#1: Bruising, Swelling, Erythema

Cause: Needle trauma, vessel puncture.
Signs: erythema, swelling, bruising.
Prevention: careful technique, cold compress.
Treatment: cold compress 24h, warm compress after, topical arnica.
Follow-up: reassure, self-limiting, record in notes.¹

#2: Lumps & Nodules

Cause: superficial placement, product aggregation, biofilm.
Signs: palpable lumps, Tyndall effect (bluish hue).
Prevention: inject at correct depth.
Treatment: massage, hyaluronidase for HA, antibiotics for biofilm.
Follow-up: review 1–2 weeks, escalate if persistent.²

#3: Infection (Cellulitis, Abscess, Biofilm)

Cause: aseptic breach, delayed biofilm.
Signs: redness, pain, warmth, pus, fever.
Prevention: strict asepsis.
Treatment: swab, antibiotics (flucloxacillin/cephalexin), drainage if abscess, hyaluronidase if HA.
Follow-up: review in 24–48h, escalate if systemic.³

#4: Delayed Inflammatory Nodules / Immune Reactions

Cause: immune activation weeks to months later, sometimes post infection/vaccine.
Signs: tender, red nodules.
Prevention: cautious patient selection.
Treatment: corticosteroids oral/intralesional, hyaluronidase if HA.
Follow-up: refer dermatology if resistant.⁴

#5: Vascular Occlusion (Skin Necrosis)

Cause: intravascular injection or compression.
Signs: immediate blanching, severe pain, mottling, blistering.
Prevention: small aliquots, aspirate (though unreliable), avoid high-risk zones.
Treatment: stop injection, warm compress, vigorous massage, hyaluronidase flooding (1500 units), aspirin 300mg, nitroglycerin paste optional.
Follow-up: daily until reperfusion. Escalate to hospital/dermatology if necrosis.⁵

#6: Ophthalmic Artery Occlusion (Vision Loss)

Cause: retrograde embolism to ophthalmic/retinal artery.
Signs: sudden vision loss, ocular pain, amaurosis, diplopia.
Prevention: avoid bolus in glabella/nasal regions.
Treatment: urgent ophthalmology, call 000, ocular massage, acetazolamide/timolol if directed, hyaluronidase retrobulbar (specialist).
Follow-up: permanent risk, document thoroughly.⁶

#7: Granulomas & Migration

Cause: immune response, poor technique.
Signs: firm nodules, filler displacement.
Prevention: good technique, conservative dosing.
Treatment: hyaluronidase for HA, intralesional steroids, excision if refractory.
Follow-up: dermatology/plastics referral.⁷

#8: Anaphylaxis

Cause: hypersensitivity to filler/lidocaine.
Signs: urticaria, airway swelling, collapse.
Prevention: allergy history, emergency kit.
Treatment: adrenaline IM 0.5 mL 1:1000, call 000, airway support, oxygen, fluids.
Follow-up: hospital admission, report to TGA/Ahpra.

Sources

1. 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 ↩︎
2. Therapeutic Goods Administration (TGA). Hyaluronidase and filler product information (Australia)., viewed 7 October 2025, https://www.ebs.tga.gov.au ↩︎
3. Australasian College of Dermatologists (2024). Dermal filler complications., viewed 7 October 2025, https://www.dermcoll.edu.au ↩︎
4. RACGP (2023). Adverse events in cosmetic procedures., viewed 7 October 2025, https://www.racgp.org.au ↩︎
5. Beleznay K, Carruthers JD, Humphrey S, Jones D. (2015). Avoiding and treating blindness from fillers. Plast Reconstr Surg 136(3):445–460., viewed 7 October 2025, https://journals.lww.com/plasreconsurg/Fulltext/2015/09000/Avoiding_and_Treating_Blindness_From_Fillers__A.41.aspx ↩︎
6. Australian Society of Plastic Surgeons (ASPS). Cosmetic injectables safety statements., viewed 7 October 2025, https://plasticsurgery.org.au ↩︎
7. BAAPS (UK). Management of complications from dermal fillers., viewed 7 October 2025, https://baaps.org.uk ↩︎