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Experience and Management of Intravascular Injection with Facial Fillers: Results of a Multinational Survey of Experienced Injectors

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  • Non-Surgical Aesthetic
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Intravascular injection leading to skin necrosis or blindness is the most serious complication of facial injection with fillers. It may be underreported and the outcome of cases are unclear. Early recognitions of the symptoms and signs may facilitate prompt treatment if it does occur avoiding the potential sequelae of intravascular injection.


To determine the frequency of intravascular injection among experienced injectors, the outcomes of these intravascular events, and the management strategies.


An internet-based survey was sent to 127 injectors worldwide who act as trainers for dermal fillers globally.


Of the 52 respondents from 16 countries, 71 % had ≥11 years of injection experience, and 62 % reported one or more intravascular injections. The most frequent initial signs were minor livedo (63 % of cases), pallor (41 %), and symptoms of pain (37 %). Mildness/absence of pain was a feature of 47 % of events. Hyaluronidase (5 to >500 U) was used immediately on diagnosis to treat 86 % of cases. The most commonly affected areas were the nasolabial fold and nose (39 % each). Of all the cases, only 7 % suffered moderate scarring requiring surface treatments. Uneventful healing was the usual outcome, with 86 % being resolved within 14 days.


Intravascular injection with fillers can occur even at the hands of experienced injectors. It may not be always associated with immediate pain or other classical symptoms and signs. Prompt effective management leads to favorable outcomes, and will prevent catastrophic consequences such as skin necrosis. Intravascular injection leading to blindness may not be salvageable and needs further study.

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No funding was asked or received, editorial support was provided. No other commercial involvement or reimbursement. Dr. Greg Goodman has received honoraria for delivering lectures and sits on advisory boards for Allergan, Galderma, Merz, Leo Pharma and is a faculty member of Allergan, Dr. Stefania Roberts is a faculty member of Allergan, Dr. Peter Callan is a consultant, clinical investigator and faculty member for Allergan.

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Correspondence to Greg J. Goodman.

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Goodman, G.J., Roberts, S. & Callan, P. Experience and Management of Intravascular Injection with Facial Fillers: Results of a Multinational Survey of Experienced Injectors. Aesth Plast Surg 40, 549–555 (2016).

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