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Cosmetic Procedures More Complex than Advertised

separator These days, it’s easy to get the impression that it’s safe to take a trip to your local day spa for removal of tattoos, birthmarks, wrinkles, spider veins and other imperfections. You may notice advertisements promising easy treatments at a low price. But don’t be fooled by the cavalier tone of these ads. It takes a lot of training and skill to perform cosmetic procedures. Unqualified practitioners can cause burns, splotching, irreversible pigmentation changes and dangerous infections.

According to a 2002 survey of dermatologic surgeons, 41 percent of the respondents saw an increase in patients who came to them needing corrective treatment for botched procedures that unqualified practitioners had performed. Laser procedures had the highest complication rate. There were 106 physicians responding to the survey who saw such complications from laser treatments as

  • Second and third degree burns
  • Permanent nerve damage
  • Scarring

Common cosmetic procedures
In the last several years, cosmetic surgery has become more and more popular, especially among people in their 20s and 30s. The most common cosmetic procedures include Botox injections, chemical peels and laser resurfacing. These procedures are not substitutes for facelifts, which treat more complex imperfections. Here’s a brief description of the most common cosmetic procedures.

Chemical peels: These are most commonly used to treat fine lines under the eyes and around the mouth, acne scars, age spots, etc. It’s also a common tattoo removal technique. During the procedure, a chemical solution (typically something called an “alpha hydroxy acid”) is applied to the skin. This chemical creates a kind of wound. New skin, usually with an improved appearance, appears as the old skin peels off. People considering having a chemical peel should have an evaluation by a dermatologic surgeon, who can determine whether your skin type and condition meet specific criteria. Not all skin types respond well to chemical peels, nor do all skin conditions.

Botox injections: These have become so popular that some people are even having “Botox parties,” gathering people together for an evening of shots in the forehead. But even Botox injections, which smooth lines in the forehead, can cause complications such as droopy eyelids and eyebrows, double vision and muscle paralysis in the face. To inject Botox successfully, practitioners have to be thoroughly familiar with facial anatomy, which is not generally part of the training of cosmetologists and beauticians. Giving a few injections may sound simple, but a simple mistake can have big implications.

Laser resurfacing: This technique can smooth and tighten eyelid skin, soften pucker marks and frown lines, improve skin tone and texture, repair smokers’ lines, etc. Laser treatments are often used in conjunction with chemical peeling, because lasers are often more effective in treating some of the more involved lines and marks that chemical peels can’t improve. The procedure works by producing an intense beam of light that can “vaporize” skin tissue. There are many different types of lasers, and the treatment requires a practitioner who is extremely precise and who has had a lot of training in laser techniques.

Don’t get lured by low rates; ask lots of questions
If advertised costs seem to be especially low, it’s probably because the people performing the procedures don’t have the high level of training that keeps complications low. It’s not worth it to go for the cheaper rates if you’re going to have to have additionally procedures to correct the mistakes.

When you visit a practitioner for an evaluation, be sure to ask plenty of questions, such as:

  • Did you specialize in this procedure?
  • Do you rent or own your equipment? (In general, owning the equipment indicates that the practitioner takes the training and procedure seriously.)
  • Ask to see before and after pictures.
  • Ask how many different types of lasers the practitioner owns. Different types of skin lesions require different types of lasers, so you would expect your practitioner to own at least several, and maybe as many as 10.
  • Make sure you feel comfortable with the doctor you choose to do the procedure. If the rapport isn’t good, then you need to find a different doctor.

The American Academy of Dermatologic Surgery; FDA Consumer, May-June 2000; The New York Times, 14 July 2002.
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