Eight things to tell your doctor before an injectable treatment

Medical history in aesthetic practice is often treated as a formality — a hurdle before the booking, from the clinic’s side, and an odd interrogation over “just an injection” from the patient’s.

But putting material into a face is among the harder things to undo. Of the seven boosters we use, only BYRYZN — a cross-linked hyaluronic acid — can be dissolved. The other six have to be waited out.

So this is part of the treatment, not a preamble to it. Each of the eight below is here because the answer changes the plan.

Aspirin, antiplatelet drugs and anticoagulants mean the same treatment bruises far more, and for longer. Supplements such as ginkgo, omega-3 and vitamin E push in the same direction, more mildly.

The most important point: do not stop them on your own. These are usually prescribed for cardiac or vascular disease, and stopping without medical advice carries a risk that is not remotely comparable to a bruise.

What we do instead is one of three things: keep the medication and design around the areas that bruise most, ask you to raise it with your prescribing doctor, or move the date if you have something important coming up.

This is the one most often left out. Sometimes it was years ago and genuinely forgotten; more often it was done elsewhere and feels awkward to raise.

But what is already in the tissue determines what can go in next. Where a material that cannot be dissolved is already present — CaHA (Radiesse, DCLASSY) or PCL (GOURI) — both volume and depth have to be planned differently.

You do not need the product name. Roughly when, roughly where, and whether it was an injection or a thread already changes the assessment considerably.

Almost nobody expects this one to be relevant.

Hyaluronic acid filler sites have been reported to swell and harden weeks to months after an uneventful treatment. This is called a delayed inflammatory reaction, and reported triggers include systemic infection, vaccination, local trauma and dental procedures. The treatment goes well; then a bout of flu or a scale-and-polish months later is followed by swelling at the site.

Reported incidence ranges widely by product, from 0.02% to 4.25%. Uncommon — but if you do not know it exists, you look for the cause in the wrong place.

So we ask two things: are you unwell now (if so, we wait until it settles), and is a vaccination or dental appointment coming up. The second usually does not mean no treatment — it means leaving a gap so that cause and effect stay legible.

There is essentially no research on aesthetic injectables in pregnancy or breastfeeding. We advise against them not because there is evidence of harm, but because there is no evidence of safety.

Tell us if you are planning a pregnancy too. It changes the scheduling more than the decision itself.

Three questions:

• Reactions to local anaesthetic — light-headedness or palpitations after dental anaesthesia, for instance. Many boosters contain lidocaine
• Reactions to previous fillers or boosters — unusually prolonged swelling, or a nodule
• Any autoimmune diagnosis — the data here is thin, so we proceed carefully

People often skip these as “probably nothing”. A reaction that happened once can happen again, and it is the kind of thing that changes which product and which anaesthetic we use.

Herpes simplex lies dormant and reactivates when provoked. Injecting around the mouth can be that provocation.

Told in advance, we can prescribe an antiviral prophylactically. Once a lesion has appeared, we wait for it to settle.

The acne medication. For years the rule of thumb was “no procedures for six months after stopping”.

That rule has been re-examined. A 2017 systematic review and expert consensus in JAMA Dermatology reviewed 1,485 procedures across 32 papers and concluded there was insufficient evidence to delay superficial chemical peels, manual dermabrasion, cutaneous surgery, laser hair removal and fractional laser procedures. It still advised against mechanical dermabrasion and fully ablative laser.

That is not the same as “anything goes”. It depends on the procedure, and that review did not cover injectables at all. So we ask whether and when you took it, and judge against the treatment in question.

CaHA products (Radiesse, DCLASSY) are radiopaque — they appear white on CT. A radiologist who does not know they are there may read them as a lesion or a foreign body.

We check for planned imaging beforehand, and afterwards we ask you to mention the treatment whenever you have a scan. This is not a danger; it is information that prevents unnecessary further investigation.

• Treatment at another clinic — we are not asking to judge it
• “It didn’t work” — this is among the most useful things you can tell us. It helps identify what did not fit
• Budget — choosing the one treatment that helps most now beats stretching to do everything. Doing less is also a plan
• “I haven’t decided yet” — a consultation on its own is a perfectly good outcome

You do not need to memorise all eight. In practice this covers it:

• Your medications — a photo of the packet
• Anything previously put into your face — even just roughly when and where
• Being unwell, or having a medical or dental appointment coming up

We will ask about the rest. And when in doubt, say it. If it turns out to be irrelevant we simply move on; proceeding without something that mattered is much harder to undo.

Written and reviewed by Lee Chi-Hak, MD, medical director of Miso Clinic in Daegu, South Korea. The clinic keeps seven collagen and skin boosters with genuinely different mechanisms alongside three lifting devices, and selects among them according to what kind of ageing the face is actually showing. Our approach is restraint: choosing to do less is also a clinical decision.