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Botox, Fillers Or Laser Treatments May Have Low Complications Risk

Experts already believed the procedures were safe since there have been few reported adverse events, the authors write in JAMA Dermatology.

“Among the most common such procedures are neurotoxins like Botox for relaxing facial smile and frown lines; fillers for plumping up areas of the face that have sagged or deflated; and lasers and light devices for removing unwanted hair,” said lead author Dr. Murad Alam of the dermatology department at the Feinberg School of Medicine of Northwestern University in Chicago.

He and his coauthors collected data on common procedures performed by a total of 23 dermatologists using laser and energy devices, as well as injectable neurotoxins and soft-tissue fillers at eight U.S. outpatient dermatology clinical practices.

They gathered data for a three-month period at each clinic, covering a total of more than 20,000 procedures.

Personnel at each site were directed to record details of all relevant procedures and any complications observed or suspected in online forms. Researchers told doctors to contact patients within a week of performing a procedure to ask about side effects, and patients were encouraged to report problems to the clinic.

By the end of the study, there were 48 recorded adverse events and 36 procedures resulted in at least one adverse event. None was life-threatening or required hospitalization.

For laser skin treatments, there were 13 reported complications, including skin darkening or redness.

There were 25 complications involving neurotoxins or fillers, most often lumps, nodules or red or purple darkening of the skin, more common after viscous fillers like Juvederm Ultra Plus or Radiesse injected into the cheeks.

These side effects should either respond immediately to treatment or be expected to disappear spontaneously, the authors write.

Overall, less than one-quarter of one percent of procedures resulted in any side effect.

“Side effects can always happen, but the key is to minimize their risk, and have a qualified doctor who can help you manage them if they occur,” Alam told Reuters Health by email. “That being said, done properly by trained physicians, these procedures are very safe.”

Dr. Anthony P. Sclafani of the New York Eye and Ear Infirmary, who was not part of the new study, agreed that by and large, these are very safe procedures.

“The (Food and Drug Administration) wouldn’t have approved these materials and devices if they didn’t have safety data already,” he noted.

But this study only included relatively well-known and well-respected cosmetic dermatologists, Sclafani told Reuters Health.

The study design with three-month windows at each clinic was limited to observing relatively immediate complications, which you would expect to go away quickly, but didn’t necessarily confirm that they went away, he pointed out.

The study is also focused on safety, but did not look at whether the treatments worked, Sclafani added. “Did we do the job with the filler? Did the skin really tighten the way we wanted with that laser? Those are completely different questions.”

Plenty of other studies have found that patients are very satisfied with these procedures, he said.

When patients are looking into getting procedures like this, Sclafani advises, they should call up the clinic and ask some general questions first about how often the doctor performs the particular procedure and whether or not he or she will actually perform it, or if the procedure will be delegated to other staff.

Board-certified dermatologists performed almost all of the procedures in the study, except for some laser treatments, which were done by physician assistants or nurse practitioners while the dermatologist supervised.

As long as the doctor sets the energy levels on the laser machine, a physician assistant or nurse should be able to perform a laser procedure, Sclafani said. But in his opinion, a doctor should be performing other procedures, he said.

“I would say see a qualified facial plastic surgeon, cosmetic dermatologist or plastic surgeon, for safety and to achieve the ideal result,” he said. A general dermatologist is not going to have the same skill level as the procedures as a cosmetic dermatologist, Sclafani said