Why is this page important?
The vast majority of filler treatments go without problems. Still, rarely, the gel-like product can enter a blood vessel or press on a vessel from outside. In that case, the skin supplied by the vessel or, very rarely, eye and brain tissue cannot get enough blood.
When vascular occlusion is recognised early, the doctor can often intervene. With hyaluronic acid fillers, the doctor can use the enzyme hyaluronidase, which dissolves the gel. Time is very important: acting the moment you notice a symptom can reduce the risk of permanent damage.
Warning signs of vascular occlusion
Symptoms can start during the procedure, immediately afterwards or sometimes within a few hours. Because the local anaesthetic can mask pain for a while, it is also important to check the area visually in the first hours.
Skin symptoms: call the doctor who performed the treatment immediately
- Sudden, severe or steadily increasing pain (clearly different from the expected tenderness)
- Whitening or marked paleness of the skin
- A purplish or bluish change in colour spreading like a net or lace pattern
- The area being cold compared with its surroundings
- Colour that darkens, small blisters or crusting over the following hours or days
Eye and nervous system symptoms: call 112 without delay or go to the nearest emergency department
- Blurred vision, darkening of the field of vision or loss of vision
- Double vision, a drooping eyelid or difficulty moving the eye
- Severe pain in or around the eye
- Sudden severe headache, dizziness
- Facial drooping, speech problems, weakness or numbness in an arm or leg (signs of a stroke)
With symptoms affecting vision, time is especially limited. If you are losing time trying to reach the doctor who performed the treatment, do not wait; call for emergency help first, then inform your doctor.
What should you do immediately?
- If you have symptoms such as problems with vision or speech, or loss of strength, or signs of a severe allergy, call 112 immediately.
- If you have only skin symptoms, call the doctor or clinic that performed the treatment immediately. Clearly describe your symptoms and when and where on your face the procedure was done. If you cannot reach the doctor straight away, go to the nearest emergency department.
- When you go to the emergency department or to another doctor, say that you have had filler in your face, when it was done and, if you know, the type of product used (whether it is hyaluronic acid).
- If possible, take a photo of the area; showing how the colour change develops helps the doctor.
- Have someone with you; if you have vision or neurological symptoms, do not drive.
What should you not do?
- Do not think “I’ll wait a bit, it will pass”. With vascular occlusion, hours and even minutes matter.
- Unless your doctor specifically tells you to, do not massage the area at random.
- Do not apply heat or ice to the area without consulting your doctor.
- Do not take a painkiller and wait for the complaint to go away; pain is an important warning sign.
- Do not try methods suggested on social media or in forums.
- Do not have a new procedure on the same area somewhere else.
How can I tell what is normal from what is urgent?
| May be considered normal (keep an eye on it) | Contact the doctor immediately |
|---|---|
| Mild to moderate swelling that increases in the first days and then goes down | Steadily increasing, severe or throbbing pain |
| Small bruises at the injection points; well-defined edges, colour turns yellow-green over time | Whitening, paleness or a purplish-bluish colour spreading like a net |
| Mild tenderness, discomfort when touched | Coldness or loss of sensation in the area |
| Mild redness that decreases within a few hours to days | Spreading redness, warmth, discharge, fever |
| Slight irregularity when touched that decreases as the swelling goes down | Blisters, crusting or an area of darkening skin |
| No change in the eyes | Any change in vision, double vision, eye pain |
If you are not sure, call. An unnecessary phone call is always better than a delayed intervention.
If you notice blanching, a dusky discolouration of the skin or any change in your vision after a filler, do not wait. Call even when you are unsure; an unnecessary phone call is always better than a delayed intervention.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
Allergic reaction
A serious allergic reaction to filler products or to the local anaesthetic they contain is rare. Mild itching or redness may occur; however, the following symptoms can be life-threatening.
Signs of a severe allergy: call 112 immediately
- Shortness of breath, wheezing or difficulty swallowing
- Rapidly increasing swelling of the lips, tongue, throat or face
- Widespread hives or itching on the body
- Dizziness, feeling faint, palpitations
Late problems: days, weeks or months later
Some problems may appear not immediately after the procedure but later. These usually do not require the emergency department; however, they should be assessed by the doctor who performed the treatment or by a doctor specialising in the relevant field.
- Infection: redness, warmth, pain, swelling, discharge or fever. Do not start antibiotics on your own; an assessment is needed.
- Nodules: hard or painful lumps that can be felt. Some are due to the product collecting, others to an inflammatory reaction; treatment depends on the cause.
- Delayed swelling: rarely, weeks or months later, swelling and redness may appear in the filler area after an infection, a vaccination or dental treatment.
- Cold sore flare-up: may occur especially around the lips in people with a history of cold sores.
With fillers that are not hyaluronic acid, that do not dissolve in the body or that stay for a very long time, late problems can be harder to treat. Knowing which product was used on you makes your doctor’s work easier if a problem arises.
Being prepared before the procedure
- Find out in advance how and when you can reach the doctor who performs the treatment after the procedure.
- Ask whether hyaluronidase enzyme and emergency facilities are available where the treatment is done.
- Ask for the type of product used and the date of the procedure in writing.
- Try not to be alone in the first hours, and check the area in the mirror.
This page is for general information and does not replace a medical examination. If in any doubt, contact the doctor who performed the treatment or the emergency services.
Questions to ask your physician
- If there is a problem after the procedure, how can I reach you at night or at the weekend?
- Are hyaluronidase enzyme and emergency facilities available here?
- Is the product you will use hyaluronic acid? Can I have the product information in writing?
- Which symptoms should I consider normal, and for which ones should I call you immediately?
- How should I check the area in the first hours?
- If I cannot reach you, in which situations should I go straight to the emergency department?
Frequently asked questions
Is it normal to have bruising after filler?
Yes, small bruises at the injection points are common and usually start to fade within a few days. If it comes with a purplish colour spreading like a net, whitening or coldness, it is not normal; contact your doctor immediately.
When do symptoms of vascular occlusion start?
Most often they start during or immediately after the procedure; however, they may sometimes be noticed a few hours later. Because the local anaesthetic can temporarily mask pain, also check the colour of the area in the first hours.
What should I do if I cannot reach my doctor?
If you have symptoms such as vision problems, difficulty speaking, facial drooping or loss of strength, call 112 without waiting or go to the nearest emergency department. If you have skin symptoms and cannot reach your doctor quickly, also go to an emergency department and say that you have had filler.
Should I massage or apply heat at home?
No, unless your doctor specifically recommends it. Doing the wrong thing can make the situation worse or lose valuable time. Call your doctor first.
Can these symptoms also occur with fillers that are not hyaluronic acid?
Yes. Vascular occlusion has been reported with different types of filler. However, because fillers that are not hyaluronic acid cannot be dissolved with hyaluronidase, the treatment options are different.
I have swelling in the filler area months later; is it an emergency?
Most often it does not require the emergency department, but it does need to be assessed. If you have a fever, rapidly increasing redness and pain, it may be an infection, so see a doctor without delay.
Sources
- Dermal Fillers (Soft Tissue Fillers) — U.S. Food and Drug Administration (FDA)
- Guideline for the Management of Hyaluronic Acid Filler-induced Vascular Occlusion (Murray G, Convery C, Walker L, Davies E). J Clin Aesthet Dermatol 14(5):E61–E69 — Journal of Clinical and Aesthetic Dermatology, 2021
- Consensus Opinion for The Management of Soft Tissue Filler Induced Vision Loss (Walker L et al.). J Clin Aesthet Dermatol 14(12):E84–E94 — Journal of Clinical and Aesthetic Dermatology, 2021
- Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature (Beleznay K et al.). Aesthet Surg J 39(6):662–674 — Aesthetic Surgery Journal, 2019
- Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol (Murray G et al.). J Clin Aesthet Dermatol 14(8):E69–E75 — Journal of Clinical and Aesthetic Dermatology, 2021
- Making Sense of Late Tissue Nodules Associated With Hyaluronic Acid Injections (Goodman GJ et al.). Aesthet Surg J 43(6):NP438–NP448 — Aesthetic Surgery Journal, 2023
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
