Hyaluronic Acid and Vascular Complications: What Every Aesthetic Physician Should Know
Hyaluronic acid dermal fillers have revolutionized aesthetic medicine due to their safety and versatility. However, like any medical procedure, they are not free from risks—and one of the most critical is vascular occlusion.
According to Dr. Manuel Rubio, “a poorly directed injection can compromise an artery and lead to tissue necrosis or even blindness.” The good news is that with proper training, most of these complications can be prevented and treated in time.
What is a vascular occlusion caused by hyaluronic acid?
It is the blockage of blood flow in an artery or capillary due to compression or accidental injection of filler into the vessel. This prevents blood from reaching the tissue, causing ischemia and, if not treated promptly, necrosis.
High-risk vascular areas
Certain facial regions require maximum caution:
- Glabellar region (between the eyebrows)
- Nose and alar grooves
- Periorbital area
- Lips
- Nasolabial fold
- Angular artery and its branches in the midface
In these areas, mastering three-dimensional anatomy is essential to avoid complications.
Warning signs: How to detect a vascular occlusion in time
Symptoms that should immediately alert the clinician during or after injection include:
- Sudden, intense pain
- Skin color changes (pallor, livedo reticularis, purple discoloration)
- Burning or tingling sensation
- Decreased temperature in the treated area
- Loss of sensation or blurred vision (if the ocular area is affected)
Early detection is crucial to avoid irreversible damage.
Immediate action protocol
At the first suspicion of a vascular occlusion, Dr. Rubio recommends acting quickly and systematically:
- Stop injecting
- Massage the area firmly to disperse the product
- Apply moderate local heat
- Administer hyaluronidase to the affected area (high doses, multiple injections in deep and superficial planes)
- Manage pain and monitor progression
- Refer to a specialist if ocular or systemic involvement is suspected
How to prevent a vascular occlusion?
- Perform a complete facial assessment beforehand
- Inject in safe planes (subdermal or supraperiosteal)
- Use cannulas in high-risk areas when possible
- Inject slowly and with low pressure
- Aspirate before each injection to ensure you are not inside a vessel
- Never become complacent: the risk exists even in seemingly safe areas
At CIME Academy, we train you to prevent and manage complications
Our hyaluronic acid training includes:
- Clinical facial anatomy applied to fillers
- Real hands-on practice with a live model in safe areas
- Simulated aesthetic emergency scenarios
- Clinical protocols for managing occlusions and other complications
- Correct use of hyaluronidase and emergency resources
We teach you not only how to inject, but how to think clinically, make decisions, and act safely.
Want to learn how to inject hyaluronic acid with precision and confidence—even in urgent situations?
Train at CIME Academy, with expert instructors and real patients.
Location: Calle Entenza 144, 08929 Barcelona – Clínica Cime Barcelona
WhatsApp: +34 690 864 816
Email: secretaria@cimeacademy.com
