Dermal fillers are injectables that are commonly used to target wrinkles and smooth or “rejuvenate” the skin. They are sometimes used to contour or shape the nose or lips.
Experts say people who have cosmetic fillers injected into their faces should be aware of the risk of a dangerous complication involving blocked arteries, which can lead to skin loss and even blindness due to impaired blood flow.
Although rare, such “vascular occlusion” events — where the filler is injected into or too close to blood vessels — can be devastating because they can cause tissue death and facial disfigurement if left untreated, says lead researcher Dr. Rosa Siegrist.
Dr. Siegrist’s team, from the University of São Paulo in Brazil, studied filler-related vascular complications in 100 patients at four radiology centers (two in Brazil, one in Colombia, and one in Chile), a dermatology center in the Netherlands, and a plastic surgery center in the United States between May 2022 and April 2025.
Dr. Siegrist says the areas around the nose are particularly high-risk injection sites because the blood vessels in the nose connect to some of the most important parts of the head.
He explains that damage to these vessels can cause severe complications, including skin damage, blindness, and stroke.
Clinics are now advised to perform ultrasound scans before injecting dermal fillers into the face to avoid damaging nearby arteries.
If complications arise, ultrasound can guide the treatment site.
“If injectors aren’t guided by ultrasound, they’re treating based on clinical findings and injecting blindly,” says Dr. Sigrist. “
But if we can see the ultrasound findings, we can target the exact location of the blockage.”
Rather than filling the area with a drug called hyaluronidase to dissolve the filler, doctors can perform guided injections that use less hyaluronidase and provide better treatment results, he says.
The use of ultrasound is increasing, but it’s not yet routine or standard.
