This article discusses the rise in non-surgical cosmetic procedures performed by unlicensed individuals, highlighting health risks such as infections and improper administration. It emphasises the need for physicians to be aware of these issues to better counsel their patients.

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With the rising demand for non-surgical cosmetic enhancements, business is booming for med spas and aesthetic clinics. The procedures offered in these places, which are primarily carried out by licensed aestheticians (read: non-physicians), demand considerable technical skill despite minimal equipment use.

This growing trend, however, has also seen a rise in unlicensed and poorly trained providers offering these services, potentially exposing your patients to health hazards. 

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1. Microblading

1. Microblading is a semi-permanent tattooing technique that involves using fine needles to deposit pigment into the superficial layers of the skin.[1] 
2. A 2024 review published in the Journal of Clinical Medicine states, “The incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple-areola, lips, and eyebrows tattooing, and utilisation in oncological radiotherapy such as colon marking.”[2] 
3. Despite being marketed as low-risk, microblading shares common tattoo-related complications such as inflammation, infection, allergic reactions, and granulomatous responses. 
4. A significant risk associated with microblading is the transmission of infections. A study by the FDA discovered that a notable percentage (19%) of even unopened and sealed permanent makeup inks were contaminated with pathogens.[3]

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2. Eyelash extensions

1. Eyelash extensions enhance the appearance of eyelashes, an attribute culturally linked to femininity. These extensions, made from synthetic (like nylon) or natural fibres (including horsehair, silk, or mink), are attached to natural lashes using a specialised adhesive. Unfortunately, ocular side effects can occur. A study done among female university students in Nigeria reported an adverse event rate of 54%.[4] 
2. The procedure can be risky due to the proximity of sharp tools to the eye or poor hygiene practices at the salon.

The American Academy of Ophthalmology cautions about the potential dangers of eyelash extensions, including risks of eyelid and corneal injuries, infections, allergic reactions to formaldehyde-based glues, vision impairment, and the possibility of permanently losing eyelashes. As well, extension fibres can often become embedded under the eye tissue, sometimes necessitating surgical removal.[5] 

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3. Phenol peel

The phenol peel—known to be the most intense chemical peel—is so aggressive that many board-certified dermatologists shy away from offering the procedure to their patients.

Its deep penetration can dramatically reverse ageing signs on the skin like no other treatment; however, it comes with significant risks, including arrhythmia, laryngeal oedema, renal toxicity, and even toxic shock syndrome. 

Given these potentially severe side effects and the availability of safer, less invasive medium-depth peels—such as the 50% trichloroacetic peel, 70% glycolic acid peel, and Jessner's solution—the phenol peel often isn't considered worth the risks.[6]

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4. Tanning beds

Contrary to common belief, tanning beds are not safer than direct sunlight.

As outlined by the American Academy of Dermatology (AAD), tanning beds significantly increase the risk of skin cancers like:

1. Squamous cell carcinoma (by 58%).
2. Basal cell carcinoma (by 24%).
3. For those who start using tanning beds before age 20, the risk of melanoma increases by 47%, escalating with each use.[7]

Tanning beds also accelerate skin ageing, causing wrinkles, age spots, and loss of skin firmness in younger people. Other risks include burns, loss of consciousness, and eye injuries, with patients often needing emergency treatment.

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5. Gel manicures

"Gel manicures are probably the most controversial salon procedure to emerge in the last few years."

— Alpana Mohta, MD, DNB, IFAAD

As highlighted by the AAD, gel manicures cause:

• Brittleness
• Peeling
• Cracking

UV exposure during the curing process in gel manicures poses risks similar to those of tanning beds, elevating the chances of skin cancer and hastening skin ageing on the hands. 

To mitigate these risks, the AAD suggests applying broad-spectrum sunscreen on the hands or wearing dark, opaque gloves with the fingertips removed for the application of the nail polish.

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Disclaimer: This story is contributed by Alpana Mohta and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.