6 Considerations to Reduce Risk of Vascular Occlusion

Vascular complications are a very rare but serious risk associated with dermal filler injections. The most concerning complication is vascular occlusion, where filler inadvertently enters a blood vessel, compromising oxygen supply to nearby tissues. When treating a patient with dermal fillers, aesthetic doctors consider 6 factors to reduce the risk of vascular complications.

• Site: Caution is needed when injecting fillers in central facial areas, particularly near critical vessels like the facial and angular arteries, along the nasolabial fold, the nose, and glabellar (frown) regions. A thorough understanding of facial anatomy is essential.
• Volume: Larger amounts of filler increase the risk of arterial obstruction. To mitigate risks, practitioners limit injections to no more than 0.1 mL per site. Smaller volumes per injection point being safe.
• Choice of needle or cannula: Small-gauge sharp needles have a higher likelihood of penetrating an artery. In addition, aspirating arterial blood with a narrow-gauge needle does not guarantee safety. The use of blunt micro-cannulae instead of a needle may decrease the likelihood of accidental intra-arterial injection, particularly in areas with previous scarring.
• Previous scarring: Areas with prior surgeries or scarring pose an elevated risk of vascular occlusion. Deep tissue scars and fibrosis may stabilize arteries, making them more susceptible to penetration by small sharp needles.
• Force of injection: when injecting dermal fillers it’s safer to inject slowly under low pressure to reduce extrusion force of the filler in the tissues.
• Composition of filler: Hyaluronic acid fillers can be dissolved using the enzyme hyaluronidase, offering a means of reversal. However, products such as CaHA, PCL, and PLLA cannot be dissolved.