Common questions about injecting in medical aesthetics

Dr Tim Pearce

June 19, 2023

When starting out in medical aesthetics, there are many scenarios that can arise which can leave you struggling for answers – can you give lip fillers to a patient with a piercing, can a patient have semi-permanent make-up after lip fillers, will the procedure trigger an outbreak of cold sores, can your patient fly and go on holiday after treatment, and can you inject in or near birthmarks and other skin lesions?

In this blog, Dr Tim Pearce answers these common questions posed by aesthetic clinicians.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

Can you perform a lip filler treatment if the patient has a lip piercing?

This is a very common question; but you need to think about the potential risks in relation to their specific piercing, says Dr Tim. If the piercing has recently been done, then absolutely do not to treat the patient with lip fillers because there is medical complexity. This presents a risk of infection or an outbreak of cold sores (herpes simplex); you want to avoid adding further complexity to the aesthetic procedure. The advice is to wait for two weeks for it to heal, and only when the piercing is stable can you consider an injectable treatment into the lips.

If you choose to treat, there are other considerations depending on what will happen to the piercing or the area around it if you perform a lip augmentation procedure. The main concern must be from post procedural swelling. This is likely to require removal of the piercing, at the point of treatment, to avoid compression of the skin due to a tight piercing ring, for example. Removal will protect the lip whilst it is swollen for some days after treatment. You should discuss this requirement with your patient beforehand.

Similarly, it is important to make patients aware, depending on the level of augmentation being performed, that they need to consider if their existing piercing will fit or sit in the same way post-procedure. This is not a risk to you, as a practitioner, but certainly worth raising for patient awareness.

Finally, to avoid the (unlikely) risk of infection post lip filler treatment, Dr Tim recommends avoiding injecting directly in the hole where the piercing passes through the lip.

Can injecting lips with filler trigger a cold sore (herpes simplex virus)?

Dr Tim does not believe that the filler product triggers the outbreak of a cold sore; it is most likely due to the inflammation and trauma caused to the vermillion border by the needle during the procedure. You may, therefore, be able to limit the risk by causing less trauma while you inject, by perhaps using a technique that requires fewer injection points or by using a cannula, entering lateral to the oral commissure, and avoiding injecting directly into the lip.

To avoid a herpes simplex outbreak, you can also use prophylaxis; prescribing acyclovir before the procedure may help. This is usually done by starting the course of acyclovir 24 to 48 hours before treatment and continuing for two or three days post-procedure to prevent development of a cold sore. The risk also depends on the patient, and the frequency of their cold sore outbreaks.

Can patients have semi-permanent make-up before or after a cosmetic injectable treatment?

The honest answer is that there will be no data on this to find out because studies will not have been commissioned. Thus, as medical professionals, we tend to use fundamental principles on all treatments that might occur around about the same time as an aesthetic injectable treatment; good practice is therefore to leave at least a two-week gap, or until all side effects or symptoms of the original treatment are gone before embarking on something else.

For example, after a semi-permanent make-up procedure, there may be redness, inflammation, minor scabbing, or the risk of an outbreak of herpes simplex (cold sores). All these side effects should have settled down before you consider carrying out any injectable treatments in the lips to keep things simple and avoid medical complexity if a complication were to occur. It is more difficult to establish cause if there is not an adequate time gap between the two treatment events.

Can you inject near or into a birth mark or other skin lesion?

It would be an absolute no to inject anything that was cancerous because it could risk causing the spread of cancer cells. Therefore, if you have a patient who has a melanoma that is due for excision you would avoid treating in the same area, even within the perimeter of the lesion.

If the patient has a normal birthmark or other skin lesion, like a mole, you should still do everything you can to avoid injecting directly into it. Although the risk is likely to be negligible, Dr Tim offers caution on whether you really want to find out, thus avoidance is best practice. If you are treating near a very vascular lesion, like a strawberry nevus, for example, you have an increased chance of bruising and bleeding. Thus, again, common sense prevails, and it is worth avoiding if you can. Other than trauma, there is unlikely to be any significant risk or obvious harm if you do pierce such skin lesions, the tissue will recover over time, but it is better to avoid for the simplicity of the aesthetic procedure.

Can my patient fly on an airplane after an aesthetic treatment?

When patients are asking about flying, they are usually concerned if there a risk due to the changes in air pressure, and whether this will have an adverse effect on their cosmetic injectable treatment. You can reassure them that there is no risk at all. Dr Tim believes this misconception may stem from advice given following cosmetic surgery procedures, particularly breast enhancement. Following breast surgery, you cannot fly immediately afterwards due to the risk of air present in the chest cavity which may expand during the flight and affect breathing. This does not apply to dermal filler or botulinum toxin treatments; however, the risk, and why practitioner might dissuade a patient from flying immediately following treatment is more about being away from your practitioner if something bad happens.

For this reason, Dr Tim recommends that if you are treating patients with dermal fillers, you have a policy of a minimum of 48 hours before they leave home and board a flight. This will give you the chance to diagnose and treat a vascular occlusion before they are in a situation where they cannot get medical assistance. Other complications that might happen once the patient is on a plane can usually wait for medical assistance, such as developing an infection or an allergic reaction. Once the patient has landed, if these do occur, you can often support them in finding a local doctor and liaise appropriately, but a vascular occlusion must be addressed quickly and during the limited period before they go on holiday; hence the 48-hour stipulation.

Botulinum toxin treatment is different, and Dr Tim does not believe there is anything to worry about in relation to Botox treatment and flying almost immediately. Any possible anaphylactic reaction would be picked up well before they got to the airport terminal, although he gives his patients the same 48-hour rule for extra safety.

You can find Dr Tim Pearce on Instagram if you have any common questions about medical aesthetic treatments, or wish to comment on any top tips you are going to implement; he loves to hear from you all.

Is your worst nightmare causing a VO?

If you want to be a great injector then you need to get over your fear of complications. Register here for the next webinar to help you overcome your complications anxiety >>

Subscribe to our YouTube channel for really useful regular tips and advice.  

Botox® is a registered trademark of Allergan Aesthetics plc.

Dermal Filler & BOTOX® Complications eLearning Courses

If you want to increase your knowledge about potential injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• BOTOX® Foundation Course
• Dermal Fillers Foundation Course
• Botulinum Toxin Complications Mastery
• Dermal Filler Complications Mastery

Both give CPD and certificates on completion and are highly rated by our delegates.

In addition, browse our FREE downloadable resources.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.