Contraindications

Contra-indications

A contraindication is the presence of a condition which may make the client unsuitable for the treatment. The treatment may not be able to take place, or the treatment will need to be adapted.

When treating a client, if they show any signs of contra-indications, you should tactfully refer them to their GP for treatment or advice. You should never make a diagnosis even if you are certain of the condition as you may be wrong.

If you are unsure about any contra-indications, then do not treat the client and refer them to their GP.

Be careful if you deal with a contra-indication, and they can often be contagious. Make sure you clean the work area and any implements between clients to prevent cross-infection.

Contraindications

Autoimmune diseases
Patients with thin skin and very little subcutaneous fat
Patients with obesity and very heavy ptotic soft tissue
Pregnancy, breast feeding
Malignant neoplasms (cancerous tumour, an abnormal growth that can grow uncontrolled and spread to other parts of the body).
Body dysmorphia
Fever
Psychical and neurological damages
Haemophilia
Inflammatory diseases of skin in zones of treatment
Previously installed non-biodegradable injection implants in zone of treatment
Tendency to formation of keloid and hypertrophic scarring

Common contra-indications

General Health & Wellness

*Condition*	*Description*	*Salon Treatment*
*Diabetes*	Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high. There are two main types of diabetes: type 1 diabetes – where the body’s immune system attacks and destroys the cells that produce insulin type 2 diabetes – where the body does not produce enough insulin or the body’s cells do not react to insulin. Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2. The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters the bloodstream, insulin moves glucose out of the blood and into cells, where it’s broken down to produce energy. However, with diabetes, the body is unable to break down glucose into energy. This is because there’s either not enough insulin to move the glucose, or the insulin produced does not work properly.	Can often be treated if the client is managing their diabetes well. Check with your insurer as their criteria may not allow treatment. A GP note may be required. Treatments that cause injury to the skin can increase the risk of infection. Those with diabetes will need to understand wound management and treatments should be done under extreme caution as to not injure the skin if necessary. Diabetics have a slower wound healing response and have a higher risk of infection. All products used must be sterile, and care should be taken not to injure the skin.
*Epilepsy*	Epilepsy is diagnosed when a person has had more than one epileptic seizure and could have more in the future. Electrical activity is happening in our brain all the time. A seizure happens when there is a sudden burst of intense electrical activity. This is often referred to as epileptic activity. This intense electrical activity causes a temporary disruption to the way the brain normally works, meaning that the brain’s messages become mixed up. The result is an epileptic seizure. There are many different types of seizure, and each person will experience epilepsy in a way that is unique to them. Some things make seizures more likely for some people with epilepsy. These are often referred to as ‘triggers. Triggers are things like stress, not sleeping well and drinking too much alcohol. Some people say they have more seizures if they miss meals. Not taking epilepsy medicine is another common trigger. A very small number of people with epilepsy have seizures triggered by lights that flash or flicker. Avoiding triggers can stop them from having seizures.	If well-managed treatments may be able to be undertaken. It is worth assessing the client and finding out what triggers a fit and when as well as how it is managed and their last episode. You may also need to check your insurer’s terms and refer the client to a GP for a letter of approval.
*Heart conditions*	Heart disease describes a range of conditions that affect the heart. Heart diseases include: · Blood vessel disease, such as coronary artery disease · Heart rhythm problems (arrhythmias) · Heart defects you’re born with (congenital heart defects) · Heart valve disease · Disease of the heart muscle · Heart infection Risk of fainting, risk of slow healing or chances that the client may be medicated to keep their condition under control are some risks you will need to be aware of when treating the client. Clients may also have a heart catheter or a pacemaker.	Treatments that do not involve electrical currents being passed through the body are usually safe. Heart conditions should be well managed. You will need to check the terms of your insurance policy. A referral to a GP may be required.
*Deficient Immune System*	Immunodeficiency disorders prevent the body from fighting infections and diseases. This type of disorder makes it easier to catch viruses and bacterial infections. Immunodeficiency disorders are either congenital or acquired. A congenital, or primary disorder is one you were born with. Acquired, or secondary, disorders you get later in life. Acquired disorders are more common than congenital disorders. Your immune system includes the following organs: · spleen · tonsils · bone marrow · lymph nodes These organs make and release lymphocytes. These are white blood cells that fight invaders cells called antigens. Cells release antibodies specific to the disease the body detects. White blood cells destroy foreign or abnormal cells. Examples of antigens that white cells might need to fight off include: · bacteria · viruses · cancer cells · parasites An immunodeficiency disorder disrupts your body’s ability to defend itself against these antigens.	A deficient immune system can increase the risk of infection. Treatments that break the skin may increase the risk of infection. Clients may need a GP referral and understand wound management.
*Pregnancy*	Pregnancy is a period of considerable changes in a woman’s body. These changes, affecting virtually every part of the body, are all geared towards growing and delivering a healthy baby, without harming the mother. Changes begin within days of conception when the fertilised egg implants itself in the wall of the uterus. The first changes are subtle, and most women will not notice them. Pregnancy lasts an average of 266 days (38 weeks) from the date of conception or 40 weeks from the first day of the last menstrual period. Pregnancy is divided into three periods of three months each. These periods are known as the first, second and third trimesters. Each trimester brings with its own unique set of experiences. Risks of pregnancy include: · Miscarriage · Increased/decreased blood flow · Risk of fainting · Oedema · Pigmentation/Chloasma/mask of pregnancy · Pelvic trauma	Nearly all treatments are contraindicated in the first trimester. Treatments that cause friction may have a side effect of PIH and should not be performed. Electrical treatments must not be performed at any point.
*Breastfeeding*	Anything the mother consumes or applies to her skin could be absorbed into the bloodstream and through into the milk ducts, where this can pass to the baby. Great care should be taken with what is being applied to the skin as well as avoiding treatments that could cause open wounds. An open wound is susceptible to infection, and this can cause infection or septicaemia. During breastfeeding, hormones are still active within the body, and these can have an overall effect on the skin. This may lead to dehydrated skin (if the mother is not ingesting enough water) and also lead to a high risk of pigmentation. Invasive procedures should be avoided until a few months after the mother has stopped producing milk.	Treatments that break the skin are strictly contraindicated. The client also has a high amount of hormone imbalance still and may be susceptible to PIH on certain treatments.
*Electrical implants or pacemakers*	A small battery-operated device called a pacemaker is placed into the chest. It sends regular electrical impulses, which help keep the heart beating regularly. The pacemaker is a small metal box weighing 20–50g. It is attached to one or more wires, known as pacing leads, that run to the heart. If the pacemaker senses that the heart has missed a beat or is beating too slowly, it sends signals at a steady rate. If it senses that the heart is beating normally by itself, it does not send out any signals. Most pacemakers have a special sensor that recognises body movement or the breathing rate. This allows them to speed up the discharge rate when active. An implantable cardioverter-defibrillator (ICD) is a device similar to a pacemaker. An ICD delivers an electrical shock to the heart during a life-threatening heart rhythm. The aim is to ‘reboot’ the heart to get it back into a normal rhythm again. Some modern devices contain both a pacemaker and an ICD.	Electrical implants contra-indicate any treatment that involves an electrical current. Other treatments that may affect blood pressure may also contra-indicate a procedure. Check your insurer’s terms and refer the client to GP for a letter of approval.
*Anticoagulant medicines such as warfarin or aspirin*	Anticoagulants are medicines that help prevent blood clots. They’re given to people at a high risk of getting clots, to reduce their chances of developing serious conditions such as strokes and heart attacks. A blood clot is a seal created by the blood to stop bleeding from wounds. While they’re useful in stopping bleeding, they can block blood vessels and stop blood flowing to organs such as the brain, heart or lungs if they form in the wrong place. Anticoagulants work by interrupting the process involved in the formation of blood clots. They’re sometimes called “blood-thinning” medicines, although they don’t actually make the blood thinner. Although they’re used for similar purposes, anticoagulants are different from antiplatelet medicines, such as low-dose aspirin and clopidogrel.	Anticoagulants prevent the blood from clotting and can affect the healing process of the skin. The client will be at higher risk of bruising also. Treatments that injure the skin or cause trauma will need to be avoided. A GP letter may be required for some services.
*Steroids, antidepressants, antibiotics and other medications*	Many drugs can affect the skin. For example, prescription antidepressants, especially the popular class of medications called selective serotonin reuptake inhibitors (SSRIs), can cause a wide variety of adverse skin reactions, including bruising. Acne medications and certain antibiotics may make the skin more sensitive to sunlight and light or heat-based procedures. It is vital that we find out the medications both prescription and over the counter drugs that the client is taking. The internet is a great source of information to establish the risks the medication may have on the skin during a procedure.	Medications can have numerous effects on the skin. If you are unsure, you should ascertain how the treatment affects the skin and the effects of the medication that is being taken. A patch test may be required or a letter from the clients GP. Where the side effects may be photosensitivity or thinning of the skin, then treatments should be avoided until the client has come off their medication for three months at their GPs request.
*Recent surgery*	Clients will have surgery for a variety of reasons and on any area of the body. Surgery puts the body under extreme pressure. The client may be on pain medication which could affect their susceptibility to feeling pain during treatment. Surgery wounds can take many months to fully heal. Post-surgery complications can also arise a few months after the procedure. This can include, infection or necrosis of the wound, infection of the blood, blood clots, internal bleeding, or fever.	If the client has had recent surgery, you will need to weigh up the risk of the procedure, the length of time between the surgery and treatment as well as where the surgery was. In most cases, it is advised to wait six months post-surgery before undertaking any procedures, especially where these may involve invasive techniques, massage or electrical machines.
*Metal plates or pins*	If you break a bone, it will need to be held in place while it heals. This can be done using a splint, sling, brace or cast. But sometimes a broken bone will need to be fixed with surgery, using metal plates, rods, wires, screws or pins. Implanted metal can help broken bones heal in proper alignment. While these implants do not help the bone heal faster, they can help to hold bones in the proper position while healing takes place. Implants may include metal plates and screws, pins, and intramedullary rods inserted into the cavity of a bone.	Electrical treatments are almost always contraindicated for clients with metal implants in their body. However, this can vary depending on the area of the implant vs the area of treatment. Care may also need to be taken when massaging over the area or any pressure is applied.
*Chemotherapy/* *radiotherapy*	Chemotherapy is a form of cancer treatment where a patient is given drugs designed to kill cancer cells. Radiation is a type of cancer treatment where high doses of radiation are delivered to cancerous tumours in the body. Both procedures can affect the sensitivity of the skin, and the skin texture may change. A waxy appearance to the skin can alter the effects of treatments and treatments may not be suitable. Clients may also be at risk of pigmentation.	Clients undergoing treatment for cancer may benefit from a number of procedures in a salon for the purpose of relaxation and pain management as well as to make them feel good. Some treatments may be too much for the client to handle and cause unwanted side-effects. It is worth discussing the treatment with the client and working out alternatives where suitable. If unsure, you may wish to ask for a letter from the client’s oncologist.
*Broken bones*	When a bone has an outside force exerted upon it, like a blow or a fall, there is potential that it cannot withstand the amount of force and it breaks. That loss of integrity results in a fracture. It is important to remember that a fracture, break, or crack all describe the same situation, an injury to the bone where it has been damaged. One term is not more serious than another. Fracture break and crack all mean the same thing.	Clients with a suspected or recent fracture should be treated with caution. If working over the area of a recent break, then the time between the break and the treatment should be at least six months. If working on other areas of the body, it is best to wait for 6-8 weeks post-injury as the client may be more susceptible to an embolism.
*Previous or recent treatments in the area*	When providing a service to the client, it is important to establish what previous treatments they have had, not only at clinics but at home. You should look to enquire over the products they use regularly that may affect the skin and the treatment outcome.	Some treatments can affect the skin by either removing out layers of the stratum corneum or stimulating a healing response. You will need to identify if the client has had any recent procedures in the treatment area you will be working on.

Contra-indications

A contraindication is the presence of a condition which may make the client unsuitable for the treatment. The treatment may not be able to take place, or the treatment will need to be adapted.

If you are unsure about any contra-indications, then do not treat the client and refer them to their GP.

Be careful if you deal with a contra-indication, and they can often be contagious. Make sure you clean the work area and any implements between clients to prevent cross-infection.

Condition	Image	Description & Cause	Salon Treatment
Psoriasis		Scaling and inflammation of the skin. Cause unknown but thought to be related to the nervous system	Treat with caution; avoid the affected area. Do not treat if the skin is weeping.
Eczema		Atopic eczema is a common skin condition that causes patches of skin that are itchy, cracked and sore.	Treat with caution: avoid the affected area.
Conjunctivitis		A transparent and sticky substance covers the white of the eye and lids. It is caused by a bacterial infection.	This is highly infections; do not treat; the client should be referred to their GP for correct diagnosis and treatment.
Cuts & Abrasions		Broken skin caused by an injury.	Avoid treatment in the affected area.
Bacterial Keratitis		A severe disorder which can result in partial or total loss of vision. It is caused by a bacterial infection.	Do not treat; refer clients to their GP for correct diagnosis and treatment.
Bruising		Black, green. Yellow or red marks appear on the skin. They are generally caused by an injury.	Avoid the area if possible.
Recent Operations (scars)		Scar tissue raised or flat undergoing the healing process. Scar tissue is very sensitive.	Avoid treatment if the scar is less than six months old.
Blepharitis		Inflammation of the eyelids; the inflammation is like eczema of the skin with red, scaly eyelids; you may notice tired or gritty eyes, which may be uncomfortable in sunlight or smoky atmospheres; they may be red and swollen and feel as though there is something in them. The exact cause is unknown, but people who have dandruff or dry skin conditions may be more prone to blepharitis.	Avoid the area; refer the client to GP for correct diagnosis and treatment.
Stye		Infection in the root of an eyelash. They are caused by a bacterial infection.	Avoid the area; no treatment until the infection has gone.
Sunburn		Sunburn is a red, painful skin that feels hot to the touch. It usually appears within a few hours after too much exposure to ultraviolet (UV) light from sunshine or artificial sources, such as sunbeds.	No treatment should be provided until the skin has healed. 48 hours should be left from sun exposure/sunbed use before a treatment.
Cold Sores		Cold sores are painful lumps or blisters on the face. They’re caused by a virus and are very contagious.	Treatment should not be provided on the face until the skin has healed. Precautions should be taken when treating other areas to avoid cross-contamination.
Impetigo		Impetigo is a highly contagious skin infection that often starts with red sores on the face or hands. It causes red sores or blisters that burst and leave crusty, golden-brown patches.	Treatment should not be provided on the face until the skin has healed. Precautions should be taken when treating other areas to avoid cross-contamination.
Moles		Moles are small, coloured spots on the skin. Most people have them, and they’re usually nothing to worry about unless they change size, shape or colour.	Avoid treating over a mole. Irritation or damage to the area may cause the mole to change.
Ringworm		Ringworm is a fungal infection on the skin. It causes a rash that is often ring-shaped.	Treatment should not be provided to the client until the condition has been treated.
Sensitive skin		Sensitive skin is a common issue but not a medical diagnosis in itself. The term generally refers to skin that is more prone to inflammation or adverse reactions. People with sensitive skin may have strong reactions to chemicals, dyes, and fragrances present in products that come into contact with the skin.	Treatments should be applied with caution. Patch tests may be required before undertaking a full procedure.

Other contra-indications to PDO Threads

Existing infections or infectious skin diseases, whether viral, bacterial or fungal.
Inflammation of the skin
Anti-coagulant medication
Skin cancers
Prone to keloids
Haematological diseases with bleeding tendencies
Active granulomatosis disease
Previously installed bio-degradable injection implants in the treatment areas.
Clients with little subcutaneous fat

Risks and Complications and their management

The barbed cog is a relatively new procedure, and its techniques are still being developed. Results have varied greatly among patients but continue to improve.

A significant risk of the barbed cogs procedure is that one mat does not notice any improvement

A symmetry is a consequence, the Practitioner has to carry out the procedure with great precision, from noticing pre-procedure asymmetries, to perfectly balanced markings, to ensuring the symmetry with the clients consent before cutting of the ends of the thread.

Some barbed cog clients with a thin skin have reported that the sutures became visible under the skin shortly after the procedure. Rippling can persist for long. The practitioner needs to be aware if this problem and have to be careful while inserting the thread so as to keep it at the optimum depth. This does require some experience, and hence there is a learning curve for this.

Some clients experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.

Infection in the treatment areas is an infrequent complication. If an infection develops, treat it with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible.

Some practitioners have noted rare migration or even total intrusion of the sutures, causing an unbalanced facial appearance. With this, or if the thread breaks, a simple reinsertion solves the problem.