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Botox, Fillers, Lasers and other Cosmetic Procedures: getting them done Safely

Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: lasers, energy devices, and injectable neurotoxins and fillers.

Alam M, Kakar R, Nodzenski M, Ibrahim O, Disphanurat W, Bolotin D, Borovicka JH, Pace N, Alster TS, Arndt KA, Beer KR, Berlin JM, Bernstein LJ, Brightman LA, Butterwick K, Cox SE, Chotzen V, Fabi SG, Fitzpatrick RE, Geronemus RG, Goldman MP, Groff WF, Kaminer MS, Kilmer S, Rohrer TE, Tanzi EL, Silva SK, Yoo SS, Weinkle SH, Strasswimmer J, Poon E, Dover JS.

JAMA Dermatol. 2015 Mar;151(3):271-7. doi: 10.1001/jamadermatol.2014.2494. Erratum in: JAMA Dermatol. 2015 Feb;151(2):236.



Cosmetic procedures doesn’t mean going only for surgical interventions. Most frequently people undergo non-invasive cosmetic procedures which include:

-injected botulinum toxin and fillers (against wrinkles)

laser and other light energy sources (Intense Pulsed Light (IPL)…)

-fat reduction (cryolipolysis)



This study was done to measure the safety of these cosmetic procedures performed by dermatologists

-US propsective study done in 8 geographical areas

-evaluation of cosmetic procedures over several months by 23 dermatologists primarily focusing on cosmetic procedures

detection of adverse events (AE) was done done by: doctors and staff, self-reporting by patients and phone follow-up.




-A total of 20399 cosmetic procedures were done during this period

Adverse events (AE) were found in 48 cases which amounts to a rate of 0.24%

-No serious AE was reported
For each procedure group the results are the following:

Lasers: out of 7991 procedures, 7AE were found (rate=0.99%). The most common AE was post-inflammatory hyperpigmentation

IPL 500-1200nm: out of 596 procedures, 2AEs were detected (rate=0.34%). The most common AE was hyperpigmentation

Radiofrequency: out of 461 procedures, 1AE was found (rate=0.22%). The AE was a burn

Botulinum toxin injection (Botox): out of 6200 procedures 2AEs were found (rate=0.03%). The AEs were lump, nodule, beading

Fillers injection: out of 4430 procedures, 23 AEs were found (rate=0.52%). The most common AEs were lump, nodule, beading.

Cryolipolysis: 1 AE was found out of 254 procedures (rate=0.39%). It was persistent dysesthesia

Ultrasound: out of 467 procedures no AE was found




-Lighter cosmetic procedures appear to be very safe when done by dermatologists.

-The occurrence of adverse events was less than 1% and according to the authors none of the procedures done in this study induced serious side-effects. One can however wonder what happened with the case of cryolipolysis-induced persistent dysesthesia

In our opinion, such results could be extended to plastic surgeons who also focus mainly on the skin as part of their training

In the end, all physicians with the proper training can do these procedures.