Dermal Filler Complication Management Policy — Australia 2025 (NSW Laws Version)

This policy outlines evidence-based clinical procedures for the prevention, recognition, and management of dermal filler complications in compliance with Australian and New South Wales (NSW) legal frameworks. It aligns with guidance from the Therapeutic Goods Administration (TGA)¹, Australian Health Practitioner Regulation Agency (AHPRA)², and NSW Health³ to ensure patient safety and professional accountability.

1. Purpose & Scope

Define practitioner responsibilities for the use of hyaluronic acid (HA) fillers in aesthetic medicine.
Standardise complication management consistent with NSW legislative frameworks⁴.
Apply to all cosmetic medical practitioners, registered nurses, and delegated clinical staff involved in injectable procedures.

2. Legal Framework (NSW)

Poisons and Therapeutic Goods Act 1966 (NSW)⁵: Regulates the possession, prescription, and administration of Schedule 4 (prescription-only) substances.
Public Health Act 2010 (NSW)⁶: Requires adherence to infection control standards for all skin penetration procedures.
AHPRA Cosmetic Guidelines (2023)²: Mandate patient assessment, informed consent, and direct prescriber oversight.
NSW Health Amendments (2021)³: Establishes recordkeeping, prescription authority, and storage obligations for cosmetic medicines.

3. Risk Assessment & Escalation

Conduct patient screening for autoimmune conditions, allergies, and previous dermal filler exposure.
Recognise early indicators of vascular compromise—pain, pallor, livedo reticularis, or visual symptoms.
Escalation protocol:
- Mild inflammation: Cold compress and topical steroid, review in 48 hours.
- Infection: Commence oral antibiotics (e.g., cephalexin 500 mg qid for 7 days)⁷.
- Vascular occlusion: Administer hyaluronidase (1500 IU/mL)⁸, apply warm compress, give aspirin 300 mg orally.
- Vision loss: Urgent ophthalmology referral and periocular hyaluronidase injection per ACE Group protocol⁹.

4. Pharmacologic Management

Hyaluronidase⁸: Enzyme that hydrolyses hyaluronic acid filler to restore perfusion in occlusion cases.
Antibiotics⁷: Cephalexin or doxycycline for cellulitis, abscess, or biofilm-related inflammation.
Corticosteroids¹⁰: Manage granulomatous or immune-mediated nodules.
Antihistamines¹¹: Used for delayed inflammatory or allergic reactions post-injection.

5. Documentation & Reporting

Document all adverse events within 24 hours of onset.
Report serious complications (e.g., vascular occlusion, visual loss) to NSW Health³ and AHPRA².
Maintain a complication register and audit outcomes quarterly for clinical governance review.

6. Education & Governance

All practitioners must complete accredited complication management training and annual CPR certification.
Clinical directors must review adverse incidents and staff compliance quarterly.
Continuous alignment with NSW Health, TGA¹, and AHPRA² safety frameworks is mandatory.

Sources

Therapeutic Goods Administration (TGA). (2024). Cosmetic injectables and safety standards, viewed 04 November 2025, https://www.tga.gov.au/ ↩
AHPRA. (2023). Guidelines for medical practitioners who perform cosmetic medical and surgical procedures, viewed 04 November 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩
New South Wales Government (NSW) (2021), Poisons and Therapeutic Goods Amendment (Cosmetic Use) Regulation 2021, viewed 04 November 2025, https://www.legislation.nsw.gov.au/view/pdf/asmade/sl-2021-372 ↩
NSW Government. (2023). Cosmetic procedure laws in NSW, viewed 04 November 2025, https://www.health.nsw.gov.au/patients/cosmetic/Pages/default.aspx ↩
Poisons and Therapeutic Goods Act 1966 (NSW), viewed 04 November 2025, https://legislation.nsw.gov.au/view/html/inforce/current/act-1966-031 ↩
Public Health Act 2010 (NSW), viewed 04 November 2025, https://legislation.nsw.gov.au/view/html/inforce/current/act-2010-127 ↩
Royal Australian College of General Practitioners (RACGP) (2024), Infection & Sepsis – Standards for General Practices (5th ed.), viewed 04 November 2025, https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/infection-and-sepsis ↩
Aesthetic Complications Expert (ACE) Group World (2024), The Use of Hyaluronidase in Aesthetic Practice (v3.1), viewed 04 November 2025, https://uk.acegroup.online/wp-content/uploads/2024/01/ACE-Group-Hyaluronidase-v3.1.pdf ↩
International Society of Aesthetic Plastic Surgery (ISAPS) (2023), Statements & Guidelines – Safety Guidelines for Aesthetic Practice, viewed 04 November 2025, https://www.isaps.org/education/patient-safety-information/statements-guidelines/ ↩
Koshi EJ, Complications of Corticosteroid Therapy (2022), PMC article, viewed 04 November 2025, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608099/ ↩
Mayo Clinic (2025), Allergy medications: Know your options (includes antihistamine overview), viewed 04 November 2025, https://www.mayoclinic.org/diseases-conditions/allergies/in-depth/allergy-medications/art-20047403 ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.