Dermatology Sense

Cosmetic dermatology and aesthetic procedures have soared in popularity worldwide. Whether it’s injectable fillers, lasers, chemical peels, or surgical lifts, many people seek subtle enhancements to look fresher, younger, or more balanced. While many procedures are considered safe, no cosmetic intervention is entirely risk-free.

Understanding the common side effects, how to mitigate them, and when to seek medical help helps patients set realistic expectations and make informed decisions. In this article, we review the typical adverse events, how they arise, special concerns (especially for darker skin types), and dermatologist-backed advice for prevention and management.

Why Side Effects Occur: The Underlying Biology

Every cosmetic intervention disrupts normal tissue — via mechanical, chemical, thermal, or surgical forces. The body responds with healing, inflammation, and remodeling. Some degree of swelling, redness, or discomfort is expected as part of that response.

However, complications arise when:

• The force is too aggressive (e.g. overly deep laser, excess filler volume).

• Patient-specific factors (skin type, comorbidities, medications) predispose to abnormal healing.

• Technique, sterility, or provider expertise is suboptimal.

• Aftercare is neglected.

As Jennifer L. Chwalek, MD, FAAD (board-certified dermatologist at UnionDerm) explained, “To perform effective cosmetic procedures, you need to understand the biology of the skin, and what is occurring to the structure and function of the skin when cosmetic treatments are performed.” Dermatology Times

Also, Anne M. Chapas, MD, FAAD (clinical instructor in dermatology) noted: “Some of the most common complications of cosmetic procedures include bruising, changes in skin pigmentation, burns, infection, scars, swelling, and ‘frozen’ facial expressions.”

These comments highlight that side effects range from mild and transient to more serious and permanent — but many are avoidable or treatable when recognized early.

Common Side Effects by Procedure Type

Below is a breakdown of common side effects, grouped by type of aesthetic procedure. Many overlap; thus, the same patient may experience a combination.

1. Injectables (Botulinum Toxin, Dermal Fillers)

Typical side effects:

• Bruising and swelling at injection sites — the most common minor reaction.

• Redness, tenderness, and itching locally.

• Lumps, nodules or bumps under the skin (especially with fillers).

• Tyndall effect (bluish hue) if very superficially injected filler.

• Asymmetry or uneven result, overcorrection or undercorrection.

• Allergic or hypersensitivity reactions (rare).

• Vascular occlusion / blindness (rare but serious) — inadvertent injection into vessels.

• Infection or granuloma formation.

A 2015 review on complications in cosmetic surgery listed filler-specific risks including granulomas, infection, tissue necrosis, hematoma, nerve damage, scarring, and even blindness when misplacement occurs.

2. Laser / Light / Energy-Based Devices

Common side effects:

• Erythema (redness) and warmth immediately post-treatment.

• Swelling around treated zones.

• Edema / fluid accumulation (in facial or periorbital areas).

• Hyperpigmentation or hypopigmentation (especially in darker skin types).

• Burns or blistering if settings are too aggressive or misapplied.

• Scarring or textural changes (rare but possible).

• Pain, stinging, or discomfort during and after treatment.

• Reactivation of herpes simplex / cold sores (especially around the mouth).

In an AMA article, Dr. Waller (dermatologist) cautioned:

“There can be side effects … with lasers, if you’re too aggressive or perhaps you have some kind of underlying autoimmune condition … we do see scarring from time to time … one thing that comes up occasionally, especially with lasers around the mouth, is it can reactivate a fever blister or herpes simplex.” American Medical Association

3. Chemical Peels & Dermabrasion

Usual side effects:

• Redness, stinging, burning sensations post-treatment.

• Peeling, flaking, crusting as the top layers shed.

• Swelling (edema), especially on more aggressive peels.

• Pigment changes (hyperpigmentation / hypopigmentation) — more risk in darker Fitzpatrick skin types.

• Prolonged irritation or sensitivity after deeper peels.

• Infection if barrier compromised.

• Scarring (rare).

According to HMP Global’s managing complications review, darker skin types must be managed cautiously since deeper peels or aggressive settings can precipitate pigmentary changes or burns.

4. Surgical / Invasive Procedures (Facelift, Liposuction, Blepharoplasty, etc.)

Common surgical side effects:

• Pain, discomfort, and soreness at incision sites.

• Swelling and bruising around treated areas.

• Numbness or altered sensation (temporary or occasionally permanent).

• Bleeding or hematoma formation.

• Wound drainage or seroma (fluid accumulation).

• Scarring, hypertrophic or keloid scars in susceptible patients.

• Infection or wound dehiscence.

• Skin necrosis (rare, especially in smokers or compromised vascular supply).

For example, Dr. Kimberly Henry notes typical side effects such as itching, redness, tenderness, numbness, fluid drainage — and that scarring is inevitable wherever an incision is made.

5. Body Contouring & Fat Reduction (e.g. CoolSculpting, Liposuction)

Device-based / surgery hybrid risks:

• Pain or aching sensation in area.

• Brusing and swelling in treated zones.

• Paradoxical adipose hyperplasia (rare – increase in fat in treated zone).

• Numbness or altered sensation.

• Contour irregularities or asymmetry.

• Skin laxity or excess skin after volume removal.

• Infection or seroma formation.

While not always cited in the above references, these are well documented in aesthetic surgery literature.

Risk Factors & Special Concerns

Skin Tone / Fitzpatrick Types

Patients with darker skin (higher Fitzpatrick scores) have increased risk of pigment changes and burns when energy devices or chemical peels are used aggressively.

Some providers may improperly use high concentrations or settings that are tolerable in fair skin but injurious in darker skin tones.

Pre-Existing Conditions

• Autoimmune disorders, connective tissue diseases, diabetes, vascular disease may impair healing.

• History of keloids / hypertrophic scarring increases risk of excessive scarring.

• Medications (e.g. blood thinners, anticoagulants, isotretinoin) can raise bleeding and delayed healing risk.

• Active skin disease or infection (e.g. acne, cold sores) at the treatment site is a contraindication for many procedures.

Provider & Technique Issues

Many complications occur when procedures are done by non-physicians or in nonmedical settings. The ASDS (American Society for Dermatologic Surgery) data show higher rates of burns and discoloration in procedures done by non-physicians versus physicians.

Dr. Chwalek also emphasized: “A board-certified dermatologist can treat these complications, so patients who experience any issues after a cosmetic treatment should see a dermatologist as soon as possible.” Dermatology Times

Psychological Impact

Complications — especially visible scars, pigment changes, or asymmetric results — can lead to mental distress, anxiety, depression, even body dysmorphic disorder (BDD) or PTSD in some patients. A 2024 survey found that botched cosmetic treatments increased risk of anxiety, depression, PTSD, particularly when multiple complications occurred.

Prevention: Best Practices Before & During Treatment

1. Choose board-certified providers — dermatologists or plastic surgeons with credential checks.

2. Thorough consultation — review medical history, exam skin type, contraindications, medications.

3. Patch testing (for peels, lasers) especially in darker skin types.

4. Start conservatively — lower energy, lower filler volume, gentler peels.

5. Strict aseptic technique — sterilization, gloves, hygienic environment.

6. Informed consent & realistic expectations — provider should explain risks, benefits, alternative options.

7. Pre-treatment preparation — discontinue certain medications (aspirin, NSAIDs, supplements) if safe, manage skin condition, control infections or active disease.

As Westlake Dermatology recommends, patients can reduce risk by avoiding blood thinners, using cold compresses, avoiding touching treated areas, and strictly following post-procedure instructions.

Management: What to Do When Side Effects Occur

• Mild swelling, redness, bruising — usually self-resolving in days. Cold compress, elevation, gentle care, analgesics as advised by provider.

• Infectious signs (pain, warmth, pus) — prompt evaluation and antibiotics.

• Persistent pigment changes — topical lightening agents, cautious use of lasers or peels once healed.

• Scarring / hypertrophic scars — silicone gels, intralesional steroids, laser therapy.

• Vascular occlusion (rare for fillers) — immediate intervention (e.g. hyaluronidase for hyaluronic acid filler, warm compress, nitroglycerin paste, and referral).

• Burns / blistering — careful wound care, dressings, dermatologic support.

• Psychological distress — counseling, mental health support, open communication with provider.

Dermatologists managing complications must have a broad arsenal of treatments and a sensitive patient approach. As one review noted, many serious adverse events, when treated early and appropriately, can avoid long-term damage and disfigurement.

When to Seek Medical Help — Red Flags

Seek prompt medical attention if you observe:

• Intensifying pain, heat, or swelling beyond expected timelines.

• Purulent discharge, foul odor, or signs of infection.

• Areas of skin turning dark, black, or unresponsive (possible necrosis).

• Worsening pigmentation or spreading beyond treated zones.

• Visual changes (if procedure near eyes), sudden vision loss.

• Persistent, worsening nodules, lumps, or asymmetry not improving.

Document photos, note timing of onset, and contact the treating physician or qualified dermatologist immediately.

Setting Realistic Expectations & Informed Consent

No provider can guarantee a flawless result. As per patient-education best practices, clients should be counseled on:

• Expected transient side effects (bruising, swelling).

• The possibility of needing touch-ups or corrections.

• Variability according to skin type, age, healing ability.

• That some procedures are elective and not covered by insurance.

Complications are generally less frequent when performed by experts and in clinical settings. As one clinic states: “The short answer is: Yes, cosmetic procedures are generally safe when performed by board-certified professionals in a reputable clinic.”

Also, Dr. Malcolm Roth (plastic surgeon) and Dr. Carolyn Jacob (board-certified dermatologist) have cautioned about risky or less studied procedures (e.g., lipodissolve) where complications like pain, contour irregularities, ulceration may outweigh benefits. ABC News

Summary & Take-Home Advice

• Cosmetic procedures carry inherent risks, even when well performed.

• Most side effects are mild and self-limited: swelling, redness, bruising, sensitivity.

• More serious complications — pigment changes, scarring, vascular injury, infections — are less common but require prompt attention.

• Darker skin types and patients with comorbidities need extra caution.

• The skill, training, and environment of the provider make a major difference in safety outcomes.

• Early recognition and management can mitigate long-term harm.

• Mental health implications from visible complications should not be underestimated.

By combining realistic expectations, choosing credentialed providers, and maintaining vigilant aftercare, patients can maximize benefits while minimizing risks.

Disclaimer: This article is for informational and educational purposes only and does not substitute for individualized medical advice. Always consult a board-certified dermatologist or qualified medical professional before undergoing any cosmetic intervention.