently asked questions

How long before my operation do I have to stop retinol?

There is no universal period, and it depends on the technique, the area and the state of your skin. It is a question for the pre-operative consultation, and it is worth asking expressly: you are not always asked about what you put on at home, and it is worth saying.

Can I use my usual cream after surgery?

On the wound, only what the person who operated on you has prescribed. On the rest of the face or body, gentle cleansing and moisturising usually come back soon; actives, later. The order is moisturise first, then protect from the sun and lastly reintroduce treatments.

Why do they go on about smoking so much?

Because it is the best-supported modifiable factor. In facial procedures, the available review describes complication risks between 1.8 and 12 times higher in smokers, with flap necrosis, infection and dehiscence the most frequent problems. It is not a lifestyle recommendation: it directly affects how the wound closes.

I have taken isotretinoin — do I have to wait?

Not necessarily, and the custom of waiting a year is not supported by the most recent consensus, which found no sufficient evidence to delay skin surgery, superficial peels or fractional lasers. What it does advise against is mechanical dermabrasion and fully ablative laser. Say so at the consultation: it is information that changes the planning even when it does not rule the procedure out.

Is there any point in preparing the skin beforehand?

There are signals that there is, and they point the same way across the available work: pre-treatment with retinoids was associated with faster wound closure. ⚠️ The evidence is limited — an animal model and a series of four patients — so it is put forward as reasonable, not as a promise. What is certain is that arriving with irritated skin does not help.

Can I sunbathe afterwards?

Not while the scar is maturing, and there the criterion is the one in the scar protocol: a recent scar exposed to the sun pigments, and that pigmentation can stay. The timings and the detail are in the scar protocol.

And make-up?

It depends on the area and on the state of the wound; on a wound that has not closed, no. It is another of the questions worth asking at the follow-up, because for many people it determines when they can go back to work or to a social life.

Sources

• Nikolis A, Nestor MS, Czuwara J, et al. Concomitant Use of Dermo-Cosmetic Skin Care in Aesthetic Procedures: Systematic Review with Expert Panel Recommendations. Clinical, Cosmetic and Investigational Dermatology, 2026;19:577128. PMID 41773167. — Systematic review of 104 publications with an expert panel: pre-procedure care rests on a level of evidence ≤ 3 and there are very few trials against not treating; stopping retinoids 1-2 weeks before a peel is recommended in phototypes IV-VI to avoid dyschromia, and no specific withdrawal period before laser is established.
• Orringer JS, Kang S, Johnson TM, et al. Tretinoin treatment before carbon-dioxide laser resurfacing: a clinical and biochemical analysis. Journal of the American Academy of Dermatology, 2004;51(6):940-6. PMID 15583586. — Randomised within-patient trial of tretinoin against placebo before CO₂ laser: no differences in re-epithelialisation, collagen or resolution of the erythema.

• Chouksey G, Agrawal A, Bhargava S, Karna ST. Review on the impact of smoking on wound healing following facial procedures. Archives of Craniofacial Surgery, 2026;27:1-9. PMID 41787902. — Scoping review of observational studies on facial procedures, with methodological appraisal using the JBI checklists; of 129 records screened, 9 studies were included. Active smoking was consistently associated with worse healing, with complication risks between 1.8 and 12 times higher in smokers; the most frequent adverse effects were flap necrosis, infection and wound dehiscence, although several studies found no statistically significant association in specific settings. The authors stress the importance of stopping smoking in the perioperative period.
• Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and Timing of Procedural Interventions: A Systematic Review With Consensus Recommendations. JAMA Dermatology, 2017;153(8). PMID 28658462. — Systematic review with consensus recommendations: insufficient evidence to delay manual dermabrasion, superficial chemical peels, skin surgery, laser hair removal and procedures with ablative and non-ablative fractional laser. Not recommended are mechanical dermabrasion and fully ablative laser during treatment with systemic isotretinoin.
• Hung VC, Lee JY, Zitelli JA, Hebda PA. Topical tretinoin and epithelial wound healing. Archives of Dermatology, 1989;125(1). PMID 2462851. — Porcine model with partial-thickness wounds: pre-treatment accelerated epithelial healing, while the continued application of tretinoin to the wounds delayed re-epithelialisation, with persistent inflammation and epithelial changes on histology. ⚠️ An animal model: it supports the direction of the effect, not a quantitative recommendation.
• Popp C, Kligman AM, Stoudemayer TJ. Pretreatment of photoaged forearm skin with topical tretinoin accelerates healing of full-thickness wounds. British Journal of Dermatology, 1995;132(1). PMID 7756151. — Pre-treatment with 0.05-0.1% tretinoin for 16 weeks: the wound areas were 35-37% smaller on days 1 to 4 and 47-50% smaller on days 6 to 11 compared with the controls, with faster re-epithelialisation clinically and histologically. ⚠️ A series of four elderly male patients with severe photodamage: the sample size obliges you to read it as a signal, not as a basis for an indication.
• AEMPS — CIMA. Summary of product characteristics for Retirides 0.5 mg/g cream (tretinoin). cima.aemps.es. — A prescription-only medicine; it recommends avoiding or reducing sun exposure during treatment and using sun protection and protective clothing over the treated areas.
• Hughes MC, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Annals of Internal Medicine, 2013;158(11). PMID 23732711. — Randomised trial in 903 adults followed for 4.5 years: 24% less skin ageing with daily sunscreen use compared with discretionary use. It underpins the priority given to sun protection in the stepped return to the routine.

Book your consultation

If you have surgery planned and a skincare routine under way, say so at the pre-operative consultation even if you are not asked: what you put on, how often and since when. It is information that changes the instructions for the preceding weeks, and it is the kind of detail almost nobody mentions because it does not seem medical.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 17 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.