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Complications can arise in any cosmetic procedure, and appropriate consultation prior to any treatment to obtain informed consent is of utmost importance. This chapter concerns the potential complications of common cosmetic procedures that are performed on Asian patients. Procedures that are discussed here include chemical peels, laser therapy, radio frequency (RF), botulinum toxin, and fillers.


Chemical peeling, especially medium depth and deep peels, are in many ways similar to ablative resurfacing and have similar potential complications, so they are discussed together. Plasma skin resurfacing and fractional resurfacing are new technologies that are considered to be nonablative but do have results that are compatible to ablative resurfacing. The complications of these procedures are also discussed.

Absolute contraindications of chemical peels and ablative resurfacing are rare and include previous history of keloid, autoimmune disease, pregnancy, and current oral isotretinoin intake. Prior to any ablative procedure, a careful inspection to detect any scars, excoriation, or inflammation is necessary. For chemical peel, the peeling agent can penetrate deep into even undetectable scars, causing unexpected worsening of the scar. Petroleum jelly should be applied onto the scar and sensitive areas such as the canthus and vermilion border.

Temporary reactions that occur after ablative procedures are expected consequences, and appropriate explanations to the patient are important to avoid any unnecessary misunderstanding. To minimize permanent or long-lasting complications, physicians must understand the properties of the peel agent and, in cases of ablative laser resurfacing, be familiar with the laser device and parameters, select the proper patients, and detect early signs of complications.


Patients often complain of a tingling, itchy feeling or pain after chemical peel or ablative resurfacing. For patients undergoing superficial chemical peel who experience excessive pain, the peeling agents should be immediately and completely removed by thorough washing. For deep peel and ablative resurfacing, a nerve block and topical anesthetic reduce the pain during the procedure. Oral analgesic is usually adequate for postoperative pain control.


In general, erythema is a normal, inevitable reaction that can occur after chemical peel, fractional resurfacing, and ablative resurfacing. Depending on the type of procedure, erythema disappears spontaneously within several hours to days. Patients should be informed that such a reaction is temporary and inevitable for such treatment. Excessive erythema can be associated with a greater risk of postinflammatory hyperpigmentation (PIH), and in cases of deep peel and ablative resurfacing, scarring can develop.

Measures to minimize erythema include avoidance of spicy food and alcohol, sunlight exposure, fragrant cosmetics (some contain photosensitizer), tretinoin use, and frequent repetitive peels. Topical antioxidant to reduce free radicals can also be helpful to minimize the erythema.

For persistent erythema (lasting longer than 1 week), low-potency topical steroid with twice-daily application can be ...

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