Can fillers and laser treatments cause long-term recurring cold sores?

I never had a cold-sore until I started doing fillers and botox. They became chronic and I had to take daily anti-viral. One day it occurred to me that there might be a relationship - particularly when I do filler near my mouth and nasal folds. I am thinking about doing a Genesis laser treatment but I'm afraid it will aggravate this further. Should I avoid the laser?

Doctor Answers (6)

While any kind of trauma including getting a needle

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can cause a flare of the herpes virus / cold sores...it neither causes the virus nor is it responsible for flares beyond the period immediately surrounding your injection...so if the herpes developed more than a week after the treatment, then it's unrelated...and if you undergo a Genesis treatment, the herpes could flare but just surrounding the treatment...and with your history, you should consider pretreatment with an anti-viral....


Las Vegas Dermatologist
5.0 out of 5 stars 7 reviews

Can fillers and laser treatments cause long-term recurring cold sores?

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The fillers and/or lasers can reactivate the virus. The dormant virus lives in the tissue.  While the fillers or lasers do not 'cause' the outbreak, they can cause them to erupt.  I suggest taking antivirals before you have the procedures.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Cold Sores and Lasers and Fillers

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The answer is simply yes. I have seen this many times although it is rare.  For patients who get chronic (>6 outbreaks a year), I put them on long term antivirals.  Typically Valtrex but if they "break through" and continue to get outbreaks then we switch to Famvir.  I've had cases where other medications such as Foscarnet or Cidofovir had to be used for those with many recurrent infections.  Additionally, I pretreat all my pateints with chronic herpes with "zoster" doses of Valtrex prior to any procedure and recommend topical treatment to the areas that have been affected in the past with topical Xerese (acyclovir and hydrocortisone) for 1-2 days prior and for 3-7 days post treatment, depending on the individual situation.  Laser genesis is deeper heating without any ablation, and should be less likely to cause an outbreak.  I suggest seeking the advice of an expert who does laser and filler treatments all day.  I'd love to consult you in the office, call anytime.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

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Can fillers and laser treatments cause long-term recurring cold sores?

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The viruses that cause these sores can remain inactive in the local nerve cells for variable periods of time. With trauma or depressed local immunity, these may become reactivated.
Fillers, lasers and chemical peels can activate these viruses and trigger "cold" sores in prone patients. It is best that you take prophylactic medications such as Acyclovir, Knowing that you are susceptible to this, everytime you have any of these procedures. I recommend you contact your primary care for proper evaluation and advice.

Maan Kattash, MD, FRCS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 10 reviews

Recurrence of cold sores with cosmetic facial treatments

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There is an association in the literature between skin trauma and breakouts of the Herpes family viruses including both cold sore (Herpes simplex) and shingles (Herpes Zoster).  Once we are exposed to the Herpes Simplex virus a stress including the immune suppression from sun exposure, systemic illness, or skin trauma may trigger a breakout of the virus that is chronically harboring in our nerve endings.  The nerve ending that the virus chooses to hang out determines which dermatome or which skin location you will get the repeated breakouts, so usually the breakout location is duplicated.  

I would suggest that in order for you to not fear your cosmetic treatments, and have an easier recovery, that you get a prescription for daily oral acyclovir or valacyclovir.  It is advised that people who get more than six episodes a year of a herpes skin breakout, go on a chronic daily suppressive antiviral regimen.  If you have never taken this medication before, you can discuss the common or rare side effects with your physician.  Topical antivirals will not be potent enough or adequate for some people.

Prior to a laser resurfacing treatment, I recommend that you increase your dose of antiviral and begin taking it at least 24 hours before the treatment, and then continue until your skin has healed to the point where it is no longer peeling.

Karen Stolman, MD
Salt Lake City Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

Procedures and Cold sores

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If you have a history of cold sores, various factors can cause them to recur; such as injections for fillers around the mouth, lasers, sunlight, stress, illness, etc.  So there is the risk with fillers and lasers that a cold sore may occur.  Discuss with your provider, and they will likely have you continue the anti-viral medication before and after the Genesis; or they may have you take a higher dose depending on your prescription.

Ronald Johnston, MD
Panama City Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.