Warning about cosmetic facial fillers as scans reveal new details of risks

People who inject their face with cosmetic fillers should be warned of the risk of a dangerous complication involving blocked arteries that can lead to skin loss and even blindness due to damaged blood flow, experts say.

Researchers used ultrasound to study 100 cases of filler injections gone wrong.

Clinics are now advised to perform an ultrasound before administering dermal fillers to the face, to avoid damaging any nearby arteries.

Lead researcher Dr Rosa Sigrist says that, although uncommon, such ‘vascular occlusion’ events – where the filler is injected into or very close to blood vessels – can be devastating because they can cause tissue death and facial disfigurement if left untreated.

Dermal fillers are injectable substances, commonly used to target wrinkles and smooth or “rejuvenate” the skin.

Sometimes they are used to contour or shape the nose or lips.

The areas around the nose are particularly dangerous injection sites, says Dr. Sigrist, because the nasal blood vessels communicate with some very important parts of the head.

Damage to these vessels can cause serious complications, such as skin lesions, blindness and stroke, he explains.

Dr Sigrist’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 US between May 2022 and April 2025.

Her work will be presented at a medical conference – its annual meeting Radiological Society of North America – this week.

In less than half of the cases, the ultrasound scans showed an absence of blood flow in small blood vessels that connect the superficial arteries to the deep ones in the face.

And in a third of cases, blood flow was absent in major blood vessels.

To avoid complications in the first place, he advises clinics to use ultrasound to plan where to inject.

If complications arise, ultrasound can guide where to treat.

“If the injectors are not guided by ultrasound, they are treating based on where the clinical findings are and injecting blindly,” says Dr. Siegrist.

“But if we can see the ultrasound finding, we can target the exact point where the blockage is occurring.”

Instead of flooding the area with a drug called hyaluronidase to dissolve the filler, clinicians can make guided injections that use less hyaluronidase and provide better treatment results, he says.

The British Association of Aesthetic Plastic Surgeons (BAAPS) says the use of ultrasound is increasing but is not yet routine or standard of care.

Ultrasound is non-invasive, does not use ionizing radiation and has no known harmful effects.

Nora Nugent, president of BAAPS, said it was proving very useful in many areas of surgery and medical aesthetics.

“Mapping the location of blood vessels undoubtedly provides valuable information prior to treatment.

“Dangers such as those from dermal fillers are one of the many reasons why we have long campaigned for increased regulation of cosmetic procedures and restrictions on the provision of medical procedures such as injectable treatments to those with medical training.”

The UK government said so plans to impose restrictions on cosmetic surgery.

Under the proposals, only “suitably qualified” health professionals will be able to carry out high-risk procedures such as Brazilian butt lifts.

Clinics that administer fillers and Botox must meet strict standards to be licensed.

A public consultation will be published in early 2026, with views on the range of procedures that should be covered under the new restrictions. Parliament will then decide what to introduce.