Waxing and Accutane: how long to wait

Isotretinoin, sold under names including Accutane and Roaccutane, works by shrinking sebaceous glands and dramatically speeding up skin cell turnover. A side effect of that is a thinner, more fragile epidermis with weaker adhesion between layers.

Wax does not distinguish between a hair and the skin holding it. On healthy skin the bond between epidermal layers is stronger than the grip of the wax, so the hair comes away and the skin stays. On skin affected by isotretinoin, that balance can invert - and the strip lifts a patch of skin instead.

This is not a rare theoretical risk. It is the single most common serious injury in waxing, and it is almost entirely preventable by asking one question.

Six months after the last dose is the period most training bodies, insurers and manufacturers converge on. Some practitioners extend it to twelve months for facial waxing, where the skin is thinnest and a scar is most visible.

The clock starts at the final dose, not at the start of the course and not at the last appointment with the prescriber. A client who stopped three months ago is still inside the window.

If you are unsure, the safe answer is to decline and offer an alternative. Trimming, threading on unaffected areas, or simply rebooking are all better outcomes than a lifted patch of skin on somebody's lip.

Prescription tretinoin, adapalene, and over-the-counter retinol all accelerate turnover in the same direction, just less aggressively. The usual guidance is to stop applying them to the area for five to seven days before waxing.

Clients frequently do not think of these as medication. Somebody who answers no to "are you taking any medication" will happily answer yes to "do you use retinol, tretinoin or another retinoid on this area" - which is why the question has to be specific rather than general.

A consent form completed at the first appointment tells you about the client as they were that day. Courses of isotretinoin start and finish between appointments, and a client who has been coming for two years is exactly the person you will forget to re-ask.

The practical answer is a form that goes out with every booking rather than a file you open once. It takes the client under two minutes and gives you a dated record of what they told you on the day of that appointment.

If the answer is yes, the useful behaviour is not a note in a file - it is the appointment being flagged loudly enough that nobody starts work before somebody reads it.