These are substances used to plump up wrinkles and areas of depressed scars. Some of the most commonly used types, and the risks they may pose to your skin, include: Collagen injections Bovine collagen (ZyDerm; ZyPlast, etc) has been around the longest. Unfortunately, around 3% to 7% (estimates vary widely) of people develop an allergy to bovine collagen. Human injectable collagen {CosmoDerm; CosmoPlast, etc) is similar to bovine collagen in its effects, but has a lower risk of allergic reactions.

Safety checklist

* Bovine collagen injections have yielded ground increasingly to other fillers, but if that" s your choice, make sure you first do a skin test to assess your sensitivity. Only if there is no reaction at the injected site after 4 weeks should you go ahead with the treatment.

* Those with connective tissue diseases such as rheumatoid arthritis appear to be more likely to develop an allergic reaction to bovine collagen.

* As for human collagen, the risk of allergy is lower, but according to the manufacturer's safety data, CosmoDerm and CosmoPlast must not be used in patients with severe allergies. Also, both these collagens contain the anaesthetic, lidocaine and must not be used in patients with known lidocaine hypersensitivity.

Auto-fat injections "Autologous fat transfer", as it's called, is a procedure in which your own fat is harvested from an area such as the abdomen, processed and injected into facial areas where volume has been lost due to aging, e.g., in the eye area, cheeks, lips and under deep smile lines. Since your own fat is used, there is no risk of allergic reaction. The biggest problem is that only a percentage of the injected fat takes hold in the treated area. Furthermore, this percentage may vary widely in people: From about 10% to 50% depending on a variety of factors.


* If you are interested in auto-fat injections you do need to find a cosmetic/ dermatological surgeon trained in the procedure. Also, make sure s/ he's had some experience with these injections; you don't want to be the first guinea pig — or even the tenth.

* Fat grafting is contraindicated if you are suffering from any disease or disorder that adversely affects wound healing, or if you are in poor overall health.

* Also, it is contraindicated for correcting contour abnormalities resulting from breast biopsy or for increasing the breast size. If this is attempted, the grafted fat can cause both, palpable nodules and calcifications.


Botox is the registered name for a purified protein produced by a bacterium (Clostridium botulinum); it works to temporarily smooth frown lines between the brows by reducing the activity of the muscles that cause these lines to form over time. Botox is good for one thing only, the treatment of motion wrinkles - the ones resulting from facial movements (e.g. frown lines, smile lines and crow's feet). Botox does not reduce other fine lines, sun damage or skin roughness, nor does it help with acne scars or uneven pigmentation. Botox injections should not be done by those who are not medically qualified, says dermatologist Sushil Tahiliani. "If injected into the wrong area, Botox can cause ptosis, i.e., drooping of the eyelids, or asymmetrical expressions on the face and these can last from 4 to 6 months. Fortunately, certain antidotes are available."


These are chemicals applied to the skin that cause a controlled burn. As the layers of old skin "peel" off, literally, the body lays down new skin that is smoother and firmer.

Peels can be of widely varying strength. The lighter peels use AHAs (alpha hydroxy acids) such as glycolic acid. While over-the-counter AHA products contain acid/s in concentrations up to 10%, dermatologists and 'cosmetologists' use concentrations of 20% or higher. Results are more dramatic than in the case of off-the-shelf products. But these are the mildest of peels. Approach them more as "freshening" peels that reduce fine wrinkling, coarseness and blotchiness.

Medium peels are usually performed using trichloracetic acid (TCA peels). Results are similar to those of light peels, but because of its deeper penetration, the TCA peel can also reduce larger wrinkles. The deep peel (phenol) penetrates the deepest into the skin, and is the most effective. But it also carries the highest risks, the main one being discoloration which can last from months to years. The deep peel in particular is falling from grace because of a safer option that's available today - the "laser peel" which uses laser energy instead of a chemical to vaporize surface skin. Because it allows greater control, the "laser peel" reduces the risks of discoloration and blotchiness.



Again, it's most important to go to a trained and skilled person. Even AHA peels can cause problems in the wrong hands. Thomas says "We have people coming in to us with burns caused by peels, either because of the ingredients not being in the proper proportion or because of the application being left on the skin for too long." If the peel penetrates the skin too deeply, you can end up with serious damage, including severe burns, swelling and pain. "Depending on the depth of the burn, you can be left with a pigment disorder which fades after a few months, or you can have scarring which is permanent," says Thomas. A beautician is not the person you should entrust to do a peel on your skin. In a widely-reported case in California, a beautician used a mixture of skin peel chemicals on a client's legs. The woman suffered seizure, shock and second-degree burns.


* Prior to undergoing a peel, tell your doctor if you have facial warts, have previously had an adverse reaction to a peel or to dermabrasion, a history of sun allergy, or a proneness to keloids (an overgrowth of scar tissue), so that the required precautions can be taken.

* All peels carry the risk of pigmentation during the recovery period, and a sunscreen must be scrupulously used out of doors since the new skin is fragile and more susceptible to injury. Strictly follow your doctor's instructions with regard to follow-up care to help the skin heal.

* In certain skin types, there is a risk of developing a temporary or permanent colour change. Birth control pills, pregnancy, or a family history of brownish discoloration on the face may increase the possibility of developing abnormal pigmentation.

* If you have persistent redness in an area after the first week, let your doctor know right away. Persistent redness of the skin can lead to brown discoloration of the red area and a scar if it is not treated right away.


The classical, conventional procedure to minimize the scars of acne, chicken pox and small pox is dermabrasion, the sanding away of the upper layers of the skin using an abrading procedure. The result: a more uniform, trough-less look. "This may not be possible in one sitting in the case of deep scars - so, you can expect a 50 to 70% reduction in such scars," says Thomas.

The face is the best candidate for dermabrasion. Areas like the arms and legs heal poorly, and scarring (from the, procedure itself) is a definite risk in the' case of the legs. Also, fairer complexions respond better to dermabrasion. Skin discoloration is a decided risk in darker- skinned people. Dermabrasion isn't appropriate for keloidal scars - it can stimulate further scar formation.

Today, laser dermabrasion is bringing in better results than conventional dermabrasion because it offers the cosmetic surgeon a greater degree of control in working over the skin. Laser re-surfacing, as it's called, has conventionally used the erbium: YAG laser or the carbon-dioxide laser, says Thomas. "These are invasive lasers where the surgeon removes the soft surface of the skin using laser energy instead of cold blade steel surgery." Even better, he says, is the newer Frazel Laser, "which has been shown to be pretty effective in getting rid of these scars without any down time, without any hospitalization. Frazel is a non-ablative laser, which doesn't remove the surface of the skin. Instead, the laser energy drills holes and damages old collagen at intermittent places on the skin. When new collagen is laid down in these areas, it forms in such a way as to ease out the scars and wrinkles. You get a significant reduction in scars."

Safety checklist

* If you decide to opt for conventional dermabrasion, keep your expectations realistic so that you don't try to pressurize the surgeon to sand away more than s/he should. "An over-aggressive approach increases the risk of scarring," warns Thomas.

* Remember, he adds, that the new skin that grows has to be protected diligently from exposure to sunlight for at least 6 weeks, otherwise on pigmented skins such as Asians', there's a risk of post-inflammatory hyperpigmentation. This means not going outdoors during daylight hours for about a month and a half; so you need to have time not only to get the procedure done, but also to stay home during the healing period. (Sunscreen can be used only once the surface skin is intact).

* In the case of keloidal scars, you can also consider alternatives such as steroid injections if the lesions are fresh, small and narrow; or, silicone gel sheeting in the case of

chronic keloidal scars.

* If you have severe acne, you should postpone dermabrasion till the acne is less weepy; otherwise, serious infection can develop.

* Dermabrasion should be avoided on certain areas of the skin such as eyelids, lower neck and upper chest.


Cool and trendy they may be, but doctors are reporting a rise in the number of people coming in with complications following body piercings.

The problems can start with the choice of jewelry itself. You could be allergic to a certain metal and not know it. If the jewellery is too heavy, the body may reject it and work to expel it like a splinter. Too small in diameter and it may choke off the blood supply, resulting in a good deal of swelling and pain. Infection is a common problem particularly in the case of mouth (lip and tongue) and nose piercings because of the millions of bacteria that live in those areas. In the case of ear piercings, too, bacterial infections and abscesses can set in; nose piercings can cause inflammation and granular growth on the nasal wings. Nipple piercings can cause mastitis (inflammation of the breast) as well as infection. Genital piercings can result in bacterial infection and/or strangulation of the head of the penis due to the retraction of narrowed or inflamed foreskin. Also, it's not a good idea to get a body piercing done if you're prone to keloids.

Safety checklist

If you do decide to get a piercing done, take the following precautions before and after:

* Make sure you’re up-to-date with your tetanus and hepatitis immunizations.

* Don't rush it. Talk to friends and others who've had piercings and check out their experience. Also, visit several piercers. Check out their work area and equipment. Is the work area sanitary, does it have sterilizing equipment? Ask if you can sit in on a piercing procedure and check out the following:

(i) Does the piercer wash and dry his/her hands immediately before piercing? Does s/he put on fresh latex gloves and keep them on through the procedure? Does s/he answer all your questions readily and adequately?

* After the piercing, make sure you keep the area around the jewellery clean and dry to allow it to heal. Wash the site with soap and water at least twice a day. Avoid fingering the jewellery during the healing process to prevent infection. If you have had a piercing done in the facial area, avoid the use of make-up during the healing process.



You can find a tattoo artiste at every Indian mela, in poky gullies, scattered on the beaches of Goa. In the case of the desi artiste, it's a hand-me-down family profession, and words like 'hygiene' and 'safety' generally don't exist in his/her lexicon. In the case of most latter-day artistes, a little knowledge becomes a dangerous thing for their clients: some of these artistes use disinfectants like Dettol to clean their needles, and far from providing the needed sterilization, the disinfectant itself becomes a vehicle to carry bacteria and viruses into the body.

"There is no regulatory authority, no licensing system, no checks," says Tahiliani. There is a wide variety of pigments and diluents being used, and the list is growing. You never know what's being introduced into your body. It could well be industrial grade inks more suited to printing inks and automobile paint than to living, breathing human skin. Thomas adds: "Tattooing is being done by artistes who have had no training in the scientific approach or in hygiene essentials, in safe pigments or in the choice of needles. Unsterile tattooing equipment and needles can transmit infections, including hepatitis B and HIV."

While infection is the biggest danger, there are other risks that accompany tattooing (and permanent make-up, such as permanent eyeliner). Some of them:

Granulomas: These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.

Keloid formation: This is a risk if you are prone to developing keloids any time you injure or traumatize your skin.

Allergic reactions: These are relatively uncommon, but when they do occur they may be particularly troublesome, because the pigments can be hard to remove. Occasionally, a person may develop an allergic reaction to a tattoo s/he has had for years.

Removal problems: This can end up being the biggest problem with tattoos. You grow weary of the design you have, or it fades or blurs. Also, the flavour of the season changes, tattoos may become outdated. The permanent makeup that may have looked flattering when first injected may later clash with your changing skin tones and/ or facial contours. And you want to remove the tattoo or permanent make-up. But - and this is a big BUT - changing a tattoo is not as easy as changing your mind. Despite advances in laser technology, removing a tattoo or permanent make-up is a painstaking process, usually involving several treatments, besides being fairly expensive. Complete removal without scarring may be impossible. Keloids, too, are more likely to occur as a result of tattoo removal.

Safety checklist

Given the realities on the ground, tattooing in India probably does not come with any guarantees, but here are some suggestions to minimize your risks to the extent possible:

* It will be a hard slog, but shop around till you find someone who takes stringent hygiene measures, besides being skilled in what he's doing. Such artistes may be few and far between. For instance, Thomas mentions a California dentist who's given up medical practice to devote himself full-time to his passion, tattooing. Hopefully, he's exercising every necessary precaution.

* When you think you've found someone you can trust your skin to, go one step further and ask whether you can sit in on a tattooing session. As in the case of piercing, the idea is to check out the turf for you. Does the tattoo artiste sterilize the equipment and the needles? Does he put on fresh latex gloves for each customer? Does he use new (and preferably also sterilized) needles, as well as fresh tubes for each person? Does he dispose of unused inks after the procedure?

* Even after you've found an artiste you feel safe with, it's a good idea to immunize yourself at least against tetanus and hepatitis B before you have the tattoo done. * If inflammation or infection does result, do not delay getting yourself to a doctor.

Parlor Procedures

Beauty parlors in India are in dire need of self-introspection and a major clean-up operation. As things stand, most of them are a perennial source of potential infections because of their unhygienic approach and practices. Thomas says, "It's not routine to wear gloves, instruments are not properly sterilized between uses in two clients, if there's a little oozing of blood while removing a blackhead, the beautician does not know how to handle it. We see a lot of infections, especially bacterial and viral, introduced into the client's skin for which s/he later has to come to us for treatment."

Safety checklist

* Combs, brushes, make-up sponges, powder puffs, waxing knives - all these can be a source of germs especially if they have come in contact with an open sore or wound just before they've been used on you. Check that the parlour you patronize cleans and/or disinfects these and other tools.

* The beautician should use disposable gloves, to the maximum extent possible, so that there is no direct contact of her / his hands with your skin.

* Be particularly wary of anything moist, like sponges and towels - they are great breeding grounds for germs. Single-use applicators, such as clean cotton swabs, are preferable to sponges that are used over and over again.

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