Necrosis after filler: what it is and how to prevent it

November 11, 2026 · 1 min read

Necrosis is the death of the cells of a tissue due to a lack of blood supply. In orofacial harmonization, skin necrosis is a rare and serious complication of fillers, almost always the consequence of a vascular occlusion: the product enters a vessel or compresses it, and the area that depends on that vessel stops receiving blood.

The picture usually progresses in stages. First come signs of ischemia, such as pallor, disproportionate pain and a mottled change in skin color. If circulation is not restored, the area can progress to blisters, crusting and tissue loss. The earlier it is recognized and treated, the greater the chance of limiting the damage.

Where is the risk greatest?

The risk exists in any area, but it is discussed with more emphasis in areas with major vessels and terminal circulation, such as the glabella, the nose, the nasolabial fold, the temples and the tear trough.

What reduces the risk and the damage?

Detailed knowledge of the vascular anatomy of each area.
Careful technique, with controlled volume and pressure.
Early recognition of the signs of ischemia.
Hyaluronidase available in the office and a defined response protocol when hyaluronic acid is used.
Referral and follow-up when the condition requires it.

With fillers that do not respond to hyaluronidase, management is different, which reinforces the importance of a careful indication.

Informed consent should mention this possibility in clear language, without alarmism and without omitting it.

Also called: cutaneous necrosis, tissue necrosis.

Frequently asked questions

Is necrosis after filler common?

It is a rare but serious complication. That is why anatomical knowledge, careful technique and hyaluronidase on hand are part of every hyaluronic acid application.

Terms mentioned

Vascular occlusion in filler Hyaluronidase Hyaluronic acid

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