Breaking the integrity of the skin during minimally invasive cosmetic procedures can provoke, among other complications, the reactivation of the herpes simplex virus. The appearance of herpes on the lips after, for example, filler injections causes significant discomfort to patients, reduces the degree of satisfaction with the result obtained, and can cause scarring of the infected area. The article estet-portal.com provides recommendations by Dr. Cormac Convery on prevention and treatment of herpes on the lips after aesthetic correction.
- Herpes virus reactivation on the face: signs and symptoms
- After what cosmetic procedures can herpes appear on the lips
- How to minimize the risks associated with HSV reactivation
- Prevention and treatment of herpes after cosmetic procedures: ACE recommendations
Reactivation of the herpes virus on the face: signs and symptoms
In the vast majority of cases, HSV-1 leads to the manifestation of herpetic elements on the face, much less often – HSV-2 (10%).
Symptoms of herpes virus reactivation often appear 24-48 hours after the procedure. First signs of complications:
- neuralgic pain;
- tingling sensation;
- itching;
- dysesthesia.
Herpes zoster results in vesicles or vesicles with a unilateral dermatomal distribution, in the case of HSV the location of the elements can be bilateral with clear boundaries of the affected areas.
In some cases, HSV can be mistaken for a bacterial infection.
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Herpetic eruptions initially appear as thin-sheathed intraepidermal vesicles that subsequently burst, crust and heal. As a rule, ulcerations are round, covered with a yellowish film, and their borders are erythematous. Ulcers that remain after the blisters break, often weeping.
After what cosmetic procedures can herpes appear on the lips
After the initial infection, the latent virus is localized in the ganglions of the dorsal roots. It is believed that its reactivation can provoke direct damage to the axon with a needle during a cosmetic procedure. Tissue manipulation, controlled skin injury, and inflammatory reactions may also be involved, but in the case of dermal fillers, hyaluronic acid acts as a protective agent, preventing virus replication.
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Herpes on the lips may appear after:
- contouring;
- mesotherapy;
- laser therapy;
- chemical peels;
- microdermabrasion, etc.
Herpetic rash after contouring is most often formed at the injection site or on adjacent areas of the face.
The frequency of herpes activation after filler injections in the lip area, according to the FDA, is 1.45% of all cases of contouring of this area.
How to minimize the risks associated with HSV reactivation
The likelihood of scarring after cosmetic procedures is low, but it should be taken into account before any correction is carried out. The risks associated with reactivation of the herpes virus can be minimized by appropriate preventive measures.
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Thus, according to the results of studies on methods for preventing recurrence of herpes infection, patients are advised to take a course of antiviral drugs before undergoing laser skin resurfacing.
Despite the limited nature of research, prophylactic antiviral therapy can be considered an effective method to reduce the risk of reactivation of
The Aesthetic Complications Expert Group (ACE) recommends prophylaxis of herpes virus reactivation in case of:
more than 3 spontaneous outbreaks of herpes per year;
- activation of herpetic infection after cosmetic procedures in history;
- history of herpes on the lips after lip augmentation with fillers;
- weakened immune defenses/taking immunosuppressants;
- fractional laser therapy, mesotherapy, medium and deep peels, microdermabrasion.
ACE:
1st line:- acyclovir
- – 400 mg twice or thrice (for patients at risk or immunocompromised) daily; 2nd line: valaciclovir
- – 500 mg once or twice (for patients at risk or immunocompromised) times daily. The prophylactic course starts 1-2 days before the procedure; its duration is 5–7 days.
1st line:
- acyclovir
- – 200 mg 5 times a day for 5 days (extend the course if healing is incomplete); or 400 mg 5 times a day for 5 days for patients at risk or with weakened immune defenses (extend the course if healing is incomplete); 2nd line: valaciclovir
- – 500 mg twice a day for 5 days.
1st line: acyclovir – 800 mg 5 times a day for 7 days;
- 2nd line: 1 g 3 times a day for 7 days.
- To make cosmetic procedures as safe as possible for the patient and reduce the risk of herpes on the lips and other treated areas, it is important to ensure proper history taking and preventive measures, especially for patients at risk.
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