I wrestled on the very low end of the indies for a while but I can probably give a little insight. The outcomes are all fixed for all matches. However back in the earlier days (and maybe still today though I have never heard of this happening) one wrestler would sometimes refuse to lose for one reason or another. This would usually result in the match being changed. Though sometimes if it happened during the match things would get more real and could turn into a “shoot” (real) fight. It has always been seen as very selfish and unprofessional and would usually get you banned from that company and potentially even more in the region. As I said this happened more in the earlier days before companies like WWE, AEW and NJPW existed so things were less worldwide and more regional if that makes sense. As far as the damage looking real goes, that is a point of pride for us. We work really hard to make it look as real as possible (yes sometimes it looks laughably fake, but that is us trying to protect each other in the ring). In addition, sometimes the damage actually is real. Injuries happen all the time. Also I would say maybe 80% of the blood you might see in a match is real, from cuts that we do to ourselves on purpose to get blood flowing to make the match look more serious. Typically if the blood is on the outside it is real, if someone is “coughing up blood” it is fake.