Preparing for an aesthetic treatment: medication, alcohol, make-up and more

Why is preparation needed?

Treatments such as botulinum toxin, filler and mesotherapy are done with a needle. When the needle enters the skin, small blood vessels may be affected, which can lead to bruising. In addition, the small entry points in the skin can provide a route for an infection to spread if there is one in the area. Consensus reports on preventing complications list taking a detailed medical history, asking about medication and making sure the skin is clean and free of infection among the basic steps before treatment^[1][2].

Plan the timing

Swelling and bruising that may appear after the treatment usually decrease within a few days, but this varies from person to person. For this reason, it is wise not to schedule a treatment right before an important event such as a wedding, a meeting, a photo shoot or a trip. With botulinum toxin, the effect starts around day 3 on average and the full effect is seen by days 7–10; for both filler and botulinum toxin, the follow-up visit takes place within 1 month of the treatment. You can plan with these timings in mind.

What will you be asked at the examination?

Every treatment is preceded by an examination by a doctor. The following topics are usually covered; thinking about your answers in advance makes the examination easier^[1]:

• Medication and herbal products you take regularly,
• Known allergies, particularly to local anaesthetics,
• Chronic conditions and treatments that affect your immune system,
• Aesthetic treatments you have had before: the date, the area and, if you know it, the product used,
• Recent or planned dental treatment and recent infections,
• The possibility of pregnancy, or whether you are breastfeeding.

Medication and blood thinners

If you take a blood thinner or any medicine that affects bleeding, be sure to mention it at the examination. These medicines can increase the risk of bruising after the treatment^[3]. However, do not stop your medication without consulting your doctor. These medicines are often taken for an important health reason, and stopping them can carry far more serious risks than the treatment itself. Your doctor will discuss with you how the treatment can be planned while you continue your medication.

Please also mention any herbal products you use at the examination. At our clinic, you will be asked to stop products such as green tea one week before the treatment, as they are thought to increase the tendency to bleed.

Alcohol and make-up

You will be asked not to drink alcohol the day before the treatment; at our clinic this is a precaution intended to reduce the risk of bruising. On the day of treatment, do not wear make-up on the area to be treated. Clean skin is one of the basic precautions for reducing the risk of infection through the needle entry points^[2]. Male patients are asked to come clean-shaven for masseter, jaw and mesotherapy treatments.

Isotretinoin, acne and cold sores

• Isotretinoin (an oral medicine used to treat acne): This medicine can affect the skin's healing process. How long to wait after the medicine is debated in the literature; the evidence behind older recommendations is described as limited^[4]. At our clinic, taking a cautious approach, treatment is planned 3 months after the end of the course.
• Active acne and infection: If there is severe active acne or another skin infection in the treatment area, treatment is not carried out, as the needle could carry the infection into deeper tissue^[2].
• History of cold sores: Especially for treatments around the lips, mention any history of cold sores at the examination. An injection can trigger a cold sore to come back^[5]. If there is an active cold sore on the day of treatment, the treatment is postponed.

Pregnancy and breastfeeding

Aesthetic treatments are not carried out during pregnancy or breastfeeding. Data on the safety of botulinum toxin and filler treatments during this period are insufficient^[1][6]; for this reason, treatments are postponed until after this period.

The day of treatment and afterwards

The topical anaesthetic cream is applied at your appointment time; the cream is left on for about 30 minutes. After the treatment, mild redness, swelling and bruising may appear in the area; these usually decrease within a few days, and this varies from person to person. Your doctor will give you aftercare instructions according to the type of treatment; for example, after mesotherapy you will be asked not to wear make-up on the area and to avoid contact with water for the first 24 hours, and to protect yourself from the sun.

Let your doctor know without waiting in the following situations:

• Pain that keeps increasing, paleness of the skin or a purple-grey change in colour,
• Increasing redness, warmth, discharge or fever,
• Drooping of the eyelid, or changes in swallowing or speech,
• Blurred vision or loss of vision (in this case, go to the emergency department without delay).

Further reading

• Botox
• Dermal fillers and facial contouring
• Mesotherapy
• What to keep in mind after botox
• Lip filler: what you need to know before and after
• How many mesotherapy sessions are needed?