While knowing the anatomy is critical for successful cosmetic filler use, that’s not the only thing that will prevent filler-related complications or help physicians to better manage those problems once they occur, according to Joel L. Cohen, M.D., director of AboutSkin Dermatology and Dermsurgery in Greenwood Village and Lone Tree, Colo.
Dr. Cohen, associate clinical professor of dermatology, University of Colorado, and assistant clinical professor of dermatology at University of California, Irvine, talked about avoiding and managing filler complications at the August 2017 Masters of Aesthetics symposium in San Diego.
One such complication can result from antiseptic skin prep.
A review article published January 2017 in Dermatologic Surgery has questioned the safety of chlorhexidine as an antiseptic skin prep, according to Dr. Cohen.
Corneal injury has occurred with its use. And, in February 2017, the FDA released a warning about a growing number of rare but serious allergic reactions reported with skin antiseptic products containing chlorhexidine gluconate.
But used safely — meaning not around the eyes — chlorhexidine is among the most effective antiseptics for prepping head and neck dermatologic surgery patients, according to Dr. Cohen, who was among the authors on a paper published August 2017 in JAMA Dermatology, comparing postsurgical infection rates for different skin preps.
“In a large dermatologic surgery trial, we found chlorhexidine had the lowest incidence of infection,” Dr. Cohen says.
Dr. Cohen says that he carefully uses chlorhexidine on the face but does not use it around the eyes or eyebrows.
“From a safety perspective, as we’re prepping a patient, we can have patients close their eyes. We use isopropyl alcohol first and then carefully chlorhexidine to regions of the face except around the eyes,” he says.
Around the eyes, Dr. Cohen uses Betadine (povidone-iodine, Purdue Pharma) or Techni-Care (Chloroxylenol, Care Tech Laboratories), but he says Betadine does cause some temporary orange-ish discoloration to the skin. While Techni-Care wasn’t used in as many cases in the recent report as chlorhexidine, it, also, had a low incidence of infection, he says.
“There have been a couple of circumstances in the past few years when Techni-Care has not been available, but it is back on the market now,” he says.