Review Article
Vascular Complications in Aesthetic Medicine: Prevention, Recognition and Management
Dr. Ahmed Haq1
- 1 Harley Street Institute, London, United Kingdom
Corresponding author: journal@harleystreetinstitute.com
Journal: HSI J Aesthet Med AI
DOI: 10.XXXXX/hsij.2025.05
Volume / Issue: 1 / 1
Pages: 52–66
Received: 2025-09-04
Accepted: 2025-10-22
Published: 2025-12-01
Licence: CC BY 4.0
Abstract
- Background.
- Vascular occlusion is the most clinically significant complication of dermal filler injection. Early recognition and immediate management determine outcome.
- Methods.
- We synthesise published guidelines and consensus statements (2014–2025) and present a structured framework for prevention, recognition and treatment.
- Results.
- A three-stage framework — prevent, recognise, treat — supports immediate clinical decision-making. Hyaluronidase remains the cornerstone of management for hyaluronic acid filler occlusion.
- Conclusion.
- Every aesthetic clinician should hold a written, rehearsed vascular emergency protocol.
Keywords: vascular occlusion, hyaluronidase, complications, dermal fillers, emergency protocol, patient safety
1. Introduction
Vascular complications, though rare, can result in skin necrosis or visual loss. This review provides a structured prevention-and-management framework.
2. Prevention
Anatomical knowledge, cannula technique in high-risk zones, low injection pressure and small aliquots reduce risk.
3. Recognition
Disproportionate pain, blanching, livedo, delayed capillary refill and vision change are red-flag signs requiring immediate response.
4. Management
High-dose hyaluronidase administered locally, warm compresses, aspirin and urgent ophthalmological referral where vision is affected, are first-line interventions.
5. Conclusion
A pre-rehearsed emergency response is the most important determinant of outcome in vascular complications.
References
- DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J. 2017;37(7):814–825.
- Beleznay K, Carruthers JD, Humphrey S, et al. Update on Avoiding and Treating Blindness From Fillers. Aesthet Surg J. 2019;39(6):662–674.
- Kapoor KM, Kapoor P, Heydenrych I, et al. Vision Loss Associated with Hyaluronic Acid Fillers. Aesthet Plast Surg. 2020;44(3):929–944.
- Urdiales-Gálvez F, Delgado NE, Figueiredo V, et al. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plast Surg. 2018;42(2):498–510.
© 2025 Harley Street Institute. Published under the Creative Commons Attribution 4.0 International Licence (CC BY 4.0).