Dermal fillers made their debut in the 1970’s when animal collagen began being used for cosmetic injections and implants.  In 2006, a new family of synthetic fillers was introduced when Restylane became the first FDA approved hyaluronic acid filler. These hyaluronic acid fillers are the most used today.

The decision to use dermal fillers for cosmetic purposes is a personal one.  Patients will discuss options with their aesthetic provider and decide whether their desired goals can be achieved with filler injections and whether the risks of potential complications are acceptable.   Potential complications include swelling, bruising, asymmetries, infection, allergic reactions, palpability of the filler under the skin surface, and the most serious complication of all – vascular occlusion. That is the focus of this blog article.

 Vascular occlusion during dermal filler treatment is rare. It is, however, a serious complication that can quickly lead to tissue necrosis if not identified and treated promptly.  Vascular occlusion can occur if filler is inadvertently injected into an artery or if enough filler is injected around an artery or blood vessel to cause a compression blockage.  In order to minimize risk of vascular occlusion, injections should be made slowly and after aspiration to help determine if the needle may have punctured a blood vessel. Injecting small amounts of filler at a single location can also help reduce risk.  In some cases, using a blunt tip cannula instead of a needle may reduce the risk of penetrating a blood vessel.

Knowledge of key anatomical facial structures is imperative for the aesthetic physician or practitioner. Awareness of the location of blood vessels and proper needle depth is essential to minimize the risk of injecting filler into a blood vessel.

Most aesthetic practitioners believe that it is not a case of IF a vascular occlusion will occur during one’s career, but rather WHEN it will occur.  If you practice long enough and inject enough patients, vascular occlusion will likely happen at some point.  How it is handled ultimately determines the outcome for the patient.  Beginning treatment quickly can mean the difference between a complete reversal of the occlusion with return of blood flow to the area and the need for a patient to have prolonged treatment and possible long-term damage to the tissue.

At Medical Day Spa of Chapel Hill, we have several policies in place not only to minimize the risk of vascular occlusion but also to create the best chance for a good outcome following a vascular event.

• Our practitioners undergo extensive training several times annually through private and manufacturer sponsored programs. This includes anatomy training, updates on techniques and products, hands-on injection training, and review of best practice protocols.
• We use only hyaluronic acid fillers. These fillers are able to be dissolved using an enzyme called hyaluronidase.  Other fillers are much more complicated to remove in the event of an occlusion.
• Blunt tip cannulas are frequently utilized and high risk areas – such as the nose, forehead, and between the brows – are not injected with filler.
• Prior to treatment, practitioners discuss the risks and benefits of dermal filler injections with patients in detail. This includes discussions on what to be aware of and communicate to us during and after treatment.
• Patients are given written post-treatment instructions following treatment. These outline both expected and unexpected reactions and how to contact us. Patients are provided with our contact information so that we can be reached after hours.
• Following the dermal filler treatment, our practitioners follow up with patients by phone or text within 10 to 12 hours after the injection. If the patient reports pain, excessive bruising, or a mottled, blanched appearance to the skin, we have them send photos for assessment or return to the office for examination.
• Our practice maintains a written protocol and vascular occlusion kit to be ready for treating an occlusion promptly and effectively. All staff are trained in the steps to initiate treatment.

Preventing complications is essential with dermal filler injections.  Nevertheless, complications can occur even in the most skilled hands.  For that reason, choosing an experienced injector in a practice prepared to manage possible adverse reactions and committed to patient follow-up is imperative for ideal patient outcomes in the medical aesthetic setting. Do your homework when choosing an aesthetic practice, ask questions, and make sure you feel well informed before undergoing dermal filler treatment.

If you are wondering, “where can I get dermal fillers near me”? Well, Medical Day Spa of Chapel Hill is the best place to get your juvederm or restylane dermal filler done.

To learn more, schedule an appointment to discuss how dermal fillers can benefit you, please call Medical Day Spa of Chapel Hill at 919-904-7111.

If you live in Raleigh, Durham, Chapel Hill, Cary, Apex, Morrisville, Hillsborough or anywhere in the Triangle area of North Carolina come on in and experience our dermaplaning facial treatment today!

Enjoy The Experience. Delight In The Results!

Frequently Asked Questions About Vascular Occlusion

Q) What is vascular occlusion with dermal fillers?

A) Vascular occlusion is a blockage of blood flow that can occur if a dermal filler is injected directly into a blood vessel or from compression of a vessel sufficient to interrupt proper blood flow.

Q) What happens if filler is injected into an artery?

A) If dermal filler is injected into an artery, it can either block the blood flow (thrombosis) at that site resulting in ischemia (reduction in oxygen to tissue) or tissue necrosis (cellular death), or it could travel to a more distant site (embolism) where it can cause ischemia or necrosis. In either event, this is an emergency that must be dealt with immediately by dissolving the filler.

Q) How do you reverse vascular occlusion from dermal fillers?

A) Hyaluronic acid (HA) dermal fillers can be dissolved with the enzyme, hyaluronidase. If vascular occlusion occurs, the most important treatment is to immediately dissolve the filler to re-establish blood flow. Application of heat, massage, and a small dose of aspirin can also increase blood flow to the area and reduce the risk of a blood clot. Vascular occlusion from other types of dermal fillers may require surgical intervention to restore blood flow.

Q) How common is vascular occlusion after fillers?

A) Vascular occlusion after dermal filler injection is a rare but potentially serious event. To minimize the risk, dermal fillers injections should be performed by adequately trained professionals who are knowledgeable about vascular anatomy of the injection area, perform injections slowly with small amounts and gentle pressure, and who can recognize and manage the complication if it occurs.

Q) Is vascular occlusion painful?

A) Vascular occlusion usually causes some pain or discomfort, but may only manifest itself by the appearance of blanching, bluish discoloration, or mottling of the skin. Anything that seems unusual even hours after dermal filler injection should be reported immediately to your treatment provider.