Adverse events in cosmetic procedures avoidable with preparation

Key Points

Miami - Thorough planning provides the best approach to recognizing, managing and preventing complications when performing aesthetic procedures, an expert says.

"Caution is your friend, especially when you're starting out with cosmetic procedures, or with a novice cosmetic patient," says Marianna Blyumin-Karasik, M.D., a Miami private practitioner who spoke at the 68th Annual Meeting of the American Academy of Dermatology. "Less is more, especially when you're starting out. Patients won't be upset if you don't reach an ideal result, but they will be very disappointed if you cause a complication - especially an unanticipated one."

Chemical peels

Hyperpigmentation also can occur with various peels. "It's more common with darker-skinned patients, especially Fitzpatrick type IV and above, and with poor sun-avoidance compliance," she says. In the latter area, it's imperative that patients of all skin types apply sunscreen even before leaving the office post-procedure.

"We see less and less scarring because the deep phenol-type peels are no longer in vogue, especially in the United States," Dr. Blyumin-Karasik adds.

"Some physicians want their patients to avoid retinoids completely before procedures because of the possibility of severe irritation. Other times, especially if the patient is getting a peel for actinic keratoses or photodamage, it's a good idea to prepare them with topical retinoids preoperatively to get a deeper, more even peel," she explains. Dermatologists also must adjust chemical peel treatment plans if patients have rosacea, atopic dermatitis or seborrheic dermatitis.

Additionally, Dr. Blyumin-Karasik always instructs patients to keep their eyes closed and tell her what they're feeling during procedures, "especially if they're feeling severe burning or pain, which are alarming symptoms of significant skin damage that signal the surgeon to reassess the procedure immediately. I also make sure to drain any excess amounts of chemical peeling agent," she says. "And I move from one side of the face to another, so there's no possibility of the material dripping into the eyes or other unintended areas."

Tools for addressing complications postprocedurally range from cooling fans to fractional lasers for scarring and hydroquinone for pigment changes, Dr. Blyumin-Karasik adds.