Until Spring 2015 the Bolam test which relied on expert evidence and responsible professional opinion was the test for consent. Now Montgomery is placing the onus on the individual practitioner. The legal right of patients to be informed of material risk is enshrined in law.
In my opinion the use of dermal fillers carries more dangers than the use of the botulinium A toxin (Botox™) cosmetically. Having said that breaking the integrity of the skin in itself carries risks. I will discuss the most common complications from dermal fillers which have resulted in litigation and which may not have been warned about pre-treatment.
Infection, although rare, can if left untreated result in abscess formation and subsequent hospitalisation, thus impacting on the NHS. I have seen two cases of severe infection resulting in hospital treatment.
Vascular occlusion leading to necrosis is becoming more widely reported. I believe this partly due to more treatments being undertaken, treatments being delivered by less experienced practitioners and also by lay persons with no training. Although medical personnel are regulated through the GMC, NMC and GDC, there is no law to stop anyone opening up a practice. There have been some cases of vascular occlusion where the diagnosis has been missed and mistaken for severe bruising or even for herpes simplex which have resulted in litigation.
The most common areas for a vascular occlusion are the lips, areas around the nostrils and the glabella because of the blood supply. As well as causing a possible necrosis a vascular occlusion can in rare cases result in irreversible blindness because filler can track from the facial artery to the retinol artery. This is a risk which must be warned about, but which practitioners miss out for fear of putting the patient off. To return to the Montgomery ruling, this is a material risk which the patient would want to be warned about.