HealthCert Blog

Complications exist in any line of work, and aesthetic medicine is no exception. They usually develop as an outcome of a doctor’s mistake or due to:

• Unfortunate circumstances,
• Adverse reaction to treatment,
• Bad luck, or
• The patient’s failure to follow aftercare advice.

Regardless of the cause, these complications are rare. In most cases, they are mild and, with proper training, manageable in a primary care setting.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Aesthetic Medicine.

Here’s an overview of potential complications physicians may encounter when providing common aesthetic treatments and the best ways to manage them.

Chemical peels

Depending on how deep the chemical peel penetrates the skin layers, we may expect different complications. Post-treatment edema and erythema are common side effects. Other possible complications include:

• Post-inflammatory hyperpigmentation (PIH),
• Hypopigmentation,
• Infections, and
• Scarring

Most complications occur in people with darker skin. Mixed ethnic background also increases the risk, regardless of the patient’s skin colour.

Patients who disregard the advice to avoid sunlight and use SPF are likely to experience complications.

The best way to manage infections is with topical and oral antibiotics. Other chemical peels complications require the help of topical retinoids, steroid creams, RF microneedling, or microdermabrasion.

Laser treatments

Lasers are among the most potent tools in aesthetic medicine. To a layperson, some outcomes of laser treatment, such as purpura or white blanching, may look like complications.

Real complications of laser treatment may include:

• Blistering,
• Burns,
• Hyperpigmentation and hypopigmentation,
• Infections,
• Scarring, and
• Ocular damage

Blisters and burns are more likely to occur in individuals with darker skin. Blistering often resolves on its own. However, topical zinc creams can help the process. Superficial and sterile burns heal well but can also benefit from soothing topicals (aloe vera, zinc, anti-inflammatory creams, etc.).

Deeper burns are rare. They can lead to infections that require treatment with antibiotics.

Pigmentary changes and scarring respond well to minimally invasive treatments, such as:

• Dermabrasion, and
• Microdermabrasion

Ocular damage is a severe complication. Its management exceeds the capacity of primary care.

Botulinum toxin injections

Ptosis is the most common complication of botulinum toxin injections. Asymmetry follows close behind.

There is nothing that can reverse the effects of botulinum toxin instantly. It takes three to four months for them to wear off. Sometimes it is possible to fix asymmetry by injecting more to the opposite side. However, this requires a high level of skill.

Platelet-rich plasma therapy (PRP)

PRP is a derivation of a patient’s blood. The treatment does not involve the use of any active substances.

Possible complications are similar to those of injections, such as:

• Erythema,
• Bruising,
• Pain at the injection site,
• Discolouration, and
• Infections

The best management methods include warm compresses, ice, anti-inflammatory creams, antibiotics (in case of an infection), etc.

Platelet-rich plasma therapy is not 100 per cent safe. There were some cases of irreversible blindness following peri-ocular delivery of PRP.¹

Dermal fillers

Most complications of dermal fillers usually occur due to improper delivery or misplacement. Early-onset complications include:

• Erythema,
• Oedema,
• Bruising,
• Lumps,
• Nodules,
• Blanching,
• Vascular occlusion,
• Hyperpigmentation,
• Skin necrosis,
• Infections, and
• Biofilms

Potential late-onset complications are:

• Granuloma,
• Migration,
• Telangiectasia,
• Hypertrophic scarring, and
• Infections

Many of these are not manageable in primary care. Early-onset complications are usually temporary and manageable. Injecting Hyaluronidase immediately after the onset of complications can prevent severe damage, especially in the case of vascular occlusion.

Additionally, it is possible to improve lumps and nodules by puncturing them and squeezing out the filler.

– Dr Rosmy De Barros

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References:

• Hamilton MM, Kao R. Recognizing and Managing Complications in Laser Resurfacing, Chemical Peels, and Dermabrasion. Facial Plast Surg Clin North Am. 2020;28(4):493-501. doi:10.1016/j.fsc.2020.06.008
• Jackson A. Chemical peels. Facial Plast Surg. 2014;30(1):26-34. doi:10.1055/s-0033-1364220
• Cavallini M, Gazzola R, Metalla M, Vaienti L. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J. 2013;33(8):1167-1174. doi:10.1177/1090820X13511970
• Sethi N, Singh S, DeBoulle K, Rahman E. A Review of Complications Due to the Use of Botulinum Toxin A for Cosmetic Indications [published correction appears in Aesthetic Plast Surg. 2022 Feb;46(1):595]. Aesthetic Plast Surg. 2021;45(3):1210-1220. doi:10.1007/s00266-020-01983-w
• ¹ https://pubmed.ncbi.nlm.nih.gov/27015236/