Living with vWD entails specific challenges and concerns that impact bot affected individuals and their families.Von Willebrand disease is the most common inherited bleeding disorder, affecting up to 1% of the population. It is characterized by a quantitative or qualitative deficiency of von Willebrand factor (vWF), a protein essential for platelet adhesion and stabilization of factor VIII. With the increasing popularity of minimally invasive aesthetic procedures — such as dermal fillers, botulinum toxin, chemical peels, and laser therapies — concerns arise regarding the risk of bleeding and bruising in patients with underlying coagulation disorders, particularly vWD. While some patients may be asymptomatic, others may present with spontaneous bruising, nosebleeds, heavy menstrual bleeding, or excessive bleeding following surgical procedures or trauma. Even aesthetic interventions considered minimally invasive may lead to significant complications in individuals with undiagnosed or inadequately managed vWD.

Although specific literature on aesthetic procedures in patients with vWD is limited, clinical experience from dermatologic, dental, and gynecologic contexts provides valuable guidance. Botulinum toxin type A (BoNT-A) is generally regarded as safe due to its superficial and minimally invasive application, often not requiring prophylaxis in well-controlled patients. In contrast, dermal fillers such as hyaluronic acid pose a higher risk of bruising, especially in highly vascularized areas like the lips and nasolabial folds, making pre-procedure assessment of hemostasis essential. Procedures involving chemical peels and ablative lasers may induce superficial bleeding and are typically contraindicated in patients with severe or poorly managed vWD. Techniques such as microneedling and dermarolling should be approached with heightened caution and, when deemed necessary, performed under hematologic supervision, ideally with the use of desmopressin or von Willebrand factor replacement therapy as prophylaxis.Clinical management of aesthetic procedures in patients with vWD requires careful planning and a multidisciplinary approach to minimize bleeding risks. Prior to the procedure, a comprehensive hematologic evaluation should be performed, including assessment of vWF and factor VIII levels, as well as bleeding time, followed by accurate classification of the vWD type and severity. Collaboration with a hematologist is essential to determine the need for prophylactic measures such as desmopressin, cryoprecipitate, or vWF/factor VIII concentrates. During the procedure, clinicians should employ minimally traumatic techniques, ensuring immediate application of cold compresses and gentle local pressure to limit vascular injury. After the intervention, patients should avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants unless clearly indicated and used with caution. Continuous monitoring for hematomas, extensive bruising, or delayed bleeding is advised, along with prompt follow-up in case of any complications.

Although von Willebrand disease poses challenges to the safe performance of aesthetic procedures, individualized assessment, well-coordinated, and multidisciplinary approaches allow many patients to undergo these interventions with minimal risk. Close collaboration between dermatologists, plastic surgeons, and hematologists is essential to ensure safety and optimal outcomes.