Four common dermatological and health conditions affecting aesthetic interventions.
Acne occurs when hair follicles get blocked with sebum from the sebaceous glands and dead skin cells causing inflammation and the typical white head or blackhead appearance of acne spots. Aesthetic procedures are not contraindicated in people with acne, in fact there are various aesthetic interventions that can be applied to acne scarring including lasers, microdermabrasion and chemical peels. Micro needling also known as collagen induction therapy can help to stimulate collagen production in the dermis which may help to soften the appearance of shallow scarring from acne. Platelet rich plasma (PRP) used in conjunction with either laser therapy or micro needling may also be useful (Hesseler and Shyam, 2019). There is also evidence that using botulinum toxin may be a potentially useful tool to treat overactivity of sebaceous glands to reduce acne (Rho and Gil 2021).
Cold sores are caused by herpes simplex virus 1 and less commonly by herpes zoster virus and are capable of latent and persistent infection. Herpes virus reactivation can occur following dermal filler injections by direct needle damage to a nerve axon or through the mild inflammatory reaction and tissue manipulation following the filler injection. Interestingly hyaluronic acid itself has been shown to be a protective agent against viral replication (Gazzola, et al 2012). Viral reactivation appears in the areas that have been treated with filler (Wang et al 2020), most commonly perioral and nasolabial fold areas. Therefore, an accurate medical history must be undertaken establishing a history of cold sores and the patient consented that filler injection may, in a small number of cases, cause a viral reactivation and cold sore outbreak. In patients that do have a history of cold sores they may wish to take prophylactic anti-viral therapy prior to dermal filler injection. It would be contraindicated to perform filler injections with someone that has a current cold sore.
Body dysmorphic disorder (BDD) is a health condition where someone is overly preoccupied with self-perceived flaws in their physical appearance including facial features. This can lead to significant stress, anxiety and depression. People present to aesthetic practitioners for injectable treatments to correct these flaws. There is evidence that botulinum toxin treatment of the glabellar produces a strong and sustained alleviation of depression in patients who did not improve sufficiently on previous medication (Wollmer 2012). The authors go on to suggest that the facial musculature not only expresses, but also regulates mood. McKeown (2021) demonstrated that hyaluronic acid and botulinum toxin treatments were associated with significant improvements in patients’ social and psychological wellbeing and reductions in appearance-related distress.
Bell’s palsy is a condition that affects the facial nerve leading to facial paralysis. This can be an extremely upsetting and disfiguring condition. Botulinum toxin treatment may be contraindicated in some cases of people that have suffered from Bell’s palsy – particularly into the facial muscles affected by weakness; however, it is also one of the most effective treatments to counteract some of the effects of Bell’s palsy. In people that have suffered Bell’s palsy there can be facial weakness in certain facial muscles but also hypertonicity and other facial muscles. Using botulinum toxin injections offers safe and effective treatment by relaxing hyperactive muscles to restore facial symmetry and improve facial appearance (de Sanctis Pecora and Shitara 2021).
de Sanctis Pecora, C., & Shitara, D. (2021). Botulinum Toxin Type A to Improve Facial Symmetry in Facial Palsy: A Practical Guideline and Clinical Experience. Toxins, 13(2), 159. https://doi.org/10.3390/toxins13020159
Gazzola, R., Pasini, L., and Cavallini, M. (2012). Herpes virus outbreaks after dermal hyaluronic acid filler injections. Aesthetic surgery journal, 32(6), 770–772. https://doi.org/10.1177/1090820X12452293
Hesseler, M. J., and Shyam, N. (2019). Platelet-rich plasma and its utility in the treatment of acne scars: A systematic review. Journal of the American Academy of Dermatology, 80(6), 1730–1745. https://doi.org/10.1016/j.jaad.2018.11.029
McKeown D. J. (2021). Impact of Minimally Invasive Aesthetic Procedures on the Psychological and Social Dimensions of Health. Plastic and reconstructive surgery. Global open, 9(4), e3578. https://doi.org/10.1097/GOX.0000000000003578
Rho, N. K., and Gil, Y. C. (2021). Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism. Toxins, 13(11), 817. https://doi.org/10.3390/toxins13110817
Wang, C., Sun, T., Yu, N., and Wang, X. (2020). Herpes reactivation after the injection of hyaluronic acid dermal filler: A case report and review of literature. Medicine, 99(24), e20394. https://doi.org/10.1097/MD.0000000000020394
Wollmer, M. A., de Boer, C., Kalak, N., Beck, J., Götz, T., Schmidt, T., Hodzic, M., Bayer, U., Kollmann, T., Kollewe, K., Sönmez, D., Duntsch, K., Haug, M. D., Schedlowski, M., Hatzinger, M., Dressler, D., Brand, S., Holsboer-Trachsler, E., and Kruger, T. H. (2012). Facing depression with botulinum toxin: a randomized controlled trial. Journal of psychiatric research, 46(5), 574–581. https://doi.org/10.1016/j.jpsychires.2012.01.027