What is vascular occlusion?
Vascular occlusion happens when filler blocks or squeezes an artery. It is rare. Blood supply to the skin beyond that point falls. The area turns pale, then dusky, and starts to hurt. Tissue goes short of blood for as long as this continues, so time matters.
Very rarely, filler can travel backwards into the circulation of the eye. That is why any change in vision is treated as an emergency. No area or technique is free of risk. Results vary from person to person, and later care depends on what happened.
Call 995 or go to A&E now
Blurred vision, lost vision, double vision or eye pain.
New weakness in the face, slurred speech, or weakness of an arm or leg.
Swelling of the lips, tongue or throat with trouble breathing.
Go to emergency care first, not to the clinic. Do not drive yourself if your vision is affected.
Warning signs of filler vascular occlusion on the skin
Skin near the site that turns white (blanching), dusky, purple, or mottled in a net-like pattern.
Pain that is severe, out of proportion to the injection, or getting worse over hours instead of settling.
Signs may appear during injection, in the hours after, or occasionally later.
These signs need urgent medical assessment now. A routine review or a slow message reply is not soon enough.
Bruise or occlusion?
Blue or purple at the needle mark. Tender, but the pain fits the injection. Pressed skin refills with colour.
Spreads along the area an artery feeds, away from the needle mark. Pain is stronger than you would expect and builds over hours.
Treat it as urgent. Swelling, tenderness and some bruising are expected after filler and do settle, but this is not something to judge alone.
What to do in the first hour
How it is treated
For hyaluronic acid filler, urgent high-dose hyaluronidase is given, repeated and reassessed until colour and circulation recover. Hyaluronidase has its own considerations, including allergy, so the treating doctor decides the dose and approach. If it happens during injection, the doctor stops and starts treatment. Straight after injection, you stay at the clinic for treatment and reassessment. Later presentations need urgent assessment now, then wound care and review until healed.
What treatment cannot do
Other fillers cannot be dissolved. This includes calcium hydroxylapatite (Radiesse), polycaprolactone (Ellansé) and poly-L-lactic acid (Sculptra). The response to these is supportive and urgent, with referral where needed. Delayed treatment raises the risk of tissue breakdown and scarring. Once the acute episode has passed, the area is reviewed, and later lumps, discolouration or scarring are assessed separately. Speed matters, which is why these signs should never wait for a routine review.
Areas of higher concern, and lowering risk
The nose, the glabella between the brows, the forehead and the tear trough raise more concern, because their arteries connect with the circulation of the eye. Lowering the risk involves knowing the arterial anatomy and depth, placing product in the planned layer, and using small amounts at low pressure. Blunt cannulas can be used where suitable, and hyaluronic acid can be chosen where the option to dissolve matters. These steps reduce risk but do not remove it. Our tear trough page explains that area.