Emergency after harmonization: what to do right away
Quick facts
- Question
- What to do right away if something seems wrong
- First step
- Call whoever injected, without waiting for it to pass
- Emergency signs
- Strong pain, pallor, net-like patches, altered vision, shortness of breath
- Who decides the course of action
- The professional who injected and the emergency service
The short answer: if, after an injectable procedure, strong pain, pale skin or skin with net-like patches, vision changes, shortness of breath or swelling that spreads quickly appear, the patient does not wait for it to pass. They call whoever injected right away and, if there is no quick response or if the symptoms involve vision, breathing or weakness, they go to an emergency room and say which procedure they had.
This page is written so that you, the professional, have a clear and calm answer for the patient who writes "I'm scared, is this normal?". It does not replace your clinic's complication protocol, which is in safety and complications.
How to tell the expected from the emergency?
After filler, a biostimulator or toxin, it is common to have redness at the points, swelling and bruising in the first days. What changes the course of action is the intensity, speed and combination of the signs.
| Sign | Usually expected | Calls for immediate contact |
|---|---|---|
| Swelling | Increases on day 1 and 2, then eases | Grows fast, is tense, comes with strong pain |
| Bruising | Patch that changes color over days | Dark patch that spreads or skin that darkens |
| Pain | Mild discomfort on touch | Severe, burning pain that does not ease and worsens |
| Skin color | Reddish at the points | Pale, white, bluish or with a net-like pattern |
| Vision | Normal | Blurring, dark spot, double vision, vision loss |
| Breathing and speech | Normal | Difficulty swallowing, speaking or breathing |
What does the patient do in the first minutes?
The most useful instruction is a short step-by-step that fits in a message. If the patient is reading this page in the middle of a scare, this is the order:
Massage, heat, home ointments and "waiting until tomorrow" are the most common mistakes. The professional may ask for massage in specific situations, but it should never be the patient's own initiative in the face of strong pain or pallor.
Which situations differ from each other?
Vascular change
White or grayish skin, disproportionate pain, net-like patches (livedo) and a slow return of color when the skin is pressed are warning signs. In the highest-risk areas, such as the glabella, nose and nasolabial fold, vigilance should be higher. Clinical management, which includes hyaluronidase when hyaluronic acid is used, is the decision of the trained professional. The overview is in labial vascular occlusion and in visual complication after filler.
Allergic reaction or angioedema
Widespread itching, hives, swelling of the lips, tongue or throat and shortness of breath are symptoms of a medical emergency. See angioedema and facial filler.
Infection
Spreading redness, local warmth, throbbing pain, pus and fever after the first days call for assessment on the same day. Details in fever after filler and in infection and biofilm.
Botulinum toxin
Difficulty swallowing, speaking or breathing, or weakness that spreads beyond the treated area, is an emergency. A drooping eyelid or asymmetry are important annoyances, but are generally not emergencies: see drooping mouth after botox.
What does the professional agree on beforehand?
An emergency is much less chaotic when the agreement exists beforehand. It is worth including in the post-procedure instructions (template in post-procedure instructions):
- A direct contact number and how to proceed outside office hours.
- A short list of signs that require an immediate call, in plain language.
- The name of the procedure and the area, noted on a record the patient carries on their phone.
- A pointer to a nearby emergency service, when the patient comes from another city.
- The commitment to record what happened in the patient record, per patient record and documentation.
And what does the professional do when the patient reports in?
Reply quickly, ask for photos and a description of the symptoms, and do not downplay by message a picture with a warning sign. If in doubt, call the patient in for an in-person assessment the same day. Document the time of the report, symptoms, action taken and follow-up. If the picture is an emergency beyond your capacity, refer and follow up, as described in patient referral.
Where does Harmy fit in?
Harmy does not triage symptoms or guide post-procedure care. What it helps with comes earlier: the projection in the consultation makes clear what will be done in each area and in what volume, and that clarity helps the patient report precisely what was treated, should they need care at another service.
Frequently asked questions
What should I do if I feel strong pain after filler?
Severe, worsening pain in the treated area should be reported immediately to whoever injected, because it may indicate vascular compromise. If there is no quick response, go to an emergency room and say which procedure was done.
Which signs after harmonization require going to the emergency room?
Vision changes, a sudden severe headache, difficulty breathing or swallowing, rapid swelling of the face or throat, and weakness on one side of the body. In these cases you do not wait for a reply to a message.
Can I wait until tomorrow if the bruising and swelling are increasing?
Mild bruising and swelling are expected. If they worsen quickly, hurt a lot or come with pallor, net-like patches or darkening skin, contact should be immediate, the same day and at any hour.
Does the professional need to leave an emergency contact?
In practice, it is good conduct to leave in writing how to reach the team outside office hours and what to do if there is no answer. Formal requirements follow the rules of each professional's regulatory board.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.