In short
- It happens when filler enters an artery or compresses it, and the tissue that depended on that artery stops receiving blood.
- Disproportionate pain is the most useful sign, particularly if it appears once the injection had already stopped hurting.
- Immediate blanching of the skin, purplish mottling and a delay in the colour returning when pressure is released are the signs looked for.
- In its most severe form it can affect vision: a review of the world literature collected 48 cases of visual loss between 2015 and 2018, with hyaluronic acid involved in 81.3%.
- The areas are not equivalent: the nasal region accounted for 56.3% of those cases, followed by the glabella, the forehead and the nasolabial fold.
- Any disturbance of vision means going to A&E, not waiting for the follow-up appointment or ringing the next day.
Of everything that can go wrong with a filler, this is the complication that matters. Vascular occlusion happens when the product enters an artery or compresses it from outside, and the territory that depended on that vessel is left without a blood supply. It is uncommon. And it is the only complication of hyaluronic acid in which the hours count.
This page explains how it is recognised, which signs oblige you to act on the spot, why some areas of the face concentrate the risk and what is done when it happens. Not so that you can treat yourself: so that you know when to pick up the phone and when to go straight to A&E.
This page expands on the serious complication of hyaluronic acid treatments. The medicine used to reverse it has a page of its own in hyaluronidase: when it is used and what risks it carries.
What exactly happens
The face has a dense arterial network with connections between territories. A filler can compromise a vessel in two ways:
- From inside. The product enters the lumen of the artery and travels with the flow until it blocks it at a narrower point. It can reach further from the injection site than seems intuitive.
- From outside. The product does not enter the vessel but is deposited around it and compresses it, especially in planes where there is little room to accommodate volume.
In both cases the result is the same: a territory of skin — or, in the worst case, of the retina — stops receiving blood. What decides the outcome is not so much what happened as how long it takes to be recognised and treated.
The signs, and the order they appear in
The standard management guideline describes the process as stages of ischaemia that help place how long the picture has been established, and that is exactly what determines what has to be done. In practice, this is what is looked for:
- Disproportionate pain. It is the most reliable sign, and very particularly pain that appears once the injection had already stopped hurting. A filler is uncomfortable while the needle is in; it should not hurt more and more afterwards.
- Blanching. The skin of the area loses colour strikingly, sometimes immediately.
- Purplish mottling in a net-like pattern, over the affected territory.
- Slow capillary refill. When the skin is pressed and released, the colour takes time to come back. It is a sign the practitioner checks by comparing with the healthy side.
- Progressive colour change over the following hours, which may evolve into a dark appearance and skin lesions.
None of these signs is for you to interpret in the mirror. They are so that you know that is not “normal after a filler” and report it immediately.
Vision: the part that will not wait
It is the most serious and the least well known. If the product reaches the circulation supplying the eye, visual loss can occur.
A review of the world literature identified 48 new cases of partial or complete visual loss between January 2015 and September 2018. Hyaluronic acid was the material involved in 81.3% of them. And the figure that weighs most: only 20.8% recovered their vision completely, and 16.7% recovered it partially.
That is why the course of action for eye pain, blurred vision, loss of visual field or any disturbance of sight after a filler is one and the same: hospital A&E, immediately.
The areas are not the same
In that same review, the injection sites involved were:
| Area | Proportion of the cases |
|---|---|
| Nasal region | 56.3% |
| Glabella | 27.1% |
| Forehead | 18.8% |
| Nasolabial fold | 14.6% |
The practical reading is not “do not have your nose treated”. It is that there are areas where the injector’s anatomical knowledge weighs far more heavily than in others, and where it makes complete sense to ask who is going to treat you and what experience they have in that particular region.
What is done when it happens
With one idea underlying it: it is an emergency, and the treatment exists.
- It is recognised and confirmed. The practitioner assesses the signs and compares with the healthy side.
- Hyaluronidase is given. It is the medicine that breaks down hyaluronic acid, and it is what allows the obstruction to be reversed. The guidelines agree on giving it as early as possible, and on repeating the assessment until the picture resolves.
- Close follow-up is arranged, because the course may call for wound support if the tissue has come to suffer.
And what is not done: you do not wait to see whether it improves on its own, you do not treat it at home, you do not massage it on your own initiative and you do not look up a dose on the internet. Hyaluronidase is a prescription medicine given by a doctor, and the regimen depends on the case.
What reduces the risk, before it happens
No technique eliminates it, but there are conditions that reduce it a great deal:
- Who injects, and with what anatomical knowledge, especially in the nose, glabella and forehead.
- That the clinic has hyaluronidase available and a written protocol for what to do. It is reasonable to ask before being treated, and the answer should be immediate. At ICPM it is kept on site and that protocol exists.
- That hyaluronic acid is used and not a permanent material. A permanent filler that occludes a vessel cannot be dissolved.
- That the signs are explained to you before you are treated, not after. If nobody has told you what to watch for, half the consent is missing.
- Knowing who to call and on what number. At ICPM, anyone treated here leaves with their surgeon’s direct number, outside consulting hours too.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
Is vascular occlusion common?
No, it is an uncommon complication. But it is the serious one, and its outcome depends above all on how quickly it is recognised and treated.
How do I know whether what I have is an occlusion or just a bruise?
Do not make that distinction yourself. The useful guide is the pain: a bruise does not hurt more and more, and a normal filler stops being uncomfortable. Increasing pain, pallor or mottling are reported on the spot.
Can it cause blindness?
In its most severe form it can affect vision. The review of the world literature collected 48 cases between 2015 and 2018, with complete recovery in only 20.8%. Any visual disturbance after a filler means going to A&E.
Which areas carry the most risk?
In the published cases of visual loss, the nasal region accounted for 56.3%, followed by the glabella (27.1%), the forehead (18.8%) and the nasolabial fold (14.6%).
Can it be reversed?
Hyaluronic acid is broken down by hyaluronidase, and that is the main reason it is preferred over permanent materials. The guidelines recommend giving it as early as possible.
What if I had the filler done somewhere else?
It does not matter where you had it done: if you have warning signs, it is an emergency. The first thing is to alert whoever treated you; if you cannot, go to the nearest centre that can see you and, for any visual disturbance, to hospital A&E. If what you have is not an emergency but an after-effect or a question about a filler placed somewhere else, ICPM will assess it during consulting hours.
How much time do I have?
There is no figure that works for every case, and that is why the guidelines talk about acting as early as possible rather than giving a deadline. The right course of action is not to wait.
Should I not have filler at all, then?
That is an individual decision. Knowing about this complication should not lead you to give up the treatment, but to choose where and with whom, and to insist on being told what to watch for.
Sources
- Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. 2019. Forty-eight new cases of visual loss between January 2015 and September 2018; hyaluronic acid involved in 81.3%; nasal region 56.3%, glabella 27.1%, forehead 18.8%, nasolabial fold 14.6%; complete visual recovery in 20.8% and partial in 16.7%. https://pubmed.ncbi.nlm.nih.gov/30805636/
- Murray G, Convery C, Walker L, Davies E. Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion. J Clin Aesthet Dermatol. 2021. Describes the pathophysiology of tissue ischaemia and introduces identifiable stages that allow the extent of the ischaemia and the time elapsed since its onset to be estimated, and indicate when wound support may be needed. https://pubmed.ncbi.nlm.nih.gov/34188752/
- Murray G, Convery C, Walker L, Davies E. Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol. J Clin Aesthet Dermatol. 2021. https://pubmed.ncbi.nlm.nih.gov/34840662/
- Baranska-Rybak W, Lajo-Plaza JV, Walker L, Alizadeh N. Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management. Dermatol Ther. 2024;14(7). https://pubmed.ncbi.nlm.nih.gov/38907876/
Book your consultation
If you have had a filler and something is not going the way you were told — pain that is increasing, a change of colour, an area that looks wrong — do not wait for your follow-up appointment: ring. And if any disturbance of vision appears, go to A&E.
ICPM keeps hyaluronidase on site and has a protocol for dealing with an occlusion. Our patients leave the consultation with their surgeon’s direct number, for out of hours too. And anyone treated elsewhere is seen during consulting hours.
Clinical confirmation by the surgeon
Registration no. 46/4624077
Registration no. 46/4624503
Last reviewed: 23 August 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
