Vascular occlusion in filler: signs and management

Vascular occlusion is the interruption of blood flow in a vessel, caused by filler entering the vessel lumen (embolization) or by external compression of it. The area that depends on that vessel is left without blood supply. It is a rare complication, but the most serious one with fillers, because it can progress to skin necrosis and, in rare situations, to visual impairment.

Which signs call for immediate attention?

• Sudden skin pallor during or right after the injection.
• Pain disproportionate to the procedure.
• Color change in a lacy or purplish pattern, which may appear in the following hours.
• Slow return of color when the skin is pressed.
• Visual complaints, eye pain or neurological changes, which require urgent referral.

Where is the risk greater?

Risk exists in any region, but it is discussed most emphatically in the glabella, nose, nasolabial fold, temples and tear trough, areas with important vessels and connections to the circulation of the eyes.

What is part of the management?

With hyaluronic acid, the main resource is hyaluronidase, applied according to the professional's protocol and the literature. That is why it must be available in the office before any HA filler. Stopping the injection, documenting the picture and closely following the progress are also part of the management. Protocol details are outside this page and should follow the guidelines of your professional council (in Brazil).

Prevention starts with anatomical knowledge, the choice of plane and instrument, and control of volume and pressure. Using a cannula can reduce the risk, but does not eliminate it.

Also called: vascular complication, arterial occlusion, filler embolization.