Dying to Be Beautiful? The Health Risks of Cosmetic Procedures

Published June 06, 2006

| WebMD

From pedicures that can net you a nasty infection, to anti-aging treatments that can land you on a ventilator, the message seems clear: Looking beautiful sometimes carries a huge price tag.

And while in the right hands experts say most beauty treatments are safe, in the wrong hands the trade-off can be steep.

“It’s an unknown risk because you’re dependant upon the technical ability and integrity of the person performing the treatment – and the types of organisms you may be exposed to can run the gamut from bacteria to viruses, to other types of organisms, like fungi, even micro bacteria related to the tuberculosis organism," cautions Phillip Tierno, PhD, director of clinical microbiology at NYU Medical Center in New York City.

And in some cases, says Tierno, exposures can be deadly. This was the case recently in Fort Worth, Texas, where a wrongful death suit claimed a woman died after contracting antibiotic-resistant Staphylococcus aureus following a pedicure at a local nail salon.

This incident, says Tierno, parallels another, even more widespread calamity that occurred when 110 people who received pedicures at a Santa Cruz, Calif. nail salon contracted a potentially dangerous infection causing treatment-resistant skin abscesses and boils.

But if you think that dangers lurk only in nail salons, think again. Within the past several years the FDA has issued consumer warnings about dangers linked to other beauty treatments as well including makeup that is permanently tattooed on.

Citing numerous reports of adverse reactions ranging from allergies to serious, disfiguring infections, the FDA cautioned consumers about the use of certain shades of inks and dyes, particularly in the red family.

But Tierno points out allergic reactions are not the only problem.

"Any time you breach the skin's surface there is a chance of getting an infection," he says. While it's usually bacterial in nature, he says it also means viruses, including HIV.

Indeed, in December 2003, a jury in San Antonio, awarded a woman more than a half million dollars after it was proven she contracted hepatitis C while having permanent makeup applied at a local salon. In Canada one patient contracted HIV.

Moreover, experts say you may run into other serious problems if you decide to reverse your color choice via standard laser tattoo removal.

"There are certain dyes used in permanent makeup that, when exposed to a laser for removal, will turn the area injected with the dye permanently black, requiring a complex surgery to fix it," says dermatologist Sumayah Jamal, MD, PhD, assistant professor of dermatology and microbiology at NYU Medical Center in New York City.

Cosmetic Procedures Gaining Popularity

Facing Facts

When it comes to the pursuit of youth, perhaps nothing has garnered more attention than "injectables" -- treatments like Botox, Restalyne, and silicone, which have successfully filled wrinkles and relaxed brows for millions of men and women.

However, the American Society of Dermatologic Surgeons (ASDS) recently issued a stern consumer warning when several reports surfaced about complications linked to non-FDA approved injectables.

In one instance a California women died following treatment with a non-FDA approved wrinkle filler administered by an unlicensed practitioner. In another, a "bootleg" version of Botox caused four Florida patients to become paralyzed, with one now living on a ventilator.

Dermatologist Rhoda Narins, MD, says she's not surprised by what happened.

"When you get a treatment with a non-FDA product there is no regulation on how it is made – or how it's used. Right now I am treating a person who went to a hotel room where a woman injected a non-FDA wrinkle filler and now one side of her head is as hard as a rock and she has a tennis-ball size enlargement of her left eyebrow," says Narins, the immediate past president of the ASDS.

But it's not just antiaging treatments that carry risks. Dermatologist Robin Ashinoff, MD, says that in the wrong hands, even a simple spa procedure like hair waxing can lead to serious complications.

"If you are taking the acne medication Accutane, and if the tech does not take precautions, your skin could come off right along with the hair being removed," says Ashinoff, medical director of Dermatologic, Mohs and Laser Surgery at Hackensack University Medical Center in New Jersey.

Similar problems, she says, can occur if you are using a strong Retin-A-based topical product or glycolic acid cream prior to having a hair removal treatment.

"This is especially true if you have your eyebrows waxed, since the skin in this area can be extremely sensitive," says Ashinoff.

Narins adds that some spas are also too liberal with their use of anesthetic creams during waxing and other procedures.

"Many do not realize that if you use too much of certain anesthetic creams they can be absorbed at such a high level, they can cause death," says Narins.

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Buying Problems

In addition to whatever beauty treatments others perform for us, experts say we can also do ourselves harm when we purchase products not intended for consumer use, particularly on the Internet.

"There are extremely reliable sources for beauty products on the Internet – but there are also some unscrupulous sites selling things like medical grade chemical peels that can do you some serious harm," says Jamal.

Case in point, she says, is one patient who recently purchased a 30% salicylic acid peel online – and in the first thirty seconds of use experienced significant burns and skin discolorations.

"Your typical over-the-counter salicylic acid solution is 0.5% to 2%. But this patient had no idea what he was buying because the product did not specify it was for physician use only," she says.

Moreover Ashinoff points out that too often spas purchase these same types of medical grade products, offering treatment without medical knowledge or skill.

"Doing the procedure is the easy part, it's handling the complications that separates the professional from the nonprofessional," she says.

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Staying Safe: 9 Things You Can Do

So, how do you keep from paying a high price for your beauty care? First, experts say remember that problems are still in the minority, and the majority of people do just fine.

That said there are ways to increase your safety odds. With the help of our four medical experts, WebMD offers this checklist of the nine most important ways to stay healthy and beautiful.

Pay attention to surroundings. Tierno says often there are signs indicating how safe and sanitary salon practices are -- if we just pay attention. "Are customers coming and going faster than instruments could be sterilized? Do you see them change the water in a footbath without sterilizing the tub? These are all signs that they may have sloppy hygiene practices," he says.

2. For the safest manicure and pedicure Jamal says bring your own tools -- and ask the tech to leave your cuticles alone. "They should not be cut or pushed back -- it breaks the natural protection barrier between the skin and the nail and invites infection," she says.

3. Never get an invasive treatment -- including wrinkle filling or relaxing injections -- from anyone other than a licensed medical doctor. Period.

4. If you can't find it in your local drugstore -- don't buy it online. This, says Jamal, includes any type of skin treatment or product. "If it's not a brand name, if you can't find it in a local store, at least bring it to your doctor and get his or her approval before you use it," she says.

5. When getting permanent makeup applied make sure the technician uses a new, disposable needle for every client. And, says Ashinoff, make certain they sterilize their hands and any other equipment that touches your skin. When having it removed, make sure a tiny test patch is done first to avoid the blackening oxidation.

6. Ask your spa or salon to see the sterilizing solution used to clean equipment. It should say on the bottle what it kills, and how long it takes to kill it -- for example a 15-minute soak. Also ask about their hygiene protocol –and if they don't have one, run the other way, says Tierno.

7. If your skin is even a little sensitive, Ashinoff says stop all use of retinol or glycolic acid five to seven days before a hair waxing. "If you are taking Accutane make sure the tech knows before the waxing. And if she says it doesn't matter, don't have the procedure done there," she says.

8. To protect against skin infections that occur after hair removal (it's those little red bumps called folliculitis) ask your doctor for an antibiotic cream and apply it for several days prior to the treatment and several days after.

9. Don't get suckered in by low prices, or promises of quick and easy treatment, cautions Narins. Moreover, she says, never have an antiaging treatment in someone's garage, basement, at an "injectable party," or in a hotel room.

Quiz: How Healthy Is Your Skin?

Visit WebMD's Skin & Beauty Center

By Colette Bouchez, reviewed by Louise Chang, MD

SOURCES: Philip Tierno, PhD, director, Clinical Microbiology NYU Medical Center, New York City. Sumayah Jamal, M.D., Ph.D., assistant professor, dermatology and microbiology, NYU Medical Center, New York City. Rhoda Narins, MD, immediate past president, American Society of Dermatologic Surgeons; dermatologist in New York City; Robin Ashinoff, MD, medical director, Dermatologic, Mose and Laser Surgery, Hackensack University Medical Center, New Jersey. Dallas Business Journal, May 16, 2006: “Fort Worth nail salon faces wrongful death suit.” WebMD Feature: “Nail Salon Health Hazards.” WebMD Medical News: “FDA Issues Alert on Tattooed Permanent Makeup.” “Warning to Consumers: Know Who’s Behind the Needle,” American Society of Dermatologic Surgeons. Associated Press.

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