How to manage skin procedures with implants, heart valves, pacemakers, etc.
Dear Dr. Irwin, Firstly thank you very much for your time and priceless advice, I am sure many patients must appreciate it. I am a 52 year old female and have terribly sagging jowls and hooded eyelids! I am on warfarin for a prosthetic heart valve and am a little more high risk for infection to the valve. Would you mind advising, does clearlift laser treatment have any risks of post infection, and would healing be slower or bruising occur due to warfarin, (though my INR range is 2 so quite low)? I am particularly concerned over any risk of infection. Thank you very much for your time and consideration, but mostly kindness for all your help and advice you provide to many patients. Very Best Wishes, Kate.
You really made my day Kate. You’re so welcome, and at some level, don’t we all live to be of service to each other? Sometimes whether we know it or not. Maybe we could get Putin and those filled with hate to figure that out.
We all know that with dentistry often antibiotics are prescribed for those with prosthetic valves, hip replacements and the like. The mouth though, is different from skin. Dentistry is much higher risk due to the amount and types of bacteria. And also the fact that the mucosa is thin and bleeds easily.
The Clearlift is a Q-switched Nd:YAG laser which doesn’t break the skin. It requires lots of treatments and patience. My vote would be to use Thermage, Exilis or Ultherapy instead, if you are wanting something gentle and noninvasive. None of these modalities will have a fabulous effect on jowls and hooding. We have seen good results though with the Thermage eyelid tip done 2-3 times over 6 months with some filler support in the brow area after for hooding. Especially if you don’t want to risk a post laser infection.
Considerations to think about – the infection risks:
- The risk of infection from skin needles and scalpels is extremely low, IF a proper skin prep is done usually with Hibiclens. Our clinic would usually prep 2-3 times over the area, and if any excess oil, use alcohol as well.
- If you are immunosuppressed, you need to discuss any procedures with your doctor. It doesn’t sound like you are though.
- For lasers, it’s more the infection risk post procedure. Consider having a nasal swab (just a q-tip) culture done to see if you are a carrier of Staph aureus 3 weeks before using lasers that break the skin barrier layer.
- Lasers that break the skin barrier layer include CO2, Fraxel, erbiums, and a few others. IPL/BBL is not in this category.
- Be sure your dermatologist for the laser knows about your valve and anticoagulation. This sounds obvious, but it’s surprising how many people forget to bring this up unless asked.
- Some dermatologists may want to use antibiotic post laser to reduce the risks.
Considerations to think about – the warfarin and anticoagulants:
- If there are no scalpels or needles, the risk of anything more than minor bruising is low. Lasers are generally fine.
- Often a nice facelift-like effect can be achieved with just fillers (when done well). This approach will bruise on anticoagulants, but can be limited by the application of a good topical anesthetic ointment for 45-60 min. This is because the small amount of epinephrine in many of these ointments constricts the blood vessels in the skin.
- It may be worth it to put up with some bruising for a week or two with a good cover up (see the Colorscience Powder in the shop). Especially if the filler is a long-lasting one. These will usually last 9-12 months before a touch up is needed.
Hope this helps!
Dr. Brandith Irwin, MD
Founder of SkinTour & MadisonMD Skincare
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