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Injectables – What could go wrong?


What is interesting to me, and strikes me during cosmetic clinics, is that most people that I see, are drawn into cosmetic clinics by the (cheap) prices, BUT:

– have no idea what they had in the past elsewhere (brand, anti-wrinkle vs filler; amount; injector experience and qualification)
– sometimes I see these people because they have had poor experiences elsewhere and want correction, or because the clinic has closed; or because there is a special on- go in, tell them what you want, it is done and they are out the door. But did they get what they paid for, even if it was “only” $200?

What is also interesting, to me, is the way consent is done- several people have had filler to their deep frown lines, without being advised, reportedly, that it can cause permanent, irreversible blindness. It is one of the riskiest areas to inject with filler due to the catastrophic consequences though theoretically, the face being a minefield, any part of it could lead These patients, “clients” have signed a consent form without an actual discussion of side effects and expectations.

So what do you need to know about cosmetic injectables before you sign up, whether with me, or anyone else?

1. who your injector is.
2. how long they have been doing this.
3. what their qualifications are – at minimum they need, in Australia, to be a doctor with appropriate training; or a dentist; or a registered nurse working with a doctor who can authorise the medication for him/her, ONLY after a consult with the doctor.
4. how do you feel with them? Do they spend time to get to know you or do you feel rushed? Do they understand what your concerns are, even if you think you know what you want/need? Are they willing to advise you if they believe your expectations are unrealistic, or if you may need more product than you have budgeted for? Are they willing to turn you away if what you are expecting for your budget won’t get you the desired result?
5. Is there a followup planned with them? Do you have access to them if something does go wrong (and something CAN go wrong, it is a medical procedure, no matter how much it is sold as a beauty procedure.)
6. how good is their understanding of facial anatomy, especially if something goes wrong? Can they fix the problem or are they likely to need to call someone else?

So, having said all that, what CAN go wrong? None of these are my patients’ photos, but here are some examples from Google.


First, the simple and relatively common ones:

Lid/brow ptosis

Lid/brow droop: with treatment to the forehead, if the muscle of the forehead was lifting your eyebrows up, relaxation of that muscle may cause the brow to droop.

This is often why I encourage my patients to consider treatment of the frown areas/ under the brows with anti wrinkle to the forehead muscles. Yes it is more expensive but it avoids temporary problems like this which are irreversible until the product wears off and can be partially corrected using an eyedrop.


Asymmetric smile : with treatment of the muscles to the smile/ corners of the mouth that can pull the corners down and cause a sad face. If the injection is a little bit off to one side, it can affect another muscle that can result in an asymmetric smile such as shown here.

Again, this is temporary, but may last as long as 3-4 months until the product wears off.



frozen face

Frozen face : “aka” Nicole Kidman face, someone joked to me recently.

I tend to under-treat than to over- treat for some simple reasons:

  1. products are expensive
  2. I don’t want unhappy patients because they’ve paid too much AND look frozen in the process.

This is also why I get you back to see me at 2 weeks after initial treatments to new areas – we take photos to compare and adjust doses until we kow your “optimal” dose that is the lowest you need to achieve your desired effect at a cost that is affordable for you.


Reactivation of the herpes/ cold sore virus with filler to the area.

It can happen to anyone and is common so ensure that you never have filler while you feel a cold sore coming on, and that if you feel one coming on after a filler treatment, that you obtain medication asap and treat it to minimise the effects.


allergic reaction

Likely allergic reaction to product.

I have a saying, “If it is too cheap to be true, it’s probably not worth it.”

It’s your face, why would you take the risk?




Abscess (pus filled infection) to the cheek following filler injection.

Rare if done under proper conditions and with due care by a qualified practitioner using appropriate product.

Don’t forget, filler is similar to a temporary implant – it is going to stay in your body for 6months to 18 months.

This abscess will need surgical drainage and will likely leave an ugly scar.


Here is a diagram of sites of the face where, if injected, filler can have highest risk of causing problems to vision – ie permanent, irreversible blindness.

38% in frown lines; 25% to the nose; 13% to the nose-to-mouth lines; 12% to forehead lines.



Another more common risk is vascular occlusion or blockage of the vessels supplying parts of the face:

vascular occlusion

An example of blockage of the blood vessel supplying the side of the face and nose, with dying skin that was luckily picked up and treated in time.



Here is another example by a colleague, Dr Naomi, when she recognised while injecting into the temple, occlusion of the artery and responded quickly to halt the process with followup for weeks afterwards.



This is not to scare you, nor to put you off anti wrinkle treatments or fillers.

It is more to highlight the fact that I see too many people who attend for treatments at places where

1. price alone is the determinant of what is done. 2. consent is a token thing, a form for patients to sign, rather than a process whereby it is explained to each person the small but real risk of real complications.

As I am fond of saying, “It is your FACE” and, “You get what you pay for.”

Any questions? Email me!



  • Dr Imaan Joshi has been working as a doctor since graduation from the University of Sydney in 2001. She spent years between 2004-2011 as a surgical trainee before switching to a different speciality program for work-life balance. She is passionate about her work in Medicine and especially about procedural Medicine, and loves her work as a Cosmetic Physician. When she isn't working, she is busy focusing on an active life with her family, which includes 4 active children! Dr S Imaan Joshi BSc, MBBS, FRACGP


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