Vascular Occlusion From Filler: Warning Signs and What to Do Now

Filler can cause a blockage in two ways. It can enter a blood vessel and block it from inside, or a lump of filler can press on a nearby artery from outside. Either way, the tissue that vessel feeds gets too little blood.

Which kind of vessel is involved changes what can happen. A blocked artery can cause skin and tissue necrosis, blindness or a stroke, while problems in a vein may lead to necrosis and, rarely, a clot in the lungs.

These events are rare, but there are no zero-risk areas on the face. Even with good knowledge of facial anatomy and correct technique, a small risk remains for every injector, including highly skilled ones.

Some areas carry more risk. The eyebrows, forehead and nose are especially prone because of their dense blood supply. Because the face's blood vessels connect, injections in other areas, such as the cheeks, nasolabial folds or lips, can also be involved.

Seek medical attention right away if you notice any of these after filler:

• Unusual pain at or near the injection site.
• Skin that looks white, gray or blue near the injection site.
• A blanched, then mottled and dusky look that follows the path of the blocked vessel.
• A purple, net-like (reticular) discoloration with pain and swelling.
• Vision changes, or any sign of a stroke, such as sudden trouble speaking, numbness or weakness, or face drooping.

Early on, there may only be some discoloration and mild pain. Without timely treatment, the discoloration, swelling and pain can increase. When the blockage is complete, symptoms can appear right away or within hours. A partial blockage can cause mild pain and swelling without much discoloration, so a call is worth it whenever something feels wrong.

Doctors describe vascular occlusion in stages, and the stage decides how urgent treatment is:

• Early: discoloration and mild pain at the injection site, a sign of minor blood vessel trouble.
• Progressing: without timely treatment, more discoloration, significant swelling and stronger pain, which can lead to tissue death.
• Advanced: extensive tissue death, with blackened skin and severe pain, and a risk of infection.

Once blindness happens from a filler blockage, removing the blockage is nearly impossible. That is why any vision change after filler is an emergency, and why prompt, accurate diagnosis followed by immediate treatment matters in every case.

If you notice warning signs after filler, act on them:

1. If your vision changes, or you have signs of a stroke, call 911 or go to the nearest emergency room.
2. Otherwise, seek immediate medical attention, starting with the clinic that treated you.
3. If you cannot reach them, go to a physician-led practice that dissolves filler, urgent care or the emergency room.

A safe practice also checks in with patients the day after filler, because some signs develop over the following days.

Hyaluronic acid filler can be dissolved with an enzyme called hyaluronidase. In an emergency, hyaluronidase is given into the affected tissue in relatively high doses, repeated until the skin's color, capillary refill and pain show the blockage has resolved.

Other filler types have no dissolving agent, so a blockage from those is managed in other ways. It is one reason to know exactly which filler you received.

For a problem that is not an emergency, such as a lump or filler that has moved, the same enzyme is used for correction. Read more about filler lumps and nodules and filler migration.

Ultrasound-guided hyaluronidase injection is emerging as a precise approach. The enzyme is placed under real-time ultrasound, rather than by feel alone.

At Spectrum, Dr. Munib maps and dissolves filler under ultrasound guidance. Learn more about filler dissolve at Spectrum and lip filler dissolve.

A real case from our office

A patient came to Spectrum after receiving hyaluronic acid filler elsewhere. A complication had restricted blood flow to part of the treated area, placing the tissue at risk of permanent damage.

The patient noticed the change and sought help quickly. Dr. Munib dissolved the filler under ultrasound guidance. Blood flow improved, and the tissue recovered.

This is a single case from our practice, not a promise of how every case turns out.

If filler pain is getting worse instead of better, or the skin looks pale or patchy, call. Do not wait for morning.

The FDA advises working with a licensed health care provider who is experienced in injecting dermal fillers and knowledgeable about anatomy and managing complications. A careful injector also:

• Knows the facial anatomy around each injection site and avoids injecting near blood vessels.
• Injects with low pressure and small amounts, and may use a blunt cannula instead of a sharp needle in high-risk areas.
• Stops the injection immediately if the skin blanches, vision changes, or there is unusual pain.
• Keeps hyaluronidase on hand and has a plan for treating a blocked vessel before it is ever needed.

With careful technique and that preparation, the risk is manageable, and most of these aesthetic complications are very treatable. Before you book, ask who will inject, which filler will be used, whether it can be dissolved, and who to call after hours.