CATEGORY AUSTRALASIAN DENTIST69 CLINICAL X Stay clear of the mandibular border, where DLI and DAO overlap. X Use conservative doses – 2–3 units per point. Management: X Usually self-resolving; advise the patient to wait 6–8 weeks. X In severe cases, consider treating the non-affected side to rebalance expression. X Caution: this may temporarily affect lower lip control, so patient consent is essential. E. Paradoxical masseter bulging Cause: X Partial treatment of the masseter – typically by missing deep or posterior fibres – leaves untreated sections contracting strongly, creating visible bulges on clenching. Prevention: X Use multiple injection points (2–3 per side) to ensure even diffusion through the superficial and deep muscle planes. X Palpatemuscle contraction dynamically before injecting. Management: X Reassess at 2 weeks; inject an additional 5–10 units into the bulging area. X Always discuss the possibility of temporary asymmetry during consent. F. Sweat gland dysfunction Cause: X Injecting too superficially into the forehead affects the eccrine sweat glands, leading to localised dry patches that appear when the patient sweats. Prevention: X “Kiss the bone” with your injection technique to ensure intra muscular placement in the frontalis. Management: X No active treatment required. Reassure the patient that the patchiness is temporary and only visible when overheated. G. Post-Rhinoplasty nasal wall collapse Cause: X Injecting the nasal alar region in patients with prior rhinoplasty can lead to collapse of the lateral nasal wall during inspiration. Prevention: X Always ask about history of nasal surgery and observe nasal movement on inspiration before injecting. X Avoid the nasal alar region in these patients altogether. Management: X This may cause permanent dynamic collapse; therefore, prevention is the only safe approach. 3. Broader complication categories In addition to functional issues, clinicians must remain alert for less frequent but serious complications, such as: X Asymmetry: Typically from uneven dosing or anatomical variation. Prevent by using standardised photography and precise documentation. X Bruising and oedema: Minimise with correct needle gauge, gentle injection, and pre-cooling the area. Headache or heaviness: Common in first-time patients; reassure that this subsides within days. X Over-correction: Avoid “chasing” small residual movement. Allow the toxin to take full effect before considering a topup. 4. Managing complications Even the best-trained injector can encounter complications. Dermal Distinction Academy will help support you through complications within our Aesthetic Chatroom environment. For time-sensitive complications, AMET (https://aestheticmet.com.au/) provides 24/7 online protocols and expert consultation for members, offering realtime advice on adverse events ranging from bruising to vascular compromise. As a complications expert for AMET, I assist practitioners in triaging, diagnosing, and managing complex cases – often involving multifactorial issues such as overlapping filler and toxin use, or pre-existing anatomical asymmetries. The immediate response plan 1. Stay calm and assess. Gather facts: date, product, dose, and site. Avoid reflex “fixing” before confirming the diagnosis. 2. Photograph and document. Record before/after visuals and detailed clinical notes for transparency and medico-legal protection. 3. Identify the mechanism. Determine if the issue is due to dose, placement, spread, or patient factors. 4. Communicate clearly with the patient. Use confident, compassionate language. Avoid blame or defensiveness; focus on collaborative resolution. 5. Consult an expert early. Reach out to Dermal Distinction Academy, AMET or a senior colleague. Second opinions prevent escalation and demonstrate due diligence. Follow a structured review schedule 6. Reassess at 2 weeks, 6 weeks, and 3 months. Most toxin-related issues resolve as the neuromodulator wears off, but follow-up reinforces trust. 5. The psychological impact of complications It’s not just physical outcomes that matter – complications can cause distress for both patient and practitioner. X For patients, facial change (even temporary) can feel catastrophic. X For clinicians, guilt or fear may lead to avoidance of future treatments. Professional support and debriefing are invaluable. At Dermal Distinction Academy, we encourage open discussion of complications in mentoring and advanced training sessions. Sharing experiences strengthens collective safety culture across the profession. 6. Learning from every case Each complication is an opportunity for growth. As injectors mature in their practice, they become more attuned to subtle warning signs – asymmetrical contraction, unexpected resistance, or a patient’s hesitation before consent. Regular reflection and ongoing education are key. Review your photography and injection patterns; consider shadowing another practitioner or participating in a complication management workshop. The best injectors are not those who never encounter complications – they are those who handle them ethically, transparently, and with patient safety as the top priority. 7. Final thoughts Botulinum toxin complications are inevitable at some point in every injector’s career. But they need not define it. Through preparation, anatomical precision, and early intervention, we can minimise their frequency and impact. As both an educator and an AMET complications expert, I’ve witnessed how effective management transforms not just the outcome but the patient relationship. When practitioners respond calmly, explain clearly, and act decisively, trust is rebuilt and confidence grows – for both injector and patient. The aesthetic industry continues to evolve, but our ethical responsibility remains the same: to protect, educate, and care. By prioritising prevention, embracing transparency, and seeking expert support when needed, we elevate the entire profession – one safe, well-managed case at a time. X For more information about cosmetic courses and complications management, visit www.dermaldistinction.com Ph: 03 9851 6771 email: academy@dermaldistinction.com www.dermaldistinction.com
RkJQdWJsaXNoZXIy MTc3NDk3Mw==