1. Expected, and not complications at all
Swelling. Bruising. Tenderness. Small raised areas at injection points. Redness for a few hours. A headache after botulinum toxin. Lips that look considerably larger than agreed for the first two or three days.
These are the normal consequences of putting a needle into a face, and they settle. Swelling in the lips peaks within about forty eight hours. Bruises follow the usual course of any bruise. Nothing here needs treatment beyond time, and judging a result while any of it is present will mislead you.
2. Common enough to plan for, and worth reviewing
Asymmetry in the first fortnight after toxin, which frequently settles as the product takes full effect by two weeks. Small palpable lumps after filler, which usually integrate over two to four weeks. Mild unevenness that a small adjustment at review would resolve.
The right response to all of these is a review appointment at the right time, which is two weeks for toxin and two to four weeks for filler. Not the following morning, when nothing can be judged, and not four months later, when the window for adjustment has closed.
A cold sore triggered by lip treatment in someone who carries the virus is common enough that it should have been discussed beforehand. Antiviral treatment is available and needs a prescriber.
3. Uncommon, and needing proper assessment
Persistent nodules that have not settled after a month. Visible or palpable product, particularly under thin skin. A bluish tinge where superficial filler scatters light. Product that has moved from where it was placed, covered in filler migration and delayed swelling.
Delayed inflammatory reactions are described with hyaluronic acid fillers, sometimes months or years after treatment, and sometimes following an illness, a dental procedure or a vaccination. They present as swelling, firmness and redness in a previously treated area, and they need assessment rather than reassurance.
Ptosis, a drooping eyelid or brow after toxin, is uncommon and self limiting, but it can last for weeks and it is distressing. It should be reviewed, both to confirm what it is and to plan the next treatment differently.
4. Urgent, and not to be slept on
Two things need same day attention.
Signs of vascular compromise after filler. Pain that is severe or out of proportion to what you were told to expect. Blanching, where an area goes white. A mottled, dusky, net like pattern in the skin. A change in the colour of the lips, nose or the skin above the eyebrows. And any visual symptom at all, including blurring, a shadow, double vision or pain in the eye. This is a medical emergency. See vascular occlusion.
Signs of spreading infection. Increasing redness spreading outward, heat, swelling that is worsening rather than settling after seventy two hours, pus, and feeling unwell with fever or chills. Infection after an injectable is uncommon and it is treatable, and it becomes harder to treat the longer it runs.
After botulinum toxin specifically, difficulty swallowing, difficulty breathing or generalised muscle weakness requires urgent medical attention. It is rare at cosmetic doses and it is not something to wait out.
5. Who deals with what
The treating clinic manages its own complications where it can. That is why the question of who manages a complication, and whether they can be reached out of hours, belongs in the consultation and not in the aftermath. It is question seven in our checklist.
Where the treating practitioner cannot prescribe, or cannot be reached, the emergency route is NHS 24 on 111 and, for severe symptoms, an emergency department. Emergency medicine will manage the immediate danger. It is not set up to reverse a cosmetic outcome, and it should not be treated as the fallback for a result you dislike.
Your GP can help with infection and with general assessment. GPs are not generally in a position to manage filler complications specifically, and asking them to unpick a cosmetic treatment they did not perform is not a reasonable expectation.
6. Reporting, which matters more than it feels like it does
Suspected adverse reactions to a medicine, including botulinum toxin, and problems with a medical device, including dermal fillers, can be reported through the MHRA Yellow Card scheme. Patients can report directly and do not need a professional to do it for them.
It feels like a small act and it is how rare problems become visible. A single report is a data point; a pattern of them is how a product or a batch gets looked at.
7. What to record while it is happening
Photograph the area in daylight, from the front and both sides, at the same distance, as soon as you notice a problem, and again each day. Note the times of everything: when you were treated, when symptoms started, when you contacted the clinic and what was said.
Keep messages. Ask for your treatment record including the product name and batch number. If the matter becomes a complaint or a claim, this material is what it turns on, and it cannot be reconstructed later.
8. What actually reduces the risk
Being treated by someone who can recognise and manage a complication, in a setting where the medicine to treat it is present, by a person who can be reached afterwards. That is most of it.
Conservative treatment helps: smaller volumes, fewer sites, longer intervals. So does a careful history, because anticoagulants, autoimmune conditions and previous filler all change the picture.
And so does knowing what you are looking for, which is the purpose of this page. Most patients who develop a serious complication did not know what the early signs were, which is why the first hours were lost. The practical sequence afterwards is in what to do when a treatment goes wrong.