Recommendations for cutaneous and aesthetic surgeries during Covid-19

Researchers in India have developed an outline of best practices and recommendations for dermatologists as they restructure their practice of procedural dermatology and cutaneous aesthetic surgeries during Covid-19.

Published in the Journal of Cutaneous and Aesthetic Surgery (Apr-Jun 2020; 13(2):77-94), the authors of the paper note the risk of Covid-19 transmission can have several implications on dermatologic practices.

“Performing procedures in the times of [the] COVID-19 pandemic presents challenges such as risk of transmission to doctors and staff due to potential aerosolization, release of virus droplets during the procedures and risk of virus transfer through the instruments both in the pre- and postoperative period,” the authors wrote. “This can have several medical, administrative and legal implications.”

The researchers suggest standard precautions such as social distancing of at least one metre, proper hand hygiene, and the use of appropriate personal protective equipment should be implemented in dermatologic practices. Further, safe injection practices, sterilization and disinfection of medical devices should be conducted.

The authors recommend that patients are seen only by appointment. Also, each clinic should have a special area at the entry of the practice for the screening of patients and where patients can be provided with sanitizers and masks.

Surgical masks should be worn for procedures that are of short duration and performed on non-facial areas, according to the recommendations.

Procedures with minimal invasiveness and bleeding as well as short-duration procedures on the face such as injectables, chemical peels and aerosol-generating procedures on non-facial areas are considered moderate risk. These procedures require healthcare workers to wear an apron with headcover, N95 mask, face shield, double gloves and smoke evacuator with high-efficiency particulate air (HEPA) or ultralow particulate air (ULPA) filter.

Lastly, aerosol and plume-generating procedures such as ablative lasers on the face, prolonged surgeries on the head such as hair transplants, intraoral and intranasal procedures are considered high risk. The recommendations state these procedures must be carried out with full-body cover with surgical gown, headcover, N95 mask, face shield, double gloves and smoke evacuator.

“Physicians should be aware of the local epidemiological situation and adhere to the relevant guidelines issued by the relevant governmental agencies,” the authors wrote.