*This article is brought to you by AAMSSA: The Aesthetic and Anti-Ageing Medicine Society of South Africa*
Find an aesthetic practitioner www.aestheticdoctors.co.za
Thanks to all the uncertainty COVID-19 has created, we now find ourselves in a situation where it’s crucial that some things still remain constant and within our control. And believe it or not, self-care is one of them. During these challenging times, self-care has become so essential that aesthetic clinics have remained busy throughout the pandemic. So, for those considering having a procedure done in the age of COVID, DR DEBBIE NORVAL clarifies which treatments are safe to pursue, and how long one should wait if illness has occurred
Just over a year ago, the WHO sounded the alarm about COVID-19. The past year has been a rollercoaster ride where the world changed forever. The scientific community has taken us on a journey of highs and lows as they navigated us through hydroxychloroquine, Zithromax, Remdesivir, Zinc and Vitamin C, corticosteroids, vaccines, new variants, politics and, more recently, ivermectin. With all this change and uncertainty, it is important that some things remain constant and within our control, like self-care. Self-care is vitally important during these challenging times, so aesthetic clinics have remained busy throughout the pandemic.
There are several reasons people continue to seek aesthetic treatments in spite of COVID-budgets and the risk of going out. Many have intentionally prioritised health and wellness during the pandemic, and so have continued with their regular skincare programme. Stress and constant background anxiety affect our hair, skin and body, and subsequently, aesthetic doctors are seeing a lot of stress-related skin and body conditions such as weight gain, mask related breakouts, tension headaches and pigmentation.
“The Zoom Boom” has resulted in an influx of patients driven to treatments after scrutinising their reflections in endless virtual meetings and webinars. People are working virtually from home, so are more flexible with their visits to the aesthetic doctor. It’s also easier to hide any downtime or possible bruises behind a mask or computer screen. Unused travel or entertainment budgets are being repurposed for aesthetic treatments. Most of all people have treatments simply to uplift their spirits. Aesthetic treatments are known to enhance mood and self-esteem and morale, all desperately needed in these challenging times.
But how safe is it to have aesthetic treatments during the COVID-19 pandemic? What if you’ve had COVID-19? What about the COVID-vaccine and aesthetic treatments? A report from the FDA about three cases of facial swelling in areas of dermal filler after COVID- vaccination has caused much anxiety. These are all very valid and important questions.
Vaccines and aesthetic treatments
On December 17 2020, The Food and Drug Administration (FDA) disclosed that three study participants in the Moderna Vaccine trial, all with a history of dermal fillers, experienced localised swelling around their fillers after receiving the vaccine. Two of those patients had prior dermal fillers in their cheeks within six months before vaccination. The other had received dermal filler in the lip two days after receiving the vaccine.
For all three participants, the reactions were mild and temporary, and either resolved spontaneously or after simple treatment with oral antihistamines or cortisone. In the case of the patient who received lip injections two days after the vaccine, it’s not clear whether the inflammatory response was the result of the vaccine or simply the normal swelling that can occur after lip fillers. In the weeks since the FDA announcement, there have been other anecdotal reports of COVID-vaccine related swelling in people with fillers.
These findings are not at all surprising, as this has happened before with other vaccines, such as the Influenza vaccine. Vaccines are designed to create inflammation.
They work by stimulating the immune system causing a temporary generalised heightened inflammatory state in the body. This causes the typical symptoms of inflammation – ranging from local, mild injection-site arm pain and swelling, – to mild fever, fatigue and muscle aches, all of which usually resolve in three to five days. The swelling, however unwelcomed, is actually a good sign that the patient is developing antibodies against the vaccine. Please note that this is not an allergy and can happen with any filler and any vaccine.
A warning about inflammatory events from vaccines and other immunologic triggers should be part of routine informed consent before having any aesthetic treatments. This pro-inflammatory state applies not only to vaccines, but to any condition that can trigger an immune reaction in the body such as a recent cold, sinusitis, and dental procedure, viral and bacterial infections.
It is routine to wait four-six weeks after infection, vaccine or dental procedure before having aesthetic treatments. With the COVID-19 vaccine, AAMSSA advises that you wait four weeks before your first, and four-six weeks after your second vaccination before having aesthetic treatments.
The good news is that swelling after having a vaccine is very rare, self-limiting and readily treatable with oral medications. The risks associated with receiving the COVID-19 vaccine have proven to be very low, and do not outweigh the benefits of delaying or not receiving the vaccine.
Of course, if you’ve experienced filler related side effects from other vaccines or illnesses in the past, please inform your doctor, as taking an antihistamine before your vaccination may be beneficial.
What about my anti-wrinkle injections?
Neuromodulators such as botulinum toxin injectables are not to be confused with dermal fillers. Neurotoxins temporarily weaken muscles to smooth wrinkles and have not been implicated in COVID-provoked swelling.
Dermal fillers and dissolvable threads are injectable implants that are designed to remain in your tissues for a protracted period of time. Toxins, on the other hand, don’t remain in the body. They do their work, chemically altering the action of neurotransmitters, and dissipate away.
Interestingly, there is actually scientific evidence that botulinum toxin has a mood-elevating effect. In these stressful times, it is helpful and psychologically uplifting (excuse the pun!) to continue with regular three-four monthly injections. The pandemic has reinforced the importance of regularly scheduled neurotoxin treatments, as those who have stopped or missed doses find that it takes longer to get back on track.
Some patients have noted that their toxin injections have been less effective during the pandemic. The jury is still out as to the cause of the reduced efficacy, but there is a definite link to reduced or missed doses. In addition, tighter budgets, cutting back on medical-grade cosmeceuticals and regular collagen induction therapy (e.g. chemical peels, micro-needling, mesotherapy and lasers) results in thinner, more dehydrated skin. As a result, the toxin injection might be blamed for not working as well as usual.
I have had COVID-19! When can I restart my aesthetic treatments?
As previously mentioned, any viral or bacterial infection triggers an immune response in the body. This pro-inflammatory state usually lasts a few weeks after recovery. AAMSSA, therefore, recommends that you wait 4-6 six weeks after the resolution of COVID-19 symptoms before having aesthetic treatments. If you had no symptoms, wait 6 weeks after the date of your positive COVID-19 test.
This is especially important with treatments like dermal fillers and thread lift procedures where an implantable medical device is injected into the body.
Please inform your aesthetic doctor if you have had COVID-19. Some of the medications you may have taken could affect treatment outcomes, so it’s vitally important that you give a full updated medical and drug history before continuing with treatments.
What’s more, as autumn and winter approach we will be at risk of the usual colds and flu and other respiratory infections. The exact same rules apply: wait four-six weeks after recovery before having treatments.
Patient safety is foremost in the practice of aesthetic medicine. AAMSSA continues to monitor the relationship between COVID-19 Infection, COVID-Vaccinations, and aesthetic treatments, in particular the relative risks for dermal fillers.
It must be emphasized that the risks of the COVID-Vaccine far outweigh the benefits in preventing potentially dangerous illnesses, the aesthetic practitioners should help to encourage vaccination to dispel misconceptions.
Reactions to aesthetic treatments post-COVID-Vaccine or infection will most likely be very rare, self-limiting and readily treatable. However, the aesthetic practitioner should remain alert to potential reactions, and manage appropriately. We should be ready to answer patient’s question and allay anxiety around aesthetic treatments and COVID-19.
The importance of expert injectors
There is a general consensus that older and poorly placed fillers tend to be more reactive than newly injected fillers delivered using proper techniques. It’s also worth noting that higher volumes of filler have been linked to swelling, which is why good aesthetic doctors generally dose conservatively, favouring a slow-and-steady approach and avoiding big bolus-style injections.
If you choose to have aesthetic treatments, go to an experienced medical doctor who you trust. An AAMSSA registered aesthetic doctor, specialist dermatologist, plastic surgeon or oculoplastic surgeon will be up to date on the latest safety protocols and know-how to minimise and manage complications – particularly those connected to COVID-19. Now is not the time to get injected by a random person in a salon or the cheapest doctor offering specials! (Don’t ever do this, actually).
Like most other decisions you’re making in this strange new world, the choice to have aesthetic treatments should not be taken lightly. As with anything, there is a risk-reward ratio to consider when deciding if you should undergo a procedure. However, it is very reassuring to know that it is safe and in fact, good for you, to have aesthetic treatments in the midst of the pandemic. Your AAMSSA registered Aesthetic Doctor follows very strict guidelines and protocols to ensure that the practice is sterilised and disinfected with appropriate use of PPE to make the experience as safe and protected as possible.
Written by Dr Debbie Norval
MBBCh (Rand) Dip Pall, Med (UK) M Phil Pall Med, (UCT) Adv Dip Aesthetic Med (FPD)
- Founder and owner at Dr Debbie Norval Aesthetics www.drdebbienorval.com
- President of AAMSSA (Aesthetic & Anti-Ageing Society of South Africa) www.aestheticdoctors.co.za
- Actively serves on the Ethics and Professionalism Committee of the SAAHSP
To report any unsafe practice or if you have any queries please feel free to contact Karen Nel at AAMSSA firstname.lastname@example.org
Find a doctor practising aesthetic medicine in South Africa by visiting www.aestheticdoctors.co.za
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Debbie Norval and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Autumn 2021 Edition (Issue 36 – Mar 2021 to Jun 2021).
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