Important Safety Information

This page collects the important safety information for the treatments offered at Prema Med Spa. Every treatment begins with a consultation with a licensed provider, who decides whether it is appropriate for you based on your medical history, current health, and goals. Please read the section for your treatment and bring any questions to your consultation.

If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency department.

To reach your Prema care team, call (216) 839-0933.

On this page

• Compounded GLP-1 Therapy (semaglutide and tirzepatide)
• Botox® Cosmetic
• Dermal Fillers (Juvéderm®)
• Skin Tightening (radiofrequency microneedling)
• IPL Photofacial (Lumecca™)
• Laser Hair Removal
• Chemical Peels

Compounded GLP-1 Therapy (semaglutide and tirzepatide)

About the medications we prescribe

Prema Med Spa’s weight management program uses compounded semaglutide and compounded tirzepatide, prescribed and supervised by our licensed medical providers under the direction of our Medical Director, Edward Cornett, DO, FAAEP.

Compounded drug products are not approved or evaluated by the FDA for safety, effectiveness, or quality. FDA-approved medications containing semaglutide and tirzepatide are available and may be appropriate for you. Your provider will discuss the differences with you before you begin treatment.

All prescription medications require a consultation with a licensed medical provider. A prescription is issued only if a provider determines it is appropriate based on your medical history, current health, and treatment goals. Access to medication is not guaranteed.

Withholding or providing inaccurate information about your health in order to obtain treatment may result in serious harm.

Warning: Risk of Thyroid C-Cell Tumors

In animal studies, GLP-1 receptor agonists including semaglutide and tirzepatide caused thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is not known whether these medications cause thyroid C-cell tumors in humans.

Do not use these medications if you or any family member has ever had medullary thyroid carcinoma (MTC), or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Tell your provider immediately if you develop a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath.

Seek medical care immediately if you experience

• Severe nausea or vomiting leading to dehydration
• Kidney problems, which may result from dehydration
• Pancreatitis — severe abdominal pain, with or without vomiting, sometimes radiating to the back
• Gallbladder problems — upper abdominal pain, fever, yellowing of the skin or eyes, clay-colored stools
• Low blood sugar — dizziness, confusion, blurred vision, shakiness, sweating, rapid heartbeat
• Allergic reaction — swelling of the face, lips, tongue or throat, difficulty breathing, severe rash
• Vision changes, particularly if you have diabetic retinopathy
• Changes in mood, depression, or thoughts of self-harm

Common side effects

Nausea, vomiting, diarrhea, constipation, abdominal pain, indigestion, fatigue, headache, dizziness, and injection-site reactions. These are most common when starting treatment and after a dose increase, and often ease over time. Tell your provider — dose adjustments are part of the program.

Before you start, tell your provider if you

• Have or have had thyroid cancer, MTC, or MEN 2
• Have or have had pancreatitis, gallbladder disease, or kidney disease
• Have type 1 or type 2 diabetes, or take insulin or a sulfonylurea
• Have diabetic retinopathy
• Have a history of depression or suicidal thoughts
• Have gastrointestinal disease, including gastroparesis
• Are taking any other GLP-1 medication, weight-loss product, or dietary supplement

Provide your full medication list, including prescription, over-the-counter, vitamins and supplements. These medications slow stomach emptying and can affect how oral medications are absorbed. Your provider will advise on timing.

Pregnancy and breastfeeding

Do not use these medications if you are pregnant. There is no benefit to weight loss during pregnancy and there may be risk to the fetus. If you are planning a pregnancy, discontinue at least 2 months beforehand and speak with your provider. If you are breastfeeding or planning to breastfeed, tell your provider before starting.

Administration

Your medication is a once-weekly subcutaneous injection given in the abdomen, thigh, or upper arm on the same day each week. Your Prema provider sets your dose and adjusts it based on how you respond — not on a fixed schedule. Do not change your dose or stop treatment without speaking to your provider first.

Botox® Cosmetic (onabotulinumtoxinA)

Botox® Cosmetic at Prema Med Spa is administered by our aesthetic nurse injector under physician oversight. It is a prescription medicine. A consultation with a licensed provider is required before treatment, and treatment is provided only if the provider determines it is appropriate for you. Botox® Cosmetic is FDA-approved to temporarily improve the appearance of frown lines between the brows, forehead lines, and crow’s feet in adults. Some treatments we offer, such as the lip flip, are off-label uses. Your provider will tell you when a treatment is off-label and what that means.

Warning: distant spread of toxin effect

The effects of botulinum toxin may spread from the injection area to other parts of the body hours to weeks after an injection, causing symptoms of botulism. These can include swallowing and breathing problems, which can be life-threatening, as well as loss of strength or muscle weakness all over the body, double or blurred vision, drooping eyelids, hoarseness or a change in voice, trouble saying words clearly, or loss of bladder control. Swallowing and breathing problems may need urgent medical care. These problems are more likely in people who already have a swallowing or breathing condition. Seek immediate medical attention if you experience any of these symptoms after treatment.

Do not receive Botox® Cosmetic if you

• Are allergic to any botulinum toxin product or any ingredient in Botox® Cosmetic
• Have an infection at the planned injection site
• Have had an allergic reaction to another botulinum toxin product, such as Dysport®, Xeomin®, Jeuveau®, or Daxxify®

Before you start, tell your provider if you

• Have a disease that affects your muscles or nerves, such as ALS, myasthenia gravis, or Lambert-Eaton syndrome
• Have had surgery on your face, or have drooping eyelids, weakness of the forehead muscles, or trouble raising your eyebrows
• Have breathing or swallowing problems, or bleed easily
• Have received any botulinum toxin product in the last four months
• Are pregnant, planning a pregnancy, or breastfeeding. It is not known whether Botox® Cosmetic can harm an unborn baby or passes into breast milk.
• Take blood thinners, muscle relaxants, allergy or cold medicines, sleep medicines, or aminoglycoside antibiotics such as gentamicin or tobramycin

Common side effects

Headache, injection-site pain or bruising, tiredness, neck pain, and eye problems including drooping of the eyelid or brow, swelling of the eyelid, dry eye, blurred or double vision, or reduced eyesight. Most injection-site effects settle within hours to days. Eyelid or brow drooping is uncommon and temporary but can last several weeks. Serious allergic reactions (itching, rash, wheezing, dizziness, faintness, swelling of the face or throat) are rare and need immediate medical care.

After treatment

Do not rub or massage the treated area, and stay upright for four hours. Do not drive or operate machinery if you develop muscle weakness, drooping eyelids, or vision changes. Results begin in three to five days and typically last three to four months. Individual results vary.

Dermal Fillers (Juvéderm® hyaluronic acid fillers)

Dermal fillers at Prema Med Spa are Juvéderm® hyaluronic acid gels, administered by our aesthetic nurse injector under physician oversight. They are FDA-approved medical devices for adults 21 and older. A consultation with a licensed provider is required before treatment. The product and amount used are chosen after your provider assesses the treatment area. Individual results vary.

Warning: unintentional injection into a blood vessel

One of the risks with any dermal filler is that it may be injected into a blood vessel by mistake. This is rare, but the consequences can be serious and may be permanent. They include vision abnormalities, blindness, stroke, tissue death (necrosis), and permanent scarring of the skin. The area around the eyes, nose, and forehead carries the highest risk. Seek medical attention right away, and call our office, if after treatment you experience any change in vision, signs of a stroke (sudden difficulty speaking, numbness or weakness in the face, arms, or legs, difficulty walking, facial drooping, severe headache, dizziness, or confusion), white or grey discoloration of the skin, unusual or severe pain, or skin that turns cold or dusky at or near the injection site.

Do not receive dermal fillers if you

• Have a history of severe allergies or anaphylaxis
• Are allergic to lidocaine or to gram-positive bacterial proteins (the hyaluronic acid in Juvéderm® is produced by bacterial fermentation)
• Have an active infection, rash, cold sore, acne, or inflammation at or near the treatment area, until it has cleared
• Are pregnant or breastfeeding. The safety of dermal fillers in pregnancy and breastfeeding has not been studied.

Before you start, tell your provider if you

• Take blood thinners such as warfarin, apixaban, or clopidogrel, or regularly use aspirin, ibuprofen, naproxen, fish oil, vitamin E, or other supplements that thin the blood. These increase the chance of bruising and bleeding.
• Have a bleeding disorder
• Have a history of keloid or hypertrophic scarring, or of pigment changes after skin injury
• Are on immunosuppressive therapy or have an immune system condition
• Have had permanent facial implants or a previous filler placed in the same area
• Have a history of herpes simplex (cold sores). Treatment can trigger an outbreak.
• Have any planned dental work, vaccination, or laser or energy treatment in the weeks around your appointment

Common side effects

Tenderness, swelling, firmness, lumps or bumps, bruising, pain, redness, discoloration, and itching at the injection site. Most resolve within two weeks. Lip swelling can take up to a month to settle. Less common effects include infection, delayed-onset lumps or nodules (which can appear weeks to months later and may need treatment), filler that is visible under the skin or moves from the injection site, and a bluish tint under thin skin. Hyaluronic acid fillers can be dissolved with an enzyme (hyaluronidase) if needed. Your provider will explain the aftercare that applies to your treatment.

Skin Tightening (radiofrequency microneedling)

Skin tightening at Prema Med Spa uses Morpheus8®, an FDA-cleared radiofrequency microneedling device, performed by our trained aesthetic provider under physician oversight. Small needles deliver radiofrequency energy beneath the skin to encourage collagen remodeling. A consultation is required before treatment, and your provider will confirm the treatment is appropriate for your skin and medical history. Most patients need a series of treatments. Individual results vary.

Do not receive radiofrequency microneedling if you

• Have a pacemaker, implantable defibrillator, or other implanted electronic device
• Have metal implants or permanent fillers in the treatment area
• Are pregnant or breastfeeding
• Have an active skin infection, cold sore, open wound, or active acne in the treatment area, until it has cleared
• Have used isotretinoin (Accutane®) in the last six months

Before you start, tell your provider if you

• Have a history of keloid or hypertrophic scarring, or of pigment changes after skin injury
• Have a bleeding disorder or take blood thinners
• Have diabetes, an autoimmune condition, or a weakened immune system, which can slow healing
• Have had a filler, neuromodulator, or other energy treatment in the same area in the last two weeks
• Have a history of cold sores. Treatment can trigger an outbreak.
• Have a recent tan or plan sun exposure in the weeks around treatment

Common side effects

Redness, swelling, warmth, pinpoint bleeding, and mild tenderness for one to three days, and small grid-pattern marks or light crusting for up to a week. Less common effects include bruising, temporary darkening or lightening of the skin (more likely in darker skin types), prolonged redness, burns, infection, and scarring. Follow your aftercare instructions, keep the treated skin clean, and use sun protection.

IPL Photofacial (Lumecca™ intense pulsed light)

The IPL photofacial at Prema Med Spa uses Lumecca™, an FDA-cleared intense pulsed light device, performed by our trained aesthetic provider under physician oversight. Pulses of light are absorbed by pigment and small blood vessels in the skin to improve sun damage, brown spots, redness, and broken capillaries. A consultation is required, and your provider will assess your skin type and history before treatment. Individual results vary.

Do not receive an IPL photofacial if you

• Have a tan, or have had sun exposure or used a tanning bed or self-tanner in the treatment area in the last two to four weeks
• Are pregnant
• Have an active skin infection, cold sore, or open wound in the treatment area, until it has cleared
• Have used isotretinoin (Accutane®) in the last six months
• Take a photosensitizing medication, such as certain antibiotics (doxycycline, tetracycline), retinoids, or St. John’s wort, without first discussing it with your provider

Before you start, tell your provider if you

• Have darker skin, or have a history of melasma or of pigment changes after skin injury. IPL can worsen melasma and carries a higher risk of pigment change in darker skin types.
• Have a history of keloid or hypertrophic scarring
• Have a seizure disorder triggered by light
• Have a history of skin cancer, or have any mole or spot in the area that is changing
• Have a history of cold sores. Treatment can trigger an outbreak.

Common side effects

Redness, mild swelling, and a sunburn-like feeling for a few hours to two days. Brown spots often darken and then flake off over one to two weeks. Less common effects include blistering, burns, crusting, temporary or lasting darkening or lightening of the skin, bruising, and scarring. Protective eyewear is worn during treatment. Strict sun protection is required for several weeks before and after each session.

Laser Hair Removal

Laser hair removal at Prema Med Spa uses DiolazeXL™, an FDA-cleared diode laser, operated by our trained aesthetic provider under physician oversight. The laser targets pigment in the hair follicle to reduce hair growth. A series of sessions is required because hair grows in cycles. Results are long-lasting hair reduction, not guaranteed permanent removal, and individual results vary. A consultation is required, and your provider will assess your skin and hair type before treatment.

Do not receive laser hair removal if you

• Have a tan, or have had sun exposure or used a tanning bed or self-tanner in the treatment area in the last two to four weeks
• Are pregnant
• Have an active skin infection, cold sore, or open wound in the treatment area, until it has cleared
• Have used isotretinoin (Accutane®) in the last six months
• Have waxed, plucked, or used electrolysis in the treatment area in the last four weeks (shaving is fine and is required before treatment)

Before you start, tell your provider if you

• Take a photosensitizing medication, such as certain antibiotics, retinoids, or St. John’s wort
• Have darker skin or a history of pigment changes after skin injury
• Have a history of keloid or hypertrophic scarring
• Have a hormonal condition such as polycystic ovary syndrome, which can affect results
• Have tattoos or permanent makeup in the treatment area. The laser will be kept off them.
• Have a history of cold sores. Treatment can trigger an outbreak.

Common side effects

Redness, swelling around the follicles, and a sunburn-like feeling for a few hours to two days. Less common effects include blistering, burns, crusting, temporary or lasting darkening or lightening of the skin, scarring, and in rare cases increased hair growth near the treated area. Protective eyewear is worn during treatment. Avoid sun exposure and use sun protection between sessions.

Chemical Peels (PCA Skin® and SkinMedica®)

Chemical peels at Prema Med Spa use professional PCA Skin® and SkinMedica® formulations applied by our trained aesthetic provider. A peel removes the outer layers of skin to improve texture, tone, fine lines, and breakouts. The peel and strength are chosen for your skin type and goals at your consultation. Individual results vary.

Do not receive a chemical peel if you

• Have used isotretinoin (Accutane®) in the last six months
• Have an active cold sore, skin infection, open wound, sunburn, or a flare of eczema, psoriasis, or rosacea in the treatment area, until it has cleared
• Are pregnant or breastfeeding, unless your provider confirms the specific peel is appropriate. Some peel ingredients, including salicylic acid and retinoids, are avoided in pregnancy.
• Are allergic to aspirin (for peels containing salicylic acid) or to any ingredient in the peel

Before you start, tell your provider if you

• Use prescription retinoids, exfoliating acids, or other active skincare, which are usually paused for several days before a peel
• Have had a recent laser, IPL, microneedling, waxing, or hair-removal treatment in the same area
• Have darker skin or a history of pigment changes after skin injury
• Have a history of keloid or hypertrophic scarring
• Have a history of cold sores. Peels can trigger an outbreak.

Common side effects

Tingling or stinging during application, redness, tightness, dryness, and flaking or peeling for three to seven days. Less common effects include swelling, blistering, crusting, temporary or lasting darkening or lightening of the skin, prolonged redness, infection, and scarring. Do not pick or pull peeling skin. Sun protection is required for several weeks after a peel.

Reporting side effects

Report any side effect or adverse reaction from any treatment to your Prema provider at (216) 839-0933. If it is an emergency, call 911 first.

This page is not medical advice

This information does not replace a conversation with your provider and is not a complete list of risks. Treatment decisions are made individually, and you will review and sign a treatment-specific consent form before any procedure.