Who cannot have facial harmonization and what the consultation checks first

Who cannot have facial harmonization

The truth is that this question has more than one answer, because facial harmonization is not a single procedure. It brings together botulinum toxin, hyaluronic acid filler, collagen biostimulator and technologies, and each one has its own restrictions. Even so, some situations come up in almost all of them.

I usually separate them into three groups. There are those who need to wait, such as pregnant women and people with an active infection. There are those who need a more careful evaluation, such as people with an autoimmune disease or on anticoagulants. And there are those who are not indicated, because they expect something from the procedure that it does not do.

Pregnant and breastfeeding women

During pregnancy, I do not perform injectable aesthetic procedures. A review of aesthetic procedures during pregnancy and lactation points out that there are no published safety data on fillers in pregnant women. For botulinum toxin, the data are still insufficient for a recommendation, and the authors advise that the consent form record pregnancy as a contraindication. The FDA, the United States regulatory agency, states that the safety of fillers is unknown during pregnancy and breastfeeding.

For breastfeeding, the same review is less restrictive with some procedures, but I remain cautious and prefer to postpone injectables. Waiting a few months does not change what can be done later and avoids exposing you and your baby to a risk that has not yet been studied. In the meantime, the consultation can already be used to plan what to do further down the line.

Active infection or inflammation

Inflamed or infected skin in the application area is a reason to postpone. The FDA's guidance is to wait until the condition is under control, and that applies to inflamed pimples and cysts, skin rashes and hives. In the case of cold sores, an international consensus on fillers recommends waiting for the lesions to heal completely before applying. If you have had cold sores before, say so beforehand, because the same consensus recommends prevention when the application is in a vulnerable area, such as the lips.

As a dentist, I also look inside the mouth. An article on patient factors that influence filler complications advises against treating anyone with a dental abscess, periodontal disease, sinusitis or an ear, nose or throat infection until the problem is resolved. The reason is that those infections can reach the filled area. If there is an infected tooth, the tooth is treated first.

Allergies, diseases and medications that call for evaluation

Some conditions do not rule out treatment forever, but they change the approach. That is why I need to know about them before any application.

Use of immunosuppressants, recent dental treatment and previous aesthetic procedures also come into that conversation, including those you had many years ago or with another practitioner.

When expectations do not fit the procedure

The last situation has nothing to do with disease, but with what the person expects. Rejuvenation is not about trying to look 20, it is about aging well, preserving your features and your expression. When someone expects a change the procedure does not make, such as ending up with someone else's face, I say so clearly before any application. I do not make false promises.

The literature treats this point as part of safety. The same article on patient factors advises aligning expectations before treatment, so that no one expects an unrealistic result, and calls for caution when there are signs of distress about one's own image. In those cases, I prefer not to apply.

What I check at the in-person consultation

Many people think the consultation is just for choosing the procedure, but it is where I find out whether you can have it now, whether you need to wait or whether you are not indicated. Before any application, I check:

• Your health history, including diseases, allergies, pregnancy, breastfeeding and regular medication.
• The procedures you have already had, with which product and how long ago, when you have that information.
• The skin and the mouth, to rule out active infection or inflammation.
• The face in layers, to understand what comes from the bone, the fat and the skin.
• What you expect, to tell you what can and cannot be done.

After that I put the plan together and explain the risks of each stage. Anvisa, the Brazilian health regulatory agency, advises that the practitioner draw up the treatment plan together with the patient, explain the possible complications and hand over the traceability card for the product used, with a copy kept in the patient record. You can ask for that card at any procedure you have.

When an impediment comes up, the plan does not end, it changes order. Sometimes the first step is treating a tooth, waiting until breastfeeding is over or talking to whoever manages your condition. Harmonization is not something to rush.

Frequently asked questions