Warning over cosmetic face fillers as scans reveal new details of risks
But here’s the core issue: cosmetic filler injections can carry a serious, potentially life-changing risk when blood vessels are affected, and ongoing research is shedding new light on how to prevent it.
Experts warn that vascular occlusion—when filler is injected into or too close to arteries—can lead to tissue death, skin loss, and even blindness if not treated promptly. A recent ultrasound-based study examined 100 filler procedures that went wrong to understand how these complications occur and how to avoid them.
Clinics are now encouraged to use ultrasound planning when performing facial dermal fillers to minimize the chance of injuring nearby arteries. Lead researcher Dr. Rosa Sigrist explains that while these events are uncommon, they can be devastating and require rapid, targeted intervention to limit damage.
Dermal fillers are injectable substances used to smooth wrinkles, restore volume, or rejuvenate the face. They’re also employed to contour features such as the nose or lips. The area around the nose is especially high-risk because nasal vessels connect to critical regions of the head. Damage to these vessels can cause severe outcomes, including skin injury, vision loss, and stroke.
Dr. Sigrist’s team, based at the University of São Paulo in Brazil, analyzed vascular complications linked to fillers in 100 patients across six centers (two in Brazil, one in Colombia, one in Chile, plus dermatology and plastic surgery centers in the Netherlands and the United States) between May 2022 and April 2025. The findings will be shared at the Radiological Society of North America (RSNA) annual conference.
In nearly half of the cases, ultrasound revealed absent blood flow in small vessels that bridge superficial arteries to deeper facial networks. In about a third of cases, major vessels showed no flow. These ultrasound insights emphasize how precisely guided treatment can differ from traditional approaches.
To prevent problems, the team recommends using ultrasound to map injection sites before proceeding. If a complication does occur, ultrasound can also guide the intervention.
“If injectors aren’t guided by ultrasound, treatment often relies on clinical signs and is more of a blind approach,” Dr. Sigrist notes. “With ultrasound visualization, the exact occlusion site becomes recognizable, allowing targeted action.”
Instead of automatically flooding the area with hyaluronidase to dissolve the filler, ultrasound-guided injections can be performed with smaller amounts of hyaluronidase and yield better outcomes.
The British Association of Aesthetic Plastic Surgeons (BAAPS) reports that ultrasound use is increasing but not yet standard practice. Ultrasound is non-invasive, does not involve ionizing radiation, and has no known harmful effects. BAAPS president Nora Nugent highlights its growing usefulness across surgical and aesthetic procedures and emphasizes that mapping vessel locations provides critical information before treatment.
These risks reinforce the broader push for tighter regulation of aesthetic procedures and for restricting certain high-risk injections to medically trained professionals. In the UK, government plans propose licensing standards that allow only suitably qualified healthcare professionals to perform high-risk procedures, such as Brazilian butt lifts. Clinics offering fillers and Botox would need to meet rigorous standards to obtain a license. A public consultation is expected in early 2026 to determine the procedures covered by the new restrictions, with Parliament set to decide the final framework.
Thought-provoking takeaway: the integration of ultrasound into facial filler practice could dramatically reduce serious complications, but it also raises questions about who should perform high-risk cosmetic procedures and how readily these safeguards will be adopted across clinics. Do you think ultrasound-guided injections should become mandatory everywhere, or should regulations focus on licensing and training rather than universal imaging requirements? Share your views in the comments.
