Management of Complications of Cosmetic Procedures: Handling Common and More Uncommon Problems

129 Pages·2012·4.224 MB·English

by  Maria Pia De Padova, Antonella Tosti (auth.), Antonella Tosti, Kenneth Beer, Maria Pia De Padova (eds.)

Management of Complications
of Cosmetic Procedures

Antonella Tosti (cid:129) Kenneth Beer
Maria Pia De Padova
Editors
Management
of Complications
of Cosmetic Procedures
Handling Common and More
Uncommon Problems
Editors
Prof. Dr. Antonella Tosti Prof. Kenneth Beer, M.D., FAAD
Department of Dermatology PA- General
and Cutaneous Surgery Surgical and Esthetic Dermatology
Miller School of Medicine West Palm Beach, FL
University of Miami USA
Miami, FL
USA
Dr. Maria Pia De Padova
Department of Dermatology
Nigrisoli Hospital Bologna
Bologna
Italy
ISBN 978-3-642-28414-4 ISBN 978-3-642-28415-1 (eBook)
DOI 10.1007/978-3-642-28415-1
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2012942342
© Springer-Verlag Berlin Heidelberg 2012
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Contents
1 Complications of Superficial and Medium Chemical Peels. . . . 1
Maria Pia De Padova and Antonella Tosti
2 Nonpermanent Fillers and Permanent Fillers. . . . . . . . . . . . . . . 9
Murad Alam and Nowell Solish
3 Complications of Fractional Lasers
(Ablative and Nonablative). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Robert Anolik and Roy G. Geronemus
4 Complications of Vascular Lasers . . . . . . . . . . . . . . . . . . . . . . . . 37
Norma Cameli, Giovanni Cannarozzo, Paolo Bonan,
Nicola Bruscino, and Piero Campolmi
5 Complications of Removal Lasers . . . . . . . . . . . . . . . . . . . . . . . . 47
Remington
6 Intense Pulsed Light Complications. . . . . . . . . . . . . . . . . . . . . . . 57
Hillary Julius
7 Complications of Photodynamic Therapy. . . . . . . . . . . . . . . . . . 65
Martin Zaiac, Adriana Abuchar, and Mercedes Florez
8 Complication of Biorivitalization. . . . . . . . . . . . . . . . . . . . . . . . . 73
Maria Pia De Padova and Antonella Tosti
9 Complications of Mesotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Doris M. Hexsel and Juliana Dumêt Fernandes
10 Complications in Radiofrequency (RF). . . . . . . . . . . . . . . . . . . . 83
Suveena Bhutani and Neil S. Sadick
11 Complications of Botulinum Toxins. . . . . . . . . . . . . . . . . . . . . . . 97
Kenneth R. Beer and Jacob Beer
12 Management of Complications of Microdermabrasion
and Dermabrasion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Meghan Dubina and Rebecca Tung
13 Complications of Needling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Gabriella Fabbrocini
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
v

1
Complications of Super fi cial
and Medium Chemical Peels

Maria Pia De Padova and Antonella Tosti
Since their potency is mild, repea ted treatment is
Key Features required to obtain the desired effects. Choice of
• Super fi cial and medium chemical peels peel depends on skin type and indication.
usually cause mild and transitory side Super fi cial and medium chemical peels usu-
effects. ally cause mild and transitory side effects. The
• Most side effects resolve spontaneously most common complication is the development
even if several months may be needed. of pigmentary changes, which are especially seen
• Topical steroids and topical and sys- in patients with dark phototypes. Development of
temic antibiotics are useful for treatment this complication may be due to utilization of a
of most complications. peeling which is too strong for the patient’s pho-
totype or to inadequate photoprotection in the
postpeeling period.
1.1 Introduction
1.2 Technology
Super fi cial and medium peelings include sali-
cylic acid 25–30%, glycolic acid 70%, pyruvic 1.2.1 Glycolic Acid 30–70%/Pyruvic
acid 40–60%, trichloroacetic acid 20–35%, and Acid 40–60% [1 – 3 ]
combination of salicylic acid or Jessner peel with
trichloroacetic acid. Glycolic and pyruvic acid peelings are utilized
Super fi cial and medium peelings are utilized to for the treatment of photoaging, melasma and
induce a damage limited to the epidermis and pap- postin fl ammatory pigmentation, and acne scars.
illary dermis. This results in epidermal regenera- Pyruvic acid can also be used for active acnes.
tion and postin fl ammatory collagen neoformation. Advantages
• Mild desquamation
• Short postoperative period
M. P. De Padova ((cid:2)) Disadvantages
Department of Dermatology , Nigrisoli Hospital Bologna , • Penetration often not uniform for glycolic
Bologna , Italy
acid
e-mail: [email protected]
• Pyruvic acid causes intense stinging and burn-
A. Tosti
ing sensation during the application and pro-
Department of Dermatology and Cutaneous Surgery ,
duces pungent and irritating vapors for the
Miller School of Medicine, University of Miami ,
Miami , FL , USA upper respiratory mucosa
A. Tosti et al. (eds.), Management of Complications of Cosmetic Procedures, 1
DOI 10.1007/978-3-642-28415-1_1, © Springer-Verlag Berlin Heidelberg 2012
2 M.P. De Padova and A. Tosti
• Require neutralization can be utilized for the treatment of melasma and
• High risk of overpeel if time of application is postin fl ammatory pigmentation.
too long or the skin is in fl amed Advantages
• Low cost
• Uniformity of application
1.2.2 Jessner’s Solution • Penetration can be easily evaluated by the
color of frost
Jessner’s solution is utilized for the treatment of Disadvantages
photoaging, melasma and postin fl ammatory pig- • Stinging and burning sensation during the
mentation, and active acne. application
Advantages • High concentrations are not recommended in
• Excellent safety pro fi le skin types V to VI
• Can be used in all skin types • Can cause hypo/hyperpigmentation
• Substantial effi cacy with minimal “down
time”
• Utilized for combination peels as it enhances 1.2.5 Combination Peeling: Salicylic
the penetration of other agents Acid 25% + TCA 15–30% [4 , 5 ]
Disadvantages
• Concerns regarding resorcinol toxicity, includ- Pretreatment with salicylic acid permits to obtain
ing thyroid dysfunction a medium peeling with low TCA concentrations
• Manufacturing variations and therefore avoids pigmentary complications
• Instability with exposure to light and air especially in dark phototypes.
• Excessive exfoliation in some patients Combination peeling with salicylic acid
+ TCA is utilized for the treatment of photoag-
ing and acne scars. Combination peeling with
1.2.3 Salicylic Acid 20–30% low concentrations of TCA can be utilized for
the treatment of melasma and postin fl ammatory
Salicylic acid peeling is utilized for the treatment pigmentation.
of melasma and postin fl ammatory pigmentation, Advantages
and comedonic and active acne. • Can be used in all skin types
Advantages Disadvantages
• Established safety pro fi le in all skin types • Risk of overpeeling
• Formation of white precipitate allows to verify • Can cause hypo/hyperpigmentation
if application is homogeneous
• Salicylic acid has an anesthetic effect that is
useful in combination peelings 1.2.6 Contraindications to Super fi cial
Disadvantages and Medium Peelings
• Causes intense stinging and burning sensation
during the application Contraindications to super fi cial and medium
• Minimal ef fi cacy in patients with signi fi cant peelings include:
photodamage • History of hypertrophic scars
• Connective tissue disorders
• Active skin disorders on the treatment sites
1.2.4 Trichloroacetic Acid 15–35% • History of treatment with systemic retinoids
in the previous 4 months
Trichloroacetic acid is utilized for the treatment of • Oral anticoagulant treatment
photoaging and acne scars. Low concentrations • Pregnancy
1 Complications of Super fi cial and Medium Chemical Peels 3
1.2.7 Prepeeling Care The patient should regularly wear a total sun
block between peeling sessions and up to 6
This is essential to obtain uniform penetration and months after the last session.
avoid postinfl a mmatory hyperpigmentation. Pres-
cribe topical products containing 1–2% salicylic
acid, 2–3% pyruvic acid, or 0.05% retinoic acid to 1.3 Epidemiology
be applied three times a week for 1 month. Prescribe of Complications
4% topical hydroquinone three times a week for
1 month. Application of these topicals should be Super fi cial and medium peels are widely utilized
interrupted 4 days before the procedure to avoid worldwide in both women and men. The relative
excessive penetration of the peeling agent. safety of these peelings in dark phototypes
Treatment with oral antivirals should be started explains their utilization in different races.
2 days before the procedure in patients with his-
tory of recurrent herpes simplex infections.
A detailed informed consent should be given to 1.4 Clinical Features
the patient at this time to give her/him the possi-
bility of understanding the procedure and asking 1.4.1 Minor Local Adverse Reactions
possible questions before treatment. We always
also provide written information about the proce- • Intense swelling.
dure. It is very important to explain clearly to the • Eye irritation due to vapors of the peeling
patient that super fi cial and medium peels require solution (e.g., pyruvic acid and TCA).
multiple sessions and can improve but not com- • Transitory nose and oral irritation is common
pletely resolve photoaging, pigmentary disorders, with pyruvic acid.
and acne scars to avoid excessive expectations. • Irritative contact dermatitis: this may be
It is mandatory to obtain good quality pictures caused by application of inadequate topical
before starting the procedure. This is an essential products (scrubs, exfoliating agents) before
documentation for follow-up and for possible complete reepithelization.
medicolegal issues. • Exudative erosions: this is due to premature
removal of scales and crust and is most com-
monly seen after medium-deep peelings. It is
1.2.8 Postpeeling Care very important to instruct the patient to not
manipulate the skin after peeling.
It is very important to explain the patient to abso- • Prolonged erythema: in some patients, ery-
lutely avoid sun exposure and prescribe a sun thema persists after 3 weeks from the proce-
block to be applied several times a day. dure (Fig. 1.1 ). These patients require a close
For the immediate postpeeling period, the follow-up as they are at risk of developing
patient should also apply a moisturizing cream postin fl ammatory hyperpigmentation. If the
three to four times a day. The patient should also patient complains of itching, consider contact
be instructed to avoid scratching or peeling the dermatitis. Exclude other skin disorders inclu-
skin. A mild skin cleanser can be utilized without ding lupus erythematosus.
rubbing. • Dishomogeneous skin color: this is due to
When reepithelization is complete, which usu- irregular penetration of the peeling agent (Fig.
ally takes 7–10 days, the patient can resume 1.2 ). This occurs more frequently in patients
application of topical products containing 1–2% with mixed skin as penetration is higher in
salicylic acid, 2–3% pyruvic acid or 0.05% retin- greasy as compared with dry skin areas.
oic acid, and 4% topical hydroquinone to prepare Possible causes include inadequate prepara-
the skin for the next procedure. tion of the skin to the procedure, incorrect