Why filler consent carries the most weight
Filler complications run from the common and cosmetic to the rare and devastating. Montgomery requires you to disclose the material risks a reasonable patient would want to know. For fillers, the most serious of those is vascular occlusion, and for the tear trough and other periocular sites, the possibility of blindness. A record that names those risks specifically is your strongest document.
The material risks to disclose and document
- Bruising, swelling and tenderness, the common effects.
- Lumps, nodules and the Tyndall effect (a bluish tinge in thin skin such as the tear trough).
- Infection and delayed inflammatory reactions, which can appear weeks or months later.
- Product migration and asymmetry.
- Vascular occlusion: filler blocking a blood vessel, causing tissue ischaemia and, if untreated, necrosis. This is the emergency you consent for. Read the full guide.
- Blindness from occlusion of a retinal artery, a recognised risk of periocular and tear-trough treatment. Rare, but material, and exactly what a claimant will say they were never warned about.
What the record must contain
Beyond the risk discussion, filler documentation should capture the product and batch or lot number, volume, and injection sites (an injection map), the consent to hyaluronidase including its own small risk of allergy and anaphylaxis, and pre-treatment photographs. When a letter of claim arrives eighteen months later, these are the entries that answer questions before they are asked.
Tear trough: the highest-stakes site
The tear trough sits over the anatomy where filler complications are most feared. It is also a treatment patients often request for a specific event or appearance, which makes the tailored, patient-centred discussion Montgomery demands especially important. Record why the tear trough was chosen or declined, the specific periocular risks explained, and the reflection time given.
Alternatives (McCulloch)
Reasonable alternatives to record include no treatment, skin boosters or skin quality treatments, and, where relevant, surgical options. In elective aesthetics, doing nothing is a reasonable alternative every time, and a record showing it was genuinely offered is one of the strongest defensive entries in the file.
Where this sits
Every material risk below is a Montgomery disclosure and, where an alternative exists, a McCulloch one too. If it was discussed, it needs to be on the record. See how the standard rose in the interactive timeline, and how a claim actually unfolds in Anatomy of a Claim.
Related: Vascular occlusion · Botulinum toxin consent · Blepharoplasty consent · Aesthetics overview