The “non-invasive” label seems to indicate that cosmetic procedures are safe, but as injectables, lasers, ultrasound, and radiofrequencies become more popular, the number of cases in which adverse effects occur also increases. And what can reduce this risk is dermatological evaluation, which most of the time does not exist in popular aesthetic clinics.
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“Every cosmetic procedure carries some type of risk and detailed analysis is essential to ensure safe treatment for each patient’s profile. A dermatologist is a doctor who has the experience and knowledge to identify skin diseases and conditions that may even contraindicate a procedure. A classic example is skin cancer. If a patient goes to a clinic for a laser and does not undergo a medical evaluation, there is a risk that the heat and light energy from the laser can cause inflammatory changes and repairers in the tissues, stimulating cell proliferation If there are cells There is a risk of stimulating their local growth or masking the boundaries of the lesion, delaying the correct diagnosis,” explains specialist Daniel Cassiano, dermatologist and communications director of the Brazilian Society of Dermatologists – São Paulo Regional (SBD-RESP).
According to SBD-RESP member dermatologist, Elizabeth Senra, prior medical evaluation is an essential step before any cosmetic procedure. “It is at this moment that the dermatologist identifies clinical conditions that could alter the expected result, aggravate pre-existing skin diseases or generate serious complications,” specifies the doctor.
SBD-RESP member dermatologist Paula Tiemi Fujioka adds that there are a wide variety of skin changes and diseases that can go unnoticed in the absence of adequate medical evaluation before proceeding with cosmetic procedures. “Among them, we distinguish skin neoplasms, such as basal cell carcinoma, squamous cell carcinoma and melanoma, which are often confused with benign lesions. And poor management of these lesions can not only delay early diagnosis, but also promote their spread or worsening,” explains the doctor.
“The presence of chronic dermatoses such as psoriasis, vitiligo and lichen planus must be carefully evaluated, as they can trigger the so-called Koebner phenomenon, that is, the appearance of lesions typical of the disease in previously healthy areas of the skin, after physical trauma, such as that caused by cosmetic procedures,” explains Paula.
Allergies, acne, redness, pimples, wounds… in fact, it is not uncommon, according to Dr Daniel, to find a pre-existing condition which merits dermatological treatment before aesthetic treatment. “This is why the dermatologist must always examine the patient’s skin. It is the basis of our care. The skin speaks,” comments the doctor.
Dermatologist Paula Tiemi Fujioka points out that skin lesions of infectious origin, such as verruca vulgaris, molluscum contagiosum and herpes simplex, often mistaken for harmless changes, can spread to other areas of the skin through trauma or improper handling, thus complicating treatment and increasing the risk of complications.
Skin conditions related to inflammation, like melasma or rosacea, also tend to worsen with aggressive procedures, like deep peels or ablative lasers. “In these cases, the dermatologist must consider gentler approaches, because excessive stimuli can trigger inflammatory or pigmentary flare-ups,” reinforces Paula.
“During the evaluation, the dermatologist also recognizes subtle signs of allergic processes or inflammatory reactions, such as red areas, scaling, hyperchromia or changes in relief resulting from previous interventions. These changes may indicate local inflammation or a reaction to a foreign body and, therefore, temporarily contraindicate several treatments, until the condition is controlled”, adds Elizabeth Senra.
In some cases, it’s not even the skin issues that need special attention. “In a patient suffering from diabetes or vascular disease, for example, the doctor must consider that there may be impaired circulation, which makes healing difficult and increases the risk of infections and delayed healing. In this case, the dermatologist will assess the state of the disease. Is it under control? Is it safe to perform a procedure, even if it is less invasive?”, explains Daniel.
“Patients with autoimmune diseases, for example, often have contraindications to various treatments due to the risk of complications. Neurological diseases can also limit the indication for certain procedures, such as the application of botulinum toxin,” adds Paula.
Another issue that is not neglected during dermatological consultations is the clinical history, which directly influences the choice and safety of the intervention. “Patients using anticoagulants, isotretinoin, immunosuppressants, corticosteroids or photosensitizing medications require specific protocols,” comments Elizabeth.
“In addition, habits such as smoking, excessive sun exposure and poor diet also negatively affect the final treatment result,” adds Paula. “The dermatologist can and should guide the patient to improve their lifestyle, not only to enhance the effects of the procedures, but also to promote health,” adds Daniel.
Finally, Daniel Cassiano reinforces that dermatological evaluation is essential to carry out aesthetic treatments. “Thanks to this we minimize the risk of side effects. But above all, as doctors, we are able to manage complications if they arise. Aesthetics is not simple. It requires in-depth knowledge of anatomy, pharmacology and clinical experience. When choosing a procedure, the patient should check if it will have a dermatological medical evaluation, be wary of very low prices, check the professional’s references and look for safe places”, he concludes.
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