TREATMENT RISKS & INFORMED CONSENT REFERENCE
This document does not replace clinical judgement or supersede practitioner obligations under applicable legislation.
MUSCLE RELAXANT INJECTABLES
Purified neurotoxin protein injected into targeted muscles to temporarily reduce muscular activity. Used for dynamic lines of facial expression, hyperhidrosis, masseteric hypertrophy, neck and jawline contouring, and other therapeutic or aesthetic indications. Onset 3–14 days; duration 3–6 months.
Common risks: Bruising and swelling at injection sites, redness or pinpoint marks, mild headache (1–2 days post-treatment), temporary tenderness to touch, mild asymmetry of effect
Uncommon risks: Eyelid ptosis (upper lid drooping), brow ptosis or brow heaviness, eyebrow shape or height asymmetry, dry eyes or increased tearing, flu-like symptoms (1–2 days), reduced expression in untreated areas, failure to achieve desired effect
Rare risks: Diplopia (double vision), neck weakness (platysma treatment), difficulty swallowing (perioral or neck), speech changes, spread of effect beyond target muscle, paradoxical muscle recruitment, injection site nodule.
Serious — seek immediate review: Anaphylaxis or severe hypersensitivity, systemic spread (botulism-like symptoms), respiratory compromise, severe or complete eyelid closure, visual disturbance.
Emergency note: Any difficulty breathing, swallowing, or speaking following treatment requires immediate emergency medical review. Ensure emergency protocols and adrenaline are available at all treatment sites.
Absolute contraindications: Pregnancy, breastfeeding , myasthenia gravis, lambert-Eaton syndrome, ALS / motor neuron disease, known hypersensitivity to formulation, active infection at site, aminoglycoside antibiotic use.
Relative cautions: Anticoagulant / blood thinner use, aspirin or NSAID use, other neuromuscular disorders, prior facial surgery or significant scarring, very low muscle bulk in treatment area, unrealistic expectations, body dysmorphic disorder (screen carefully).
Aftercare:
First 4 hours — remain upright; avoid rubbing, pressing or massaging treated areas; avoid vigorous exercise.
24 hours — avoid strenuous exercise, saunas, steam rooms, hot showers and alcohol.
48 hours — avoid facial massage or facial treatments; avoid lying flat for extended periods.
Ongoing — broad-spectrum SPF50+ daily; no direct UV exposure to treated areas during healing; avoid extreme heat.
Follow-up — review at 2 weeks to assess result; do not re-treat at less than 3 months.
Results are not guaranteed. Outcome varies by individual anatomy, muscle activity, lifestyle and metabolism. Repeat treatments required for maintenance. Results are temporary and product will naturally dissipate. No practitioner can guarantee a specific cosmetic outcome.
VOLUME INJECTABLES
Gel-based injectable substances used to restore or augment volume, define contours and improve the appearance of lines and folds. Hyaluronic acid (HA) formulations are the most widely used; other agents include calcium hydroxyapatite and poly-L-lactic acid. Common treatment areas include lips, cheeks, tear troughs, nasolabial folds, jawline, chin and hands. Duration 6–24 months depending on product and area.
Common risks: Bruising at injection sites, swelling (particularly lips and under eyes), redness and tenderness, temporary firmness or lumpiness, tyndall effect (bluish tint if placed too superficially).
Uncommon risks: Contour irregularity or asymmetry, visible product under thin skin, prolonged swelling (up to 2 weeks), reactivation of herpes labialis (perioral area), migration of product from original placement, nodule or granuloma formation, palpable but not visible product.
Rare risks: Infection or abscess, biofilm formation (delayed infection), inflammatory nodules, skin necrosis (vascular compromise), product overcorrection, delayed hypersensitivity reaction.
Serious — seek immediate review: Vascular occlusion — risk of tissue necrosis, visual disturbance or sudden vision changes, blindness (intra-arterial injection), stroke or neurological symptoms, severe anaphylaxis, signs of impending necrosis: pallor, pain, mottling.
Vascular occlusion protocol: Any sign of vascular compromise (blanching, mottling, disproportionate pain, capillary refill >2 sec) requires immediate cessation of treatment and emergency management including high-dose hyaluronidase (for HA products). All practitioners must have a documented vascular occlusion protocol, hyaluronidase on site and appropriate emergency training.
High-risk anatomical zones: Glabella, nasal dorsum and tip, periorbital region, nasolabial folds, temples and forehead carry elevated vascular risk. Enhanced caution, aspiration techniques (where applicable), and low injection volumes are required in these areas.
Absolute contraindications: Pregnancy, breastfeeding, active infection or inflammation at site, known hypersensitivity to product components, permanent filler in the treatment area, active autoimmune skin condition at site.
Relative cautions: Anticoagulants (high bruising risk), history of cold sores (pre-treat with antiviral), keloid or hypertrophic scarring history, autoimmune or connective tissue conditions, multiple prior treatments in same area, active dental work (lip area), unrealistic expectations.
Aftercare:
First 6 hours — avoid touching, pressing or manipulating treated areas; do not apply makeup to injection sites.
24 hours — avoid strenuous exercise, alcohol, extreme heat (saunas, steam, hot yoga), dental procedures.
48–72 hours — avoid facial massage, microdermabrasion or any treatment over the injected area. Lips specifically — avoid very hot food and drinks; sleep on back if possible; avoid kissing and smoking. Swelling — cold compresses (not ice directly) for first 24 hours if needed; arnica may assist bruising.
Ongoing — SPF50+ daily; avoid prolonged sun and UV exposure; protect treated area from extreme temperatures.
Follow-up — review at 2–4 weeks to assess result and integration; note: some swelling can persist up to 4 weeks (especially lips and under eyes).
HA-based products can be partially or fully dissolved with hyaluronidase if required. Non-HA products cannot be reversed. Duration is variable and affected by metabolism, lifestyle, muscle movement and product type. Results are not guaranteed and individual anatomy will determine the achievable outcome.
INJECTABLE COLLAGEN STIMULATORS
Injectable agents that stimulate the body's own collagen production rather than providing immediate volumisation. Active agents include poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA) and polynucleotides (PDRN/PN). Used for facial and body skin laxity, volume loss and skin quality improvement. Results are gradual (3–6 months) and typically longer lasting (up to 2 years). Not reversible.
Common risks: Injection site bruising, swelling, redness , tenderness lasting several days, temporary firm papules at injection points, temporary over-correction (resolves).
Uncommon risks: Persistent palpable nodules, uneven or asymmetric collagen stimulation, delayed swelling (PLLA, 3–5 days post), visible subcutaneous papules, insufficient or absent response.
Rare risks: Granuloma formation, persistent nodules requiring treatment, overcorrection requiring intervention, vascular occlusion, infection.
Serious — seek review: Vascular compromise, severe or persistent granulomatous reaction, systemic hypersensitivity reaction, abscess formation.
Important expectation setting: Results are not immediate. Patients commonly see minimal change at 4 weeks. Full results develop over 3–6 months as new collagen is produced. Multiple sessions (typically 2–3) are often required. This must be explicitly discussed and documented in the consent process.
Absolute contraindications: Pregnancy, breastfeeding, active infection or inflammation at site, known hypersensitivity to product components, autoimmune connective tissue disorders (relative).
Relative cautions: Anticoagulant therapy, immunocompromised patients, keloid or hypertrophic scarring history, prior permanent filler in area, unrealistic expectations re: gradual results, history of inflammatory reactions to injectables.
Aftercare:
First 24 hours — avoid exercise, heat, sun exposure; cold compress as needed for swelling.
5-5-5 rule — massage the treated area 5 minutes, 5 times per day, for 5 days post-treatment (PLLA specific — reduces nodule risk).
Ongoing — SPF50+ daily; stay well hydrated; avoid prolonged sun exposure.
Follow-up — review at 4 weeks; plan subsequent sessions 4–6 weeks apart; full assessment at 3–6 months.
Not reversible — hyaluronidase does not affect PLLA, CaHA or PN products. Treatment plan, number of sessions and expected timeline must be clearly documented. Individual response to collagen stimulation varies significantly.
CHEMICAL SKIN RESURFACING
Controlled application of chemical exfoliating agents to induce targeted removal of damaged skin layers and stimulate renewal. Superficial peels (AHA, BHA, PHA, low-concentration TCA) target the epidermis; medium peels (TCA 20–35%) reach the papillary dermis; deep peels (phenol, high TCA) penetrate to mid-reticular dermis. Used for pigmentation, acne, texture, fine lines and scarring.
Common risks: Redness, warmth and sensitivity, flaking and peeling (days 2–7), temporary tightness and dryness, mild swelling (medium and deep peels), temporary skin sensitivity to products.
Uncommon risks: Post-inflammatory hyperpigmentation (PIH), prolonged erythema (>2 weeks), milia formation, reactivation of herpes simplex (perioral), uneven peeling or patchy result, acne flare (purging).
Rare risks: Infection (bacterial, viral, fungal), hypopigmentation (loss of pigment), scarring (medium and deep peels), prolonged or permanent sensitivity, allergic contact dermatitis, lines of demarcation.
Serious — seek review: Chemical burn beyond intended depth, permanent pigmentation change, systemic absorption (deep/phenol peels — cardiac risk), severe secondary infection.
Absolute contraindications: Active infection or open wounds at site, isotretinoin use within 12 months (medium/deep), pregnancy (medium and deep), k allergy to peel agents, recent radiation to treatment area, compromised skin barrier.
Relative cautions: Fitzpatrick IV–VI (elevated PIH risk — adjust agent and concentration), active rosacea or eczema, photosensitising medications, recent sun exposure or tanned skin, history of cold sores (pre-treat with antiviral), keloid history.
Aftercare:
Do not — pick, peel or rub skin; use active skincare (retinoids, AHAs, vitamin C) until fully healed.
Moisturise — apply gentle barrier repair moisturiser frequently during peeling phase; petroleum jelly for deep peels.
Sun protection — SPF50+ physical sunscreen daily; avoid direct sun exposure; wear hat outdoors — mandatory throughout healing and beyond.
Downtime — superficial: minimal; medium: 5–10 days; deep: 2–6 weeks. Communicate downtime clearly before treatment.
Follow-up — review at 2 weeks; reassess skin barrier; plan subsequent sessions minimum 4–6 weeks apart.
Results vary by skin type, peel depth, sun history and compliance with aftercare. Multiple sessions may be required. PIH risk must be specifically documented for Fitzpatrick IV–VI skin types. Pre-treatment skin preparation (pre-peel priming) is recommended for all medium and deep peels.
SKIN NEEDLING
Controlled mechanical creation of micro-channels through the skin using fine needles to stimulate the wound-healing cascade and natural collagen and elastin production. Performed with motorised pen-style devices at needle depths of 0.5mm–2.5mm depending on indication. Used for acne scarring, skin texture, pore size, fine lines and stretch marks. Topical anaesthetic applied prior to treatment.
Common risks: Redness and warmth (24–72 hours), pinpoint bleeding during treatment, skin sensitivity post-treatment, mild swelling, feeling of skin tightness.
Uncommon risks: Post-inflammatory hyperpigmentation, reactive of herpes simplex, mild bruising, temporary breakout or purging, prolonged redness (>72 hours), mild peeling.
Rare risks: Bacterial or viral infection, track marks or grid patterns (improper technique), scarring, tram-track marks, allergic reaction to topical agents used during treatment.
Serious — seek review: Secondary bacterial infection · Severe allergic reaction to topicals (PRP, serums) · Widespread skin breakdown.
Absolute contraindications: Active acne, infection or open wounds, isotretinoin within 6 months, active cold sores in treatment area, pregnancy, anticoagulant conditions (haemophilia), rosacea (active flare)
Relative cautions: Fitzpatrick IV–VI (PIH risk — reduce depth), blood thinners (increased bleeding/bruising), history of keloid or hypertrophic scarring, autoimmune skin conditions, eczema or psoriasis at treatment site.
Aftercare:
24 hours — no active skincare, no makeup; use only gentle cleanser and barrier moisturiser; avoid all heat.
48–72 hours — no exercise, saunas, steam or swimming; avoid sun exposure; no exfoliation.
Sun protection — SPF50+ physical sunscreen from day 2; avoid prolonged sun for minimum 2 weeks post-treatment.
Return to actives — gradually reintroduce at day 5–7 when skin barrier is restored.
Spacing — minimum 4 weeks between sessions; 6 weeks at deeper depths or for sensitive skin.
A course of 3–6 treatments is typically recommended for scar and texture improvement. Single treatments may improve skin quality. Results are gradual and cumulative. Prior history of cold sores must be documented; antiviral prophylaxis recommended for perioral treatments.
RADIOFREQUENCY SKIN NEEDLING
Combines micro-needle penetration with delivery of radiofrequency energy to the dermis, producing both mechanical and thermal stimulation of collagen and elastin. Delivers controlled heat at precise depths, independent of skin colour. Used for skin laxity, scarring, pore size, texture and body skin tightening. Higher downtime and efficacy than standard skin needling. Topical or local anaesthetic required.
Common risks: Redness and warmth (2–5 days), swelling (especially periorbital area), pinpoint bleeding and crusting, skin sensitivity and tightness, grid pattern visible (resolves 24–48 hrs).
Uncommon risks: Post-inflammatory hyperpigmentation, reactivation of herpes simplex, prolonged erythema, acne flare, mild bruising, temporary skin texture irregularity.
Rare risks: Thermal burn (excessive energy settings), scarring, persistent grid marks, infection, significant bruising around eyes.
Serious — seek review: Thermal burn injury, secondary bacterial infection, severe allergic reaction, interference with electronic implants.
Absolute contraindications: Pacemaker or implanted electronic device, metal implants in treatment area, active infection at site, isotretinoin within 6 months, pregnancy, active cold sores in treatment area.
Relative cautions: Anticoagulant use, keloid or hypertrophic scarring history, autoimmune skin conditions, fitzpatrick IV–VI (adjust energy, use insulated tips), blood sugar disorders — affects healing, prior radiation in area.
Aftercare: 24 hours — no active skincare, no makeup; gentle cleanser and approved barrier moisturiser only; avoid all heat. 72 hours — no exercise, saunas, steam or swimming; avoid sun exposure; sleep elevated if periorbital area treated. 1 week — no exfoliation; reintroduce actives slowly from day 5–7 when barrier is restored. Sun protection — SPF50+ physical sunscreen mandatory from day 2; avoid UV for minimum 4 weeks. Spacing — minimum 6 weeks between sessions.
Downtime 3–7 days. Results develop over 3–6 months. More aggressive treatment than standard needling — downtime and risk profile must be specifically communicated. Skin type and clinical indication will determine appropriate energy settings and needle depth.
LASER AND LIGHT-BASED HAIR REDUCTION
Targeted photothermolysis using laser or intense pulsed light (IPL) energy absorbed by melanin in the hair follicle to disable follicular activity. Effective across most body areas. Treatment outcome depends on hair and skin colour, hormonal factors and hair growth cycle. Multiple sessions are necessary due to hair growth cycle phases. Described as hair reduction rather than permanent hair removal — residual regrowth varies between individuals.
Common risks: Redness and warmth immediately post-treatment, perifolicular swelling (small bumps), skin sensitivity for 24–48 hours, shedding of treated hairs over 2–3 weeks, temporary darkening of treated hairs before shedding.
Uncommon risks: Post-inflammatory hyperpigmentation, hypopigmentation (lightening of skin), paradoxical hair stimulation (especially hormonal areas), blistering (inappropriate parameters for skin type), crusting at treatment site.
Rare risks: Thermal burns and scarring (inappropriate parameters), permanent pigmentation change, textural skin change, ocular injury (inadequate eye protection).
Serious — seek review: Thermal burn requiring wound care, permanent scarring, ocular damage — eye protection is mandatory at all times.
Eye safety: Appropriate wavelength-specific safety eyewear must be worn by both patient and practitioner at all times during laser and IPL treatments. Failure to use appropriate eye protection risks permanent ocular damage.
Absolute contraindications: Active tanned or sunburned skin, active infection in treatment area, photosensitising medications (isotretinoin, some antibiotics), pregnancy, tattoos in direct treatment area, recent waxing, threading or epilating (shaving permitted).
Relative cautions: Fitzpatrick V–VI (require appropriate technology — Nd:YAG), history of keloid scarring, hormonal conditions (PCOS, thyroid) — manage expectations, history of PIH, hormonal medications affecting hair growth, very fine, blonde, grey or red hair (poor melanin target).
Aftercare:
24 hours — avoid heat; no exercise, saunas, hot showers; no deodorant (underarms) for 24 hours.
48 hours — no exfoliation; avoid perfumed products; use gentle, fragrance-free moisturiser.
Sun protection — SPF50+ to treated areas; avoid direct sun for 2 weeks; absolutely no fake tan or tanning beds.
Hair removal — shave only between sessions; no waxing, threading or plucking; do not attempt to pull out shedding hairs.
Session spacing — face: 4 weeks; body: 6–8 weeks; 6–10 sessions typically required; maintenance sessions expected.
Results described as hair reduction, not guaranteed permanent hair removal. Individual outcomes depend on hair type, skin type, hormonal status and adherence to treatment schedule. Hormonal conditions, medications and lifestyle factors affecting hair growth must be documented and discussed.
LASER SKIN RESURFACING (ablative and non-ablative)
Ablative lasers vaporise layers of skin to stimulate new collagen formation and resurface irregular texture, pigmentation and scarring. Non-ablative fractional lasers (1550nm, 1927nm) create controlled columns of thermal injury while leaving surrounding tissue intact, with less downtime. Used for scarring, pigmentation, sun damage, fine lines and skin texture.
Common risks: Significant redness and swelling (ablative), weeping, crusting and peeling, skin sensitivity and tightness, itching during healing phase, redness lasting weeks to months (ablative).
Uncommon risks: Post-inflammatory hyperpigmentation, milia formation, prolonged erythema, reactivation of herpes simplex (antiviral prophylaxis required), acne flare.
Rare risks: Hypopigmentation (long-term, ablative), infection (bacterial, fungal, viral), ectropion (lower eyelid, periorbital ablative), scarring, lines of demarcation.
Serious — seek review: Deep burn or injury beyond intended depth, severe or disseminated herpes, permanent scarring, permanent pigmentation loss, ocular injury.
Herpes prophylaxis required: Any patient with a history of cold sores or HSV must receive antiviral prophylaxis (e.g. valaciclovir) commencing prior to ablative or perioral treatment and continuing for 7–10 days. Failure to do so risks severe dissemination across resurfaced skin.
Absolute contraindications: Isotretinoin within 12 months (ablative), active infection or open wounds, pregnancy, active autoimmune skin disease at site, recent radiation in area · Immunosuppression (high-level ablative).
Relative cautions: Fitzpatrick IV–VI (high PIH risk — non-ablative preferred), history of keloid scarring, photosensitising medications, prior cosmetic surgery in area, active acne (may worsen), unrealistic expectations re: downtime.
Aftercare:
Wound care — keep treated skin moist and clean; use prescribed ointment (petrolatum or healing balm); do not allow skin to dry out during healing (ablative).
Do not — pick, peel or scratch healing skin; apply makeup until fully re-epithelialised; use active ingredients during healing.
Downtime — ablative: 1–2 weeks minimum before public-facing activities; redness may persist 1–3 months. Non-ablative: 2–5 days.
Sun protection — strict SPF50+ physical sunscreen and sun avoidance for minimum 3 months post-ablative treatment — critical to prevent PIH.
Eye protection — appropriate laser eyewear mandatory for patient and all personnel in room at all times.
Downtime, redness duration and risk of PIH must be clearly communicated and documented before treatment. Ablative laser resurfacing involves significant recovery and must not be understated in the consent process. Results can be dramatic but are associated with the longest downtime of any non-surgical skin treatment.
INTENSE PULSED LIGHT SKIN TREATMENT
Broad-spectrum pulsed light delivered through filters to target chromophores in the skin — primarily melanin (pigmentation) and haemoglobin (redness/vessels). Used for sun damage, age spots, rosacea-related redness, superficial vascular lesions, uneven skin tone and photorejuvenation. Minimal downtime. Not appropriate for Fitzpatrick types V–VI due to competing melanin absorption.
Common risks: Redness and warmth immediately after, temporary darkening of pigmented lesions (normal and expected), mild swelling, coffee-ground appearance of treated pigment (resolves 7–14 days).
Uncommon risks: Post-inflammatory hyperpigmentation, blistering (inappropriate parameters), prolonged redness, crusting over pigmented areas, incomplete clearance of lesion.
Rare risks: Burns and scarring, hypopigmentation, worsening of melasma, ocular injury (without appropriate eyewear).
Serious — seek review: Thermal burn, permanent pigmentation change, ocular damage.
Absolute contraindications: Tanned or recently sun-exposed skin, fitzpatrick V–VI, active infection at site, photosensitising medications, pregnancy, active melasma (risk of worsening).
Relative cautions: Fitzpatrick IV (use caution — reduce fluence), history of PIH, rosacea (adjust parameters carefully), recent chemical peel or laser treatment, aspirin / anticoagulant use.
Aftercare:
24 hours — avoid heat; cool treated area; no exfoliants; no makeup on treated pigmented areas.
Pigment — allow darkened pigment to shed naturally (7–14 days); do not pick or scrub.
Sun protection — SPF50+ physical sunscreen mandatory; avoid sun entirely for 2 weeks post-treatment.
Sessions — 3–6 sessions typically recommended, 3–4 weeks apart.
FACIALS AND NON-INVASIVE SKIN TREATMENTS
Non-invasive treatments using mechanical, light-based or enzymatic methods to cleanse, exfoliate and nourish the skin without breaking the skin barrier. Includes hydrodermabrasion (vortex-cleansing systems), LED photobiomodulation (red, near-infrared, blue wavelengths), oxygen infusion facials and enzyme-based treatments. Suitable for most skin types with minimal risk.
Common risks: Temporary flushing or redness, mild sensitivity immediately post-treatment, skin purging following extractions (1–2 weeks), temporary dryness.
Uncommon risks: Breakouts post-extraction, mild stinging or irritation from active serums, sensitivity to products used during treatment, temporary worsening of redness in rosacea-prone skin.
Rare risks: Contact allergy to ingredients, skin barrier disruption (overly aggressive extraction), exacerbation of existing skin condition.
Serious — seek review: Anaphylaxis to topical product ingredient (rare) · Secondary infection following extractions.
Absolute contraindications: Active skin infection or open wounds, known allergy to treatment products or ingredients, severe inflammatory skin conditions (active flare).
Relative cautions: Rosacea (adapt protocol — avoid heat and strong actives), highly reactive or sensitised skin, recent cosmetic procedures (allow 2–4 weeks healing), isotretinoin use (avoid extractions and strong actives), pregnancy (avoid certain active ingredients).
Aftercare:
24 hours — avoid heat, exercise and sun exposure; use gentle cleanser and light moisturiser.
Extractions — do not touch extraction sites; no makeup for 12–24 hours; keep skin clean.
Sun protection — SPF50+ recommended post-treatment; avoid peak UV hours.
UNIVERSAL CONSENT REQUIREMENTS
Written informed consent must be obtained and retained before every treatment. Consent documentation must include: nature of the procedure, expected outcomes, alternatives, realistic limitations, all risks and possible complications, aftercare obligations, the right to withdraw consent at any time, and practitioner details and qualifications. For Schedule 4 prescription medicines, a valid prescription from a registered medical practitioner is legally required. All records must be retained in accordance with applicable state and territory health records legislation and AHPRA professional standards. Photographic records are strongly recommended.
