Dear Dr. Irwin, first of all thank you for your time and invaluable advice, I’m sure many patients will appreciate it. I am a 52 year old female with horrible sagging cheeks and closed eyelids! I am on warfarin for a prosthetic heart valve and am at slightly higher risk of valve infection. Could you advise me, does the Clearlift laser treatment have risks of post-infection and would healing be slower or bruising due to warfarin (although my INR is 2, so quite low)? I am particularly concerned about the risk of contamination. Thank you for your time and consideration, but most of all kindness for all your help and advice you give to many patients. Kind regards, Kate.
You really made my day Kate. You’re welcome, and on some level don’t we all live to serve one another? Sometimes whether we know it or not. Maybe we could get Putin and the hateful to find out.
We all know that dentistry often prescribes antibiotics for patients with artificial valves, hip replacements and the like. However, the mouth is different from the skin. Dentistry is a much higher risk due to the amount and type of bacteria. And also the fact that the mucous membrane is thin and bleeds easily.
The Clearlift is a Q-switched Nd:YAG laser that does not damage the skin. It requires many treatments and patience. My vote would be to use Thermage, Exilis or Ultherapy instead if you want something gentle and non-invasive. Neither of these modalities will have a fabulous effect on the cheeks and hood. However, we have seen good results with the Thermage eyelid tip applied 2-3 times over 6 months with some filler support in the brow area after concealing. Especially if you don’t want to risk post-laser infection.
Considerations to think about – the risks of infection:
- The risk of infection from skin needles and scalpels is extremely low when proper skin preparation is normally performed with Hibiclens. Our clinic usually prepares the area 2-3 times and also uses alcohol in case of excess oil.
- If you are immunocompromised, you must discuss all procedures with your doctor. It doesn’t sound like you are, though.
- With lasers, it is more the risk of infection after the procedure. Consider having a nasal swab (just a cotton swab) 3 weeks before having lasers that break the skin barrier to determine if you have Staph Aureus.
- Lasers that break the skin barrier include CO2, Fraxel, Erbium, and a few others. IPL/BBL does not belong to this category.
- Make sure your dermatologist knows about your valve and anticoagulation for the laser. That sounds obvious, but it’s surprising how many people forget to bring this up unless asked.
- Some dermatologists may want to use an antibiotic after the laser to reduce the risks.
Considerations for Thought – Warfarin and Anticoagulants:
- In the absence of scalpels or needles, the risk of more than minor bruising is low. Lasers are generally fine.
- Often a nice facelift-like effect can only be achieved with fillers (if done well). This approach tends to bruise on anticoagulants but can be limited by applying a good topical anesthetic ointment for 45-60 minutes. Because the small amount of adrenaline in many of these ointments constricts the blood vessels in the skin.
- It may be worth putting up with some bruising for a week or two with good coverage (see Colorscience Powder in the shop). Especially if the filler is durable. These typically last 9-12 months before a touch up is needed.
Hope that helps!
dr Brandith Irwin, MD
founder of SkinTour & MadisonMD skin care
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