Implications of Dermatologic Disorders in Facial Cosmetic Surgery: A Systematic Review

Invasive and minimally invasive cosmetic procedures in patients with autoimmune or inflammatory skin disorders can carry an increased risk of surgical site infection, disease exacerbation, atrophic/hypertrophic scarring, or suboptimal cosmetic results. As facial procedures continue to rise in popularity, increasing complications are being reported in association with underlying dermatologic disease. In this review, we aim to bring attention to these dermatologic conditions and the potential challenges that they pose to the facial plastic surgeon.

A comprehensive literature search was conducted across PubMed, Embase, and MEDLINE for articles published before January 2025 describing one or more patients with complications following facial or scalp procedures relating to a pre-existing or underlying dermatologic disorder or systemic condition with dermatologic manifestations. Articles were screened according to PRISMA guidelines, and data extraction included dermatologic disease diagnosis and severity, facial procedure performed, perioperative or postoperative complications, and resolution/treatment.

Our search criteria identified 2452 articles; 53 articles met the inclusion criteria. In a total of 469 patients with pre-existing dermatologic conditions, mild-severe complications were reported after blepharoplasty (41/469, 8.7%), rhinoplasty (254/469, 54.2%), rhytidectomy (25/469, 5.3%), hair transplantation (37/469, 7.9%), cosmetic injections (35/469, 7.5%), lasers (15/469, 3.2%), and microneedling (50/469, 10.7%). Dermatologic disorders included acne, atopic dermatitis, frontal fibrosing alopecia, lichen planopilaris, rosacea, and vitiligo; systemic conditions with dermatologic manifestations included Ehlers-Danlos syndrome, sarcoidosis, scleroderma, and systemic or discoid lupus erythematosus. Complications ranged from mild postoperative disease exacerbation to severe hypertrophic scarring, ulcerations, and wound healing defects.

The existing literature, while limited to case reports and small case series, demonstrates potential risks following facial procedures in patients with dermatologic disorders. This review highlights the importance of consideration of dermatologic disease in facial surgery planning and decision-making and summarizes effective strategies to minimize any potential risk.