Vascular occlusion after dermal filler

Reference material only. This article is general reference information, not clinical, medical or legal advice. It does not replace your clinic's own written emergency protocols, your clinical judgement, up-to-date professional guidance, or the emergency services. In an emergency, call 999 without delay. Every clinic remains responsible for its own emergency preparedness, training, equipment and drugs, and for acting within each practitioner's scope of competence and insurance.

Vascular occlusion (VO) is filler compressing or entering a blood vessel, cutting off blood supply. It is the most time-critical complication in dermal filler work: outcomes depend on how quickly it is recognised and managed.

Recognising it

• Pain that is disproportionate or increasing, though occlusion can be painless.
• Blanching or a white/grey patch appearing during or shortly after injection.
• Dusky, mottled or livedo (net-like) discolouration developing over minutes to hours.
• Delayed capillary refill in the affected skin, and later blistering or crusting.
• Any visual change, eye pain, or ptosis is a red flag for ocular compromise and a sight-threatening emergency.

If you suspect it

• Stop injecting immediately.
• Follow an established protocol such as the ACE Group World vascular occlusion guidance and your clinic's own written protocol.
• Hyaluronidase is the mainstay for hyaluronic-acid filler VO: high-dose, repeated dosing and flooding the affected area is typically described, guided by current guidance and the prescriber's assessment. Warm compress and massage are commonly used adjuncts.
• Consider aspirin only where appropriate and not contraindicated, per protocol and prescriber judgement.

Hyaluronidase considerations

Hyaluronidase is a prescription-only medicine and carries its own risk of allergy and anaphylaxis. It must be immediately available, in date, and only used by, or under the direction of, an appropriate prescriber. Patch testing is debated and should not delay treating a genuine occlusion. Know your product, your dose and your source before you ever need it.

Escalation

Suspected ocular involvement (visual disturbance, severe pain) needs immediate emergency ophthalmology and 999. For a progressing or extensive occlusion not responding to treatment, arrange urgent specialist input. Document everything, photograph the area, and arrange close follow-up until fully resolved.