A wrinkle faded in a few minutes, a slightly redesigned nose, fuller lips… Facial filler injections have established themselves as a quick, almost banal beauty procedure. A new international study, based on ultrasound examinations, however, reminds us that, in rare cases, an artery in the face can become blocked and lead to loss of skin or even vision.
A study of 100 cases of complications
Filler injections have become a common aesthetic procedure, used to smooth wrinkles, restore volume or reshape certain areas of the face. Hyaluronic acid remains the flagship product, with more than 5.3 million treatments performed in the United States in 2024, according to researchers.
Presented at the annual meeting of the Radiological Society of North America, the study analyzed 100 cases of vascular complications following hyaluronic acid injections, followed between May 2022 and April 2025 in several centers located in Latin America, Europe and the United States. The team led by radiologist Rosa Maria Silveira Sigrist (University of São Paulo) used Doppler ultrasound to observe facial blood flow.
The images show blockages in both small vessels and major arteries, particularly around the nose. “Vascular occlusion events in the face can be devastating because, if not properly treated, they can cause necrosis and even facial deformity“, said researcher Dr. Rosa Maria Silveira Sigrist, radiologist at the University of São Paulo.
Serious complications observed
Ultrasound analysis demonstrated an absence of flow in the small perforating vessels in approximately 42% of cases. In 35% of cases, a major facial artery found itself obstructed, often linked to the vessels supplying the nasal area. Occlusion occurs when the filler is injected into or too close to a blood vessel, blocking circulation and depriving the tissues of oxygen.
When it affects the skin, the main consequence is necrosis, with a risk of scarring or lasting deformation. The nose area is particularly sensitive. “Areas around the nose are particularly risky injection sites, because the arteries there connect to blood vessels supplying the face as well as major organs“, said the radiologist. “Serious complications caused by damage to these vessels can include blindness and stroke“.
Faced with these risks, the British Association of Aesthetic Plastic Surgeons insists on the need to strengthen regulations: “Mapping the location of blood vessels undoubtedly provides valuable information prior to treatment. Risks like these with dermal fillers are among the many reasons why we have long campaigned for increased regulation of cosmetic procedures and for restricting the performance of medical procedures such as injections to those with medical training.“, said Nora Nugent, president of the British Association of Aesthetic Plastic Surgeons, quoted by the
BBC.
Measures to put in place
The study highlights the importance of ultrasound, used before the injection to map the vessels of the face and identify areas at risk, but also after the appearance of a complication to locate the occlusion and guide the hyaluronidase treatment.
“If injectors are not guided by ultrasound, they treat based on clinical findings and inject blindly“, Sigrist said. “But if we can see the ultrasound result, we can target the exact location where the occlusion is occurring“, Sigrist continued. “Rather than flooding the area with hyaluronidase, we can do guided injections which use less hyaluronidase and provide better treatment results“.
Learned societies point out that ultrasound is non-invasive, free of ionizing radiation and has no known harmful effects. However, its use remains far from systematic in aesthetic medicine. In the United Kingdom, the authorities have already announced their intention to reserve certain risky acts for professionals.sufficiently qualified” and to subject clinics offering fillers and botox to a licensing system, with a public consultation planned for 2026.
Finally, the researchers emphasize the need to standardize the mapping of facial vessels and point out that “results presented at medical meetings should be considered preliminary until published in a peer-reviewed journal“.