Cosmetic Dermatology: Device Selection, Injectables, and Complication Safety
Match the tool to the target
Cosmetic dermatology questions test patient selection, chromophore matching, and complication recognition. Assess Fitzpatrick skin type and the risk of postinflammatory hyperpigmentation. For lasers, identify the target: melanin for pigmentation and hair, hemoglobin for vascular lesions, and water for ablative resurfacing. Nonablative devices spare the epidermis; ablative devices remove it and carry longer recovery. Chemical peels range from superficial to deep, and depth determines indications and risks.
Injectables
Neuromodulators relax dynamic rhytids and typically begin working within days, peak in 1-2 weeks, and last about 3-4 months. Fillers restore volume or contour; choose product viscosity and duration by location and plane. Hyaluronic acid fillers can be dissolved with hyaluronidase; non-HA fillers cannot. Know facial danger zones and the signs of vascular occlusion: blanching, pain, livedo, and visual change.
Traps
Do not use neuromodulators for static volume loss or fillers for purely dynamic lines. Do not treat active infection or poorly controlled systemic disease without reassessment. Consent, photography, and patch testing are part of the record. Avoid claiming that isotretinoin absolutely prohibits all laser or surgical procedures; assess individually.
Worked rule
For suspected hyaluronic acid vascular occlusion, stop injection, attempt aspiration, and use hyaluronidase promptly; do not massage or apply heat as definitive treatment. For visual symptoms, arrange emergency ophthalmologic care.