Complications in Aesthetic Medicine

ABSTRACT

Aesthetic medicine procedures have become increasingly sophisticated and widely practiced, yet complications—although often preventable—remain a critical concern for patient safety and clinical excellence. Complications arise from injectables, lasers, energy-based devices, threads, chemical peels, and regenerative therapies. This educational module provides a comprehensive overview of common and serious complications, focusing on prevention strategies, risk factors, early detection, and evidence-based management protocols. It equips practitioners with essential knowledge to recognize warning signs, apply immediate corrective actions, and maintain long-term patient care.

LEARNING OBJECTIVES

Upon completion of this module, learners will be able to:

1. Identify common complications associated with aesthetic procedures.
2. Recognize high-risk patient factors and treatment conditions.
3. Apply preventive strategies across injectables, lasers, peels, and surgical adjuncts.
4. Manage complications confidently using standardized clinical protocols.
5. Understand when to refer to specialists for advanced care.
6. Maintain patient communication and documentation for medico-legal safety.

1. INTRODUCTION

Complications can occur with any aesthetic procedure—regardless of provider experience. Most complications are mild and transient, but serious adverse events, though rare, demand immediate intervention to prevent permanent harm.

High standards in:

• Anatomical knowledge
• Technique precision
• Sterile procedures
• Patient selection
• Device understanding

…are essential to ensure safety.

This module covers complications related to:

• Dermal fillers
• Botox (BoNT-A)
• Laser & energy-based devices
• Chemical peels
• Thread lifts
• Regenerative medicine (PRP, exosomes, polynucleotides)

2. COMPLICATIONS RELATED TO DERMAL FILLERS

Dermal fillers are widely used for facial contouring, rejuvenation, and volume restoration. Complications range from mild swelling to life-threatening vascular compromise.

2.1 Early, Expected Reactions

• Swelling
• Redness
• Tenderness
• Bruising

These typically resolve within days.

2.2 Filler Nodules

Types

1. Inflammatory
2. Non-inflammatory (product-related)

Management

• Warm compress
• Massage
• Hyaluronidase (for HA fillers)
• Antibiotics if infected

2.3 Tyndall Effect

Cause:

Superficial placement of HA filler.

Management:

• Small dose of hyaluronidase
• Avoid re-injecting too superficially

2.4 Vascular Occlusion — Most Serious Complication

Signs

• Immediate severe pain
• Blanching
• Livedo pattern
• Cool skin
• Delayed capillary refill
• Skin discoloration

Emergency Management Protocol

1. Stop the procedure immediately
   2. High-dose hyaluronidase injections repeatedly
   3. Warm compress
   4. Massage area
   5. Aspirin 300 mg (if not contraindicated)
   6. Nitroglycerin ointment (optional)
   7. Oral antibiotics
   8. Refer to specialist if no improvement

If visual symptoms appear (rare but critical):

Emergency referral to ophthalmology within minutes.

2.5 Infection

Signs

• Redness
• Heat
• Pain
• Swelling
• Discharge

Management

• Oral antibiotics
• Avoid injecting during active infection

2.6 Delayed-Onset Nodules (Biofilm)

Management

• Antibiotics (macrolides, tetracyclines)
• Steroids (short-term)
• Hyaluronidase
• Culture if needed

3. COMPLICATIONS FROM BOTULINUM TOXIN

Botulinum toxin is generally safe but can cause functional and aesthetic complications.

3.1 Ptosis (Eyelid or Brow)

Cause

• Diffusion to levator palpebrae or frontalis imbalance

Management

• Apraclonidine or oxymetazoline drops
• Correct approach in future sessions

3.2 Smile Asymmetry

Cause

• DAO or DLI overdosing

Management

• Micro-adjustments on opposite side
• Conservative future dosing

3.3 Frozen Look or Heavy Brows

Cause

• Excessive toxin in forehead

Management

• Allow natural recovery
• Adjust pattern next session

3.4 Dysphagia or Weakness

Rare and usually dose-dependent.

4. COMPLICATIONS FROM LASERS & ENERGY-BASED DEVICES

Laser complications are often related to:

• Incorrect parameters
• Inadequate cooling
• Poor patient selection
• Recently tanned skin

4.1 Burns

Most common laser complication.

Management

• Immediate cooling
• Topical steroids (short-term)
• Hydrocolloid dressings
• Monitor for infection

4.2 Post-Inflammatory Hyperpigmentation (PIH)

Particularly in skin types IV–VI.

Prevention

• Gentle parameters
• Pre-treatment priming
• Avoiding aggressive heat

Treatment

• Topical brighteners
• Sunscreen
• Low-strength peels once healed

4.3 Hypopigmentation

Caused by melanocyte injury.
More likely after aggressive resurfacing.

4.4 Scarring

Rare but occurs from:

• High fluence
• Overlapping passes
• Infected wounds

4.5 Herpes Reactivation

Common after CO₂ resurfacing.
Requires antiviral prophylaxis.

4.6 Worsening of Melasma

Melasma is heat sensitive.
High-energy lasers can cause rebound.

5. COMPLICATIONS FROM CHEMICAL PEELS

5.1 Prolonged Redness

Common after medium-depth peels.
Usually resolves spontaneously.

5.2 PIH

Most frequent complication.

Prevention

• Pre-Treatment priming
• Avoid sun
• Avoid over-aggressive peeling

5.3 Burns

Caused by excessive layers or poor neutralization.

Management:

• Immediate neutralization (if required)
• Topical steroids
• Cooling
• Hydration

5.4 Scarring

Rare but higher with phenol or TCA.

5.5 Infection

Especially in deeper peels.

6. COMPLICATIONS FROM THREAD LIFTS

6.1 Bruising & Swelling

Common and expected.

6.2 Dimpling / Irregular Contour

Management

• Gentle massage
• Release tension after 1–2 weeks if persistent

6.3 Thread Extrusion

Management

• Remove the exposed segment under sterile technique

6.4 Thread Migration

Management

• Reposition if possible
• Remove if necessary

6.5 Asymmetry

Often due to tissue settling; reassess after 2–4 weeks.

6.6 Infection

Prevention: strict sterility
Management: antibiotics ± thread removal

7. REGENERATIVE THERAPIES (PRP, EXOSOMES, PN)

7.1 PRP Complications

• Bruising
• Swelling
• Infection (rare)
• Temporary worsening of shedding in hair protocols

7.2 Exosome Therapy Complications

Generally minimal:

• Redness
• Sensitivity
• Mild swelling

7.3 Polynucleotides (PN / PDRN)

• Mild erythema
• Swelling
• Rare hypersensitivity events

8. GENERAL PRINCIPLES OF COMPLICATION PREVENTION

8.1 Patient Assessment

• Medical history
• Skin type
• Medications
• Contraindications
• History of keloid or poor wound healing

8.2 Informed Consent

Must include:

• Expected outcomes
• Risks
• Alternatives
• Pre/post-care instructions

8.3 Sterile Technique

Critical for injectables, threads, PRP, and microneedling.

8.4 Understanding Anatomy

Most severe complications are anatomical errors involving:

• Arteries
• Veins
• Nerves
• Fat compartments

8.5 Conservative Treatment Approach

Use the lowest effective:

• Toxin dose
• Laser fluence
• Filler volume
• Peel depth

9. EARLY DETECTION & MANAGEMENT FRAMEWORK

Early intervention is the key to preventing long-term damage.

Red Flags

• Sudden severe pain
• Blanching
• Vision changes
• Blistering
• Rapid swelling
• High fever

Immediate action is required if any appear.

10. DOCUMENTATION & MEDICO-LEGAL SAFETY

10.1 Documentation

Record:

• Product details
• Lot numbers
• Injection points
• Energy settings
• Pre/post photographs

10.2 Patient Communication

Provide:

• Clear instructions
• Emergency contact
• Written aftercare

10.3 Follow-Up

Schedule:

• 1–2 week review
• Additional visits if concerns arise

11. KEY LEARNING POINTS

• Complications occur even with experienced practitioners—prevention is essential.
• Thorough patient assessment reduces risk significantly.
• Fillers carry the highest risk of vascular compromise; practitioners must master protocols.
• Botulinum toxin complications are often functional and reversible.
• Lasers must be used cautiously in darker skin types to avoid PIH.
• Thread lifts require proper plane placement to avoid visibility and extrusion.
• Early intervention and documentation protect patient safety and clinical reputation.
• Continuous training and emergency preparedness are mandatory for all aesthetic practitioners.