1. Purpose & Scope

This Standard Operating Procedure (SOP) defines safe, reproducible injection techniques for dermal fillers and botulinum toxin at Newcastle Cosmetic Doctor (NCD). It aims to minimise avoidable risk by standardising anatomical mapping, safe depth/plane selection, instrument choice, and procedural checks across all high‑risk facial regions. The SOP supports compliance with Australian cosmetic practice guidance, clinical governance standards, and patient‑safety frameworks. ^{1 2 3}

2. Clinical Governance Alignment

This SOP aligns with AHPRA/Medical Board cosmetic procedure guidelines, NSQHS Clinical Governance and Partnering with Consumers Standards, and RACGP safety expectations for procedural practice. It should be read alongside NCD’s consent policy, incident management and adverse event SOPs, and emergency response protocols (BLS/anaphylaxis/vascular occlusion). Audit of documentation quality, consent completeness, and complications forms part of ongoing clinical governance. ^{1 3 4}

3. Facial Anatomy Overview

Safe injection technique depends on three elements: understanding vascular pathways, respecting depth planes, and anticipating anatomical variation. Arterial branches at risk include the supratrochlear, supraorbital, angular, infraorbital, facial, mental, and superficial temporal arteries; venous congestion may present more subtly than arterial compromise. Depth planes (intradermal, subdermal, subcutaneous, superficial musculoaponeurotic system (SMAS) plane, supraperiosteal) determine product behaviour and risk. Operators must adapt technique to patient-specific anatomy, previous procedures, and tissue compliance. ^{5 6}

4. Injection Safety Principles

Adopt a ‘safety-first’ sequence: pre‑procedure photography and mapping; skin antisepsis; correct patient positioning; instrument choice (needle vs cannula) based on zone risk; low volumes per pass; slow injection with minimal pressure; frequent needle movement; and continuous visual monitoring for pallor, pain, livedo, or coolness. For toxin: avoid intravascular injection by using superficial intramuscular or intradermal depths appropriate to target, conservative unit dosing, and symmetry checks. For fillers: prefer cannula in high‑risk zones when appropriate, inject on bone for structural support using micro‑aliquots, and avoid bolus in known danger areas. ^{1 5}

5. Anatomical Zones

5.1 Forehead & Glabella

Risks: retrograde embolisation via supratrochlear/supraorbital branches and dorsal nasal communication. Toxin: target frontalis in the superficial plane; avoid excessive medial dosing to reduce brow ptosis risk. Filler: avoid glabellar bolus; if correction is essential, consider micro‑aliquots with blunt cannula in the proper plane and maintain readiness for immediate vascular occlusion management. ⁵

5.2 Temple

Risks: superficial temporal artery/vein injury and potential retrograde flow. Filler: favour deep supraperiosteal or sub‑SMAS plane with minimal aliquots; consider cannula to reduce arterial penetration risk; aspirate judiciously understanding its limitations. Monitor for pain, blanching or livedo; stop immediately if suspicious changes occur and initiate emergency protocol. ^{5 6}

5.3 Periorbital Region

Risks: arterial compromise with visual symptoms; oedema and Tyndall effect with superficial placement. Toxin: use conservative dosing and superficial placement to avoid diffusion causing ptosis or diplopia. Filler: prefer cannula in tear trough where indicated; place micro‑aliquots on periosteum with minimal pressure; avoid intravascular injection by continuous movement and low force. Immediate ophthalmology escalation is indicated for any visual change. ⁵

5.4 Nose

Risks: dorsal nasal and angular artery compromise with potential skin necrosis or visual sequelae. Avoid high‑pressure bolus and repeated passes in the same track; consider cannula approaches and remain strictly supraperiosteal or perichondrial when indicated. Terminate injection at any sign of blanching, livedo, severe pain or coolness and initiate hyaluronidase protocol where HA is present. ^{5 6}

5.5 Cheeks & Midface

Risks: infraorbital and facial artery branches. Filler: structural augmentation is safest on bone (supraperiosteal) using small aliquots with withdrawal technique; avoid intravascular placement by maintaining low pressure and deliberate depth control. Monitor for periorbital oedema with malar injections; adjust technique to tissue compliance and previous filler. ⁵

5.6 Lips & Perioral Area

Risks: labial artery branches and mucosal vascularity; Tyndall effect with overly superficial placement. Toxin: micro‑dosing for perioral lines to avoid oral incompetence. Filler: use micro‑threads or micro‑aliquots intradermally/subdermally; avoid deep high‑pressure bolus; consider cannula for vermilion border definition; stop for pain, pallor or livedo. ⁵

5.7 Chin & Jawline

Risks: mental and facial artery branches; venous congestion presenting as swelling or dusky discoloration. Filler: place on bone for projection using small volumes; avoid intravascular injection with controlled pressure and steady cannula/needle movement. Assess occlusion risk where previous implants or scarring exist; escalate early if vascular compromise suspected. ^{5 6}

6. Product Handling & Preparation

Adhere to TGA scheduling and product information for reconstitution, storage and stability. Maintain cold‑chain for botulinum toxin (2–8 °C) and document batch/lot, expiry, dilution and units. Use sterile technique for syringe preparation and minimise product exchanges that increase contamination risk. Confirm product identity aloud with a ‘read‑back’ before injection and photograph labels for traceability. ^{7 8}

7. Risk Recognition & Immediate Response

Stop injection for blanching, livedo, severe pain or coolness. Initiate vascular occlusion protocol for HA filler (high‑diffusion hyaluronidase; reassess perfusion; repeat if necessary). Escalate immediately for any visual symptoms (urgent ophthalmology). For anaphylaxis, administer IM adrenaline per ARC guidance and call 000. Document exam findings, timings and all interventions; provide written aftercare and safety‑net advice. ^{5 9 2}

8. Documentation & Patient Consent

Use AHPRA‑compliant consent with clear discussion of benefits, risks, alternatives, costs and recovery. Record mapping, product details, dose/units, depth/plane, injection sites, batch/lot/expiry, and pre/post photographs. Provide written aftercare instructions and document teach‑back understanding where appropriate. ^{1 3}

9. Follow‑Up & Complication Review

Schedule routine review (10–14 days for toxin symmetry; 2–4 weeks for filler settling) or earlier if concerns arise. Enter any incidents into the risk register; review at governance with root‑cause analysis and corrective actions. Where indicated, submit reports to TGA DAEN (medicines/devices) and follow local complaint pathways. ^{2 3}

Sources

1. AHPRA / Medical Board of Australia, Guidelines for Non‑Surgical Cosmetic Procedures (2025)., viewed 27 October 2025, https://www.ahpra.gov.au/News/2025-01-31-Guidelines.aspx ↩
2. Therapeutic Goods Administration (TGA), Reporting Adverse Events (DAEN)., viewed 27 October 2025, https://www.tga.gov.au/reporting-adverse-events ↩
3. Australian Commission on Safety and Quality in Health Care (ACSQHC), NSQHS Standards., viewed 27 October 2025, https://www.safetyandquality.gov.au/standards ↩
4. RACGP, Clinical governance and procedural safety resources., viewed 27 October 2025, https://www.racgp.org.au/clinical-resources/clinical-guidelines ↩
5. ACE Group World, Aesthetic Complications Expert Group Guidance (2024)., viewed 27 October 2025, https://uk.acegroup.online/ ↩
6. Australasian College of Aesthetic Medicine (ACAM), Clinical Safety Resources., viewed 27 October 2025, https://www.acam.org.au/ ↩
7. Australian Resuscitation Council (ARC), Anaphylaxis & Emergency Guidelines., viewed 27 October 2025, https://resus.org.au/guidelines/ ↩
8. Product Information & ARTG Entries, Therapeutic Goods Administration (TGA)., viewed 27 October 2025, https://www.tga.gov.au/products/artg ↩
9. NSQHS, Partnering with Consumers Standard & Clinical Governance., viewed 27 October 2025, https://www.safetyandquality.gov.au/standards/nsqhs-standards ↩