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People receiving cosmetic facial fillers should be made aware of a potentially dangerous complication involving blocked arteries — a condition that can lead to skin loss, tissue death, and even blindness, experts caution.
A new analysis using ultrasound technology examined 100 cases of filler procedures that had gone wrong, revealing how injections placed too close to critical blood vessels can severely disrupt circulation.
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Ultrasound urged before facial fillers
Clinics are now being advised to perform ultrasound scans before administering dermal fillers, allowing practitioners to map out nearby arteries and avoid dangerous injection spots.
Lead researcher Dr. Rosa Sigrist explains that although these “vascular occlusion” events are uncommon, they can be devastating when they occur, potentially causing severe deformity, facial tissue death, or vision loss.
Dermal fillers — used to smooth wrinkles or add facial contouring to areas such as the lips and nose — pose particular risk around the nasal region. Blood vessels in this area are linked to critical parts of the head, meaning that damage can lead to skin injury, blindness, or even stroke, Sigrist warns.
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Study reveals widespread blood flow disruption
Sigrist’s team, based at the University of São Paulo, analyzed data from patients treated between May 2022 and April 2025 across radiology centers in Brazil, Colombia, Chile, the Netherlands, and the United States.
Key findings from the ultrasound scans include:
- Nearly half showed absent blood flow in small vessels connecting superficial and deeper facial arteries
- One-third showed blockage in major arteries, posing far greater risk of tissue damage
These results will be presented at this week’s annual meeting of the Radiological Society of North America (RSNA).
One ultrasound image showed complete loss of blood flow in part of a patient’s lip artery — with black areas indicating no circulation, and red and blue areas showing directional blood flow.
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Using ultrasound could improve safety and treatment
Dr. Sigrist says using ultrasound both before and after filler injections can transform safety:
- Before treatment: Ultrasound can identify safe injection sites
- If complications occur: It allows practitioners to target the blockage precisely
Without imaging, clinicians treat “blindly,” she says, flooding large areas with the drug hyaluronidase to dissolve filler. Guided injections, however, use less medication and achieve better outcomes.
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Growing calls for regulation
The British Association of Aesthetic Plastic Surgeons (BAAPS) says ultrasound use is increasing but is not yet standard practice.
BAAPS president Nora Nugent stresses that mapping blood vessels before treatment is vital, and underscores the need for stricter regulation. The organization has long advocated for ensuring only medically qualified professionals perform injectable procedures.
The UK government has announced plans for tighter rules on aesthetic treatments. Under the proposals:
- Only “suitably qualified” healthcare professionals could perform high-risk procedures
- Clinics offering fillers and Botox would require a licence
- A public consultation will launch in early 2026, followed by parliamentary decisions