The Non-Negotiables
Contraindications exist to protect both the client and the practitioner. Absolute contraindications mean the procedure does not happen, regardless of client insistence, peer pressure, or commercial incentive. Relative contraindications mean the procedure may happen under specific conditions with additional precautions and informed consent. The distinction between these two categories is not flexible.
Absolute Contraindications
Active herpes simplex (cold sores) on or near the lips is the most common absolute contraindication in lip blushing. The procedure involves thousands of needle punctures across the lip surface, creating an ideal environment for viral reactivation and spread. Proceeding during an active outbreak risks severe complications including widespread infection, scarring, and significant pigment loss.
Pregnancy and breastfeeding, current isotretinoin (Accutane/Roaccutane) use or use within the past six months, active autoimmune conditions affecting the lips or oral mucosa, blood clotting disorders, and current chemotherapy or immunosuppressive therapy are all absolute contraindications. No exceptions. These are not conservative recommendations — they are clinical boundaries based on documented adverse outcome data.
Isotretinoin deserves particular attention because clients frequently underestimate its relevance. The drug thins the skin, impairs wound healing, and dramatically increases scarring risk. Effects persist for months after discontinuation. Ask specifically about current and recent isotretinoin use — many clients will say "no" to a general medication question but "yes" when asked about Accutane by name.
Relative Contraindications
History of cold sores without active outbreak is the most common relative contraindication. These clients can proceed with antiviral prophylaxis — typically valacyclovir 500mg twice daily starting 2-3 days before the procedure and continuing for 5-7 days after. Document the prophylaxis protocol and confirm the client has obtained their prescription before scheduling.
Recent lip filler (within 4-6 weeks), well-managed diabetes (requires GP clearance letter), active eczema or dermatitis near the lip area, and regular aspirin or blood thinner use all require assessment rather than automatic refusal. For each, the diagnostic question is whether the condition can be safely managed within the procedure protocol.
The Herpes Simplex Protocol
Cold sore history deserves its own protocol because of its prevalence and the severity of complications when mismanaged. Approximately 67% of the global population carries HSV-1. Many carriers are asymptomatic and unaware of their status. The consultation must explicitly ask about cold sore history — do not rely on the client volunteering this information. Ask: "Have you ever had a cold sore on or near your lips, even once, even years ago?"
For clients with confirmed HSV-1 history: antiviral prophylaxis is mandatory, not optional. Valacyclovir 500mg twice daily, starting 2 days before the procedure and continuing for 5 days after. Confirm the prescription has been filled before the appointment date. If the client arrives without having taken the prophylaxis, reschedule. Do not proceed and hope for the best — the consequences of a post-procedure outbreak are severe and entirely preventable.
For clients who are uncertain about their HSV-1 status: recommend prophylaxis anyway. The medication is well-tolerated and the cost is minimal compared to the risk of an untreated outbreak on a freshly needled lip surface. Prophylaxis without infection causes no harm. Infection without prophylaxis causes significant harm.
Client Disclosure Challenges
Clients do not always disclose relevant medical information. Some forget. Some do not consider their medication relevant. Some deliberately withhold information because they fear being declined. The consultation form must ask specific, direct questions rather than relying on open-ended prompts. Instead of asking whether the client takes any medications, ask specifically about blood thinners, isotretinoin, immunosuppressants, and hormonal treatments. Name the medications. Clients recognise brand names more readily than generic categories.
Follow up verbal disclosure with the written form. Clients sometimes mention something in conversation that they do not write down, or vice versa. Cross-reference both. If there is any discrepancy, clarify before proceeding.
Infection Control Standards
Standard precautions apply to every procedure without exception. Single-use needles, cartridges, and pigment caps. Barrier film on all surfaces within the working zone. Sterile technique for skin preparation. Hand hygiene before and after gloving. These are not differentiators — they are baseline requirements that every procedure must meet regardless of archetype, client presentation, or time pressure.
Emergency Preparedness
Adverse reactions during lip blushing are rare but not impossible. Anaphylaxis, severe vasovagal response, and excessive bleeding all require immediate, confident response. Know your emergency protocol before you need it. Keep adrenaline auto-injectors accessible and in-date. Know the location of your nearest emergency department and the fastest route to it. Have a clear plan for managing a client who loses consciousness. These preparations are not alarmist — they are the minimum standard of professional practice for any invasive procedure.
Informed Consent
Informed consent is not a form to be signed. It is a process that ensures the client understands the procedure, its risks, its limitations, and its realistic outcomes. The consent conversation should cover: what the procedure involves physically, the expected healing timeline, possible complications and their likelihood, aftercare requirements, and the probable need for touch-up sessions. The signed form documents that this conversation occurred — it does not replace it.
Case Study: The Undisclosed Medication
A client completes the medical screening form indicating no medications and no medical conditions. During the consultation, while discussing aftercare, she casually mentions she "can't take ibuprofen because of her blood thinner." Further questioning reveals she takes warfarin daily for a heart condition. She did not disclose this on the form because she did not consider a heart medication relevant to a lip procedure.
The diagnostic response: warfarin is a relative contraindication. It significantly increases bleeding during the procedure, which dilutes pigment deposition and compromises retention. The procedure can proceed but requires GP clearance confirming the INR is within safe range, and the client must understand that results may require additional sessions due to blood-thinned healing response.
The systemic lesson: this case illustrates why generic medical questions fail. The client answered honestly — she did not think warfarin was relevant. Had the form specifically asked "Do you take blood thinners such as warfarin, apixaban, or rivarelbam?" she would have disclosed immediately. Update your consultation form to name specific medications rather than relying on clients to self-identify relevance.