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The top 5 riskiest cosmetic procedures

MDlinx Mar 27, 2024

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. 


Given these concerns, let’s examine the most popular yet potentially hazardous non-surgical aesthetic procedures to help you better advise and protect your patients.




Microblading is a semi-permanent tattooing technique that involves using fine needles to deposit pigment into the superficial layers of the skin.

Suleman S, Villegas M, Davis T, et al. Chronic granulomatous reaction to semi-permanent eyebrow tint. Cureus. 2023;15(8):e44070.

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 utilization in oncological radiotherapy such as colon marking.”

Bălăceanu-Gurău B, Apostol E, Caraivan M, et al. Cutaneous adverse reactions associated with tattoos and permanent makeup [igments. J Clin Med. 2024;13(2):503.



Despite being marketed as low-risk, microblading shares common tattoo-related complications such as inflammation, infection, allergic reactions, and granulomatous responses. 

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.

Yoon S, Kondakala S, Nho SW, et al. Microbiological survey of 47 permanent makeup inks available in the United States. Microorganisms. 2022;10(4):820.


The pathogens included clinically relevant bacteria such as Alloiococcus otitis, Dermacoccus nishinomiyaensis, Kocuria rosea, and Pasteurella canis. The implication is concerning, as these pathogens can potentially cause human microbial infections when introduced into the dermis through the microblading process.


Eyelash extensions


Eyelash extensions enhance the appearance of eyelashes, an attribute culturally linked to femininity. These extensions, made from synthetic (like nylon) or natural fibers (including horsehair, silk, or mink), are attached to natural lashes using a specialized adhesive. Unfortunately, ocular side effects can occur. A study done among female university students in Nigeria reported an adverse event rate of 54%.

Idu FK, Efosa AD, Mutali M Jr. Ocular side effects of eyelash extension use among female students of the University of Benin, Benin City, Edo State, Nigeria. Cureus. 2024;16(1):e53047.



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 fibers can often become embedded under the eye tissue, sometimes necessitating surgical removal.

Mukamal R. Eyelash Extension Facts and Safety. American Academy of Ophthalmology. February 23, 2018.



Notably, the US FDA does not regulate eyelash extensions or their adhesives, adding another layer of concern. 


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 aging signs on the skin like no other treatment; however, it comes with significant risks, including arrhythmia, laryngeal edema, renal toxicity, and even toxic shock syndrome. 

These necessitate continuous heart monitoring and IV drips to eliminate the systemically absorbed phenol.

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.

Nikalji N, Godse K, Sakhiya J, et al. Complications of medium depth and deep chemical peels. J Cutan Aesthet Surg. 2012;5(4):254–260.



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 squamous cell carcinoma (by 58%) and basal cell carcinoma (by 24%). For those who start using tanning beds before age 20, the risk of melanoma increases by 47%, escalating with each use.

10 surprising facts about indoor tanning. American Academy of Dermatology. April 26, 2023.


Tanning beds also accelerate skin aging, 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.


Gel manicures


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

As highlighted by the AAD, gel manicures cause brittleness, peeling, and 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 aging on the hands. 


A 2023 study in Nature Communications has linked DNA damage and carcinogenesis in an in-vitro study to ultraviolet-emitting nail polish dryers, often employed in gel manicures.

Zhivagui M, Hoda A, Valenzuela N, et al. Author Correction: DNA damage and somatic mutations in mammalian cells after irradiation with a nail polish dryer. Nat Commun. 2023;14:1424.

Gel manicures: tips for healthy nails. American Academy of Dermatology. April 2023.


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


What this means for you

The core issue with newer cosmetic procedures such as lash extensions and gel manicures is their relatively recent development and lack of regulation, which leaves a void in research about their potential and long-term side effects. Moreover, many non-surgical aesthetic treatments, including chemical peels, are now frequently administered by aestheticians, whose practices aren't uniformly regulated globally. In light of these concerns, physicians must keep themselves updated on the risks of these common non-surgical aesthetic procedures.


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