Considering Cosmetic Resurfacing?

Last Editorial Review: 1/30/2005

Think Herpes Prevention

WebMD Feature

Reviewed By Gary Vogin

Sept. 14, 2001 -- Laser skin resurfacing has become a popular cosmetic procedure to reduce fine facial lines and wrinkles. But in recent years doctors have reported that the laser used can reactivate the herpes simplex virus (HSV) and result in severe facial outbreaks.

More than 60,000 laser skin resurfacing procedures are done each year in the United States, according to the American Society of Plastic and Reconstructive Surgeons, and the American Academy of Facial Plastic and Reconstructive Surgery. Peels are commonly done by plastic surgeons, dermatologists, and cosmetic surgeons.

It's become common for doctors to suggest that anyone with a history of herpes -- either type 1, which typically appears as cold sores, or type 2, which usually affects the genitals -- take a preventive course of antiviral medication before undergoing the so-called laser peel.

A team of surgeons from Shreveport, La., goes a step further by suggesting that everyone undergoing laser resurfacing -- even if they have no history of herpes infection -- should take a course of antiviral medication.

The surgeons base their recommendation on their study -- published in the September 1999 issue of Plastic and Reconstructive Surgery -- in which they compared the results of laser resurfacing for two groups of patients: those who took an antiviral medicine and those who didn't.

They found that the antiviral medicine greatly reduced or even eliminated outbreaks of facial herpes. Among those who took the medication, only 1.1% of those without a history of herpes experienced an outbreak -- and among those who did have a history of herpes, not one experienced an outbreak. But among those who weren't given the medication, 9.4% had an outbreak.

Is Prevention the Best Medicine?

Stephen J. Ramey, MD, a Shreveport plastic and reconstructive surgeon and one of the study's authors, says that those with a history of either genital herpes or facial herpes should strongly consider taking the medication. He recommends a dose of 250 milligrams twice daily for seven days.

But while cold sores are usually the result of type 1 herpes, they can sometimes be related to type 2, he warns. And the reverse is true for genital herpes -- while it is usually type 2, it can be type 1. "Because of increased incidence of oral sex, it's harder to separate type 1, the oral-facial herpes, from type 2, which is primarily genital," Ramey says. Blood tests would be necessary to identify the types.

A plastic and reconstructive surgeon not involved in the study, James M. Stuzin, MD, noted in the same issue of the journal that although "it troubles me that we perhaps are overtreating many patients," the concept of preventive antiviral treatment is probably one whose time has come.

Other Ways to Minimize Herpes Outbreaks

One in five people over the age of 12 in the United States has genital herpes, according to the American Social Health Association (ASHA), an organization devoted to research and education about sexually transmitted diseases. But most people have such mild symptoms that they don't even realize they have the virus. In people who are 50 and older -- the very ones most likely to have skin resurfacing -- the prevalence of herpes type 1 exposure might be as high as 90%, Ramey says, citing a study published in the journal Seminars in Dermatology.

Once someone is infected, the herpes simplex virus stays in the body for a lifetime. After the first outbreak, subsequent episodes can be painful and disruptive to a person's daily life. People who have herpes and are painfully aware of it often find that managing recurrences can seem like a full-time job.

Among ASHA's tips for minimizing outbreaks:

  • Eat a well-balanced, nutritious diet.
  • Get plenty of rest.
  • Reduce stress: Try relaxation techniques like biofeedback, yoga, walking, or meditation.

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