Anti-Wrinkle (Botulinum Toxin A) — Complication Fact Sheet

#1: Bruising, Swelling & Injection Site Pain

Trauma to small vessels and tissue during injection. Common in anticoagulated patients or thin skin.

Signs: local erythema, swelling, bruising.
Prevention: avoid blood thinners where safe, apply cold pre/post, fine needle technique.
Treatment: cold compress 24h, then warm; Arnica/vitamin K creams optional. Self-limiting in 7–10 days. Documentation: record site, management, patient reassurance.¹

#2: Headache & Flu-like Reactions

Cause: mild immune or neuromuscular response post-injection.
Signs: headache, fatigue, malaise within 48h.
Prevention: patient counselling.
Treatment: paracetamol/NSAIDs. Documentation: reassure, note in records.²

#3: Asymmetry / Suboptimal Effect

Cause: uneven dosing or placement, variable muscle anatomy.
Signs: asymmetrical movement, suboptimal cosmetic result.
Prevention: mapping, conservative dosing. Treatment: review at 2 weeks, corrective top-up if indicated. Documentation: photographs, dose/site record.³

#4: Ptosis (Eyelid or Brow Drop)

Cause: diffusion to levator palpebrae or frontalis.
Signs: eyelid droop, brow heaviness, onset 3–7 days.
Prevention: avoid injections <1 cm from supraorbital ridge, counsel not to rub.
Treatment: Apraclonidine 0.5% drops 2–3x/day; resolves 2–12 weeks.
Documentation: photograph, record dose, reassure, schedule review.⁴

#5: Smile Asymmetry / Functional Weakness

Cause: diffusion into perioral muscles.
Signs: uneven smile, speech/drinking difficulty.
Prevention: careful dosing near perioral muscles.
Treatment: usually resolves in 2–8 weeks. Supportive advice.
Documentation: record onset, advice, review planned.⁵

#6: Rare Systemic Reactions

Cause: toxin spread/systemic effect, allergy.
Signs: dysphagia, dysphonia, respiratory weakness, urticaria, anaphylaxis (very rare).
Prevention: thorough medical history, dose limits.
Treatment: mild systemic → refer GP/neurology; anaphylaxis → adrenaline IM, call 000, oxygen, airway support.
Documentation: record time, meds given, regulatory notification if severe.⁶

Sources

Ahpra & National Boards (2025). Guidelines for practitioners performing non-surgical cosmetic procedures., viewed 7 October 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩︎
Therapeutic Goods Administration (TGA). Botulinum Toxin Product Information (Australia)., viewed 7 October 2025, https://www.ebs.tga.gov.au ↩︎
Australasian College of Dermatologists (2024). Botulinum toxin complications., viewed 7 October 2025, https://www.dermcoll.edu.au ↩︎
RACGP (2023). Adverse events in cosmetic procedures., viewed 7 October 2025, https://www.racgp.org.au/clinical-resources/clinical-guidelines/view-all-racgp-guidelines ↩︎
TGA (2024). Apraclonidine Product Information., viewed 7 October 2025, https://www.ebs.tga.gov.au ↩︎
Australasian College of Dermatologists (2024). Eyelid ptosis management in cosmetic dermatology., viewed 7 October 2025, https://www.dermcoll.edu.au ↩︎

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.