• A woman needed hospital treatment after a cosmetic procedure on her lips didn’t go as planned.
• The nurse failed to recognise and act on signs of a condition known as vascular occlusion.
• The cosmetic nurse who did the treatment was found to have breached the health consumers’ code and must apologise.

A woman who was told she had a “gummy smile” and that lip filler would improve its appearance ended up being treated in hospital for damage caused by a blocked blood vessel.

And not only did the woman require hospital treatment, she says she was left with a smile that she “hates” as a result of the cosmetic procedure.

Now, the cosmetic nurse who did the procedure in October 2020 has been found to have breached part of the health consumers’ code by failing to provide an appropriate standard of care.

Deputy Health and Disability Commissioner Vanessa Caldwell, said in her report released today that she acknowledged the nurse’s commitment to the client’s care related to the hospital events, but the fundamental issue was that she failed to recognise and act on a “textbook presentation” of a vascular occlusion.

A blood vessel blockage caused by a clot or pressure on arteries after a dermal filler procedure is known as vascular occlusion.

The client was told she had "bigger lips to begin with", so would need more filler. Photo / 123rf

The nurse was trained in facial anatomy and in administering Botox and dermal fillers and had a brief education on identifying vascular occlusion and administering Hyalase, which is the main ingredient in fillers.

According to the decision, the woman booked an appointment to have lip filler on the afternoon of October 30, 2020.

She wanted only a “small amount of lip filler” but was advised she would be better to buy a package which included 1ml of lip filler and Botox in her upper lip - a procedure known as a “lip flip”.

She was not keen but was told to trust the advice.

“You have bigger lips to begin with, so you will need more filler. You’re just going to have to trust me, ok,” the nurse was quoted as saying.

The woman was still unsure, but in the end, was happy to be guided by the nurse.

The nurse noted that the woman might also benefit from Botox in her upper lip muscle to relax it and reverse the effects of a “gummy smile”.

The client then agreed to go ahead with the package deal, with each procedure at the same time as opposed to re-assessing after two weeks.

Risks ‘explained’

The nurse claimed to have explained the risks of vascular occlusion to the client, with the signs and symptoms to look out for in the following 72 hours.

The nurse said she also advised the woman that swelling and bruising was common post-procedure, and that she would see her again in two weeks, but this discussion was not documented in the clinical notes, Caldwell said.

She said none of what the nurse claimed she noticed during the procedure or how she responded was documented in the contemporaneous clinical notes.

The client told HDC that she was not aware of the risk of vascular occlusion before her appointment.

About 30 minutes after the procedure, the woman noticed the injection site was “filling up with blood like a blood blister.” Hours later, she had “strange lace like bruising beneath [her] lip”.

The woman sent the nurse pictures of her lips, but because she did not report any pain, the bruising had not worsened, and other indicators showed no real cause for concern, the nurse advised the woman to let her know if she had any further worries that evening, and would see her the next morning.

She also advised the woman to apply cream and a warm compress to her lips and told the woman to call her during the night if she had any concerns.

The nurse claimed that because of the time of night, she was unsure about contacting the beauty clinic’s medical directors for advice, which was the usual process.

Instead, she messaged another nurse at a different branch of the clinic for advice and sent her the video sent by the client.

The other nurse responded that she would “hyalase for sure” but that it could wait until the following morning.

The client told the HDC that she believed the beauty clinic relying on “virtual medical assessment” posed a real risk of negligence.

‘Pustules’ from follow-up treatment

A follow-up procedure to correct the problem led to pain and the development of pustules just below the woman’s lip, prompting her to go to hospital instead of returning to the beauty clinic as advised.

The woman needed several visits to the hospital and further treatment with Hyalase provided by the beauty clinic to fix the damage to her lip caused by the vascular occlusion.

Caldwell was unable to make a finding on whether or not Hyalase should have been administered immediately following treatment, but accepted advice from another nurse that by 9pm on the night of her treatment the client was showing clear symptoms of a vascular occlusion.

She said the nurse who did the treatment should have asked her to return to the clinic for the administration of Hyalase at that stage.

However, she acknowledged she was in a difficult situation, working alone in the clinic at the time that the client was reporting possible symptoms of a vascular occlusion.

The nurse accepted that she failed to act decisively and that the failure fell below the acceptable standard of care.

She also acknowledged that she should have contacted the clinic’s medical director immediately following the woman’s appointment on the afternoon of October 30.

The nurse was recommended to provide a written apology to the client and has since undergone extra training.

Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.