How to avoid arteries when injecting fillers?

Author: Jamison Vandervort  |  Last update: Tuesday, August 5, 2025

Prevent vascular occlusion by choosing an ABFCS surgeon
  1. Use a cannula vs a needle. An ABFCS surgeon will understand that a blunt-tip cannula will spread filler out more evenly beneath the skin and reduce the risk of injection into an artery or blood vessel. ...
  2. Aspirate their cannula. ...
  3. Avoid deep bolus injections.

How to avoid injecting fillers into blood vessels?

The best strategy for prevention is avoiding the “danger zones,” especially in the glabellar, forehead, and upper nasal labial fold areas. If vision loss is suspected, the client must make an emergency visit to an ophthalmolo- gist.

What happens if filler is injected into an artery?

Accidental intra-arterial filler injection may cause significant tissue injury and necrosis.

Where is the safest place to inject fillers?

Infraorbital Foramen (Nasolabial)

Injecting above the infraorbital foramen, i.e., superficially, in the fatty tissue is considered safer. To safely inject in this area, consider marking out your patient so you can establish your known anatomy and then you can avoid the area of the infraorbital foramen.

How rare is vascular occlusion from fillers?

A proper calculation on the risk of vascular occlusion has, to our knowledge, never been performed because odds are low and total numbers of injections are generally unknown. In medical literature, frequencies of vascular adverse events (VAEs) are not detailed but estimated to be 1:2000 to 1:10,000 (0.05–0.01%).

Lip Injection Techniques to Avoid the Arteries | Vertical or Horizontal?

How do you know if a filler hits an artery?

Bruising may occur if an artery or blood vessel has become blocked due to filler injection. Bruising may range from a blue discoloration to a dusky purple-grey appearance. Swelling is likely to occur in and around the injection site if vascular obstruction is present, and may range from mild to severe.

What are the early signs of vascular occlusion?

Early signs of vascular occlusion include pain, pale skin or white blanching after filler and prolonged capillary refill. These symptoms are commonly seen within minutes to an hour of an occlusion occurring. Later signs of an occlusion are perishingly cold skin and purple mottling or livedo reticularis.

What is the danger zone for fillers?

The most common dermal filler danger zones are the following: Glabellar region (just above the nose and between the eyebrows) Temporal fossa (area around the temples bordered by the outer eye socket, upper cheekbone, hairline, and forehead) Infraorbital region (malar cheek fat pad, located right under the eye sockets)

What are the high risk areas for vascular occlusion?

Evidence dictates that there are two main areas on the face that have a higher incidence of vascular occlusion following soft tissue augmentation with filler: the glabellar region and the nasolabial fold, nasal tip, and alar triangle.

What are the riskiest places for fillers?

Common danger zones include the glabellar region, temporal fossa, infraorbital region, perioral region, lips, oral commissure, nasal area, and areas with major arteries like the supratrochlear, supraorbital, infraorbital foramen, mental foramen, facial artery, and deep temporal arteries.

How do injectors avoid vascular occlusion?

How do you reduce the severity of a vascular occlusion? This is largely about reducing the amount of filler that gets injected into the wrong place during treatment. Separating out the volumes as you inject, into small aliquots at a time allows you time to validate that there is no VO in between each injection.

Can filler travel to the brain?

The arteries of the face are thin. If larger volumes of filler is injected into one of them it can travel quite a distance, sometimes to the artery that supplies oxygen to the retina in the back of the eye. And if it does reach the back of the eye it is only a few more millimetres to the brain.

How long does it take to get vascular occlusion after fillers?

If you have a vascular occlusion after a dermal filler, you could experience symptoms 12 to 24 hours after your filler procedure. Vascular occlusion is a serious condition that needs medical treatment immediately.

How do you prevent an artery from injecting?

You can avoid hitting an artery by:
  1. Never injecting where you feel a pulse.
  2. Injecting only into surface veins and not trying to hit those that lie deeper.

What are the first signs of impending necrosis?

SIGNS AND SYMPTOMS OF NECROSIS
  • Pain. 2,3,5,6,7 Severe pain is usually experienced by the patient when necrosis ensues. ...
  • Prolonged blanching. 2,3,5,7 When the vasculature is affected, the area will often initially look very pale, white, or dusky due to the reduction in blood supply. ...
  • Dusky, purple discoloration. ...
  • Coolness.

Can filler migrate into an artery?

The backflow of substances from the injection area into the internal carotid artery and small facial arteries occurs due to pressure and the vascular network, leading to complications such as ocular and cerebral infarction, skin ischaemia and necrosis7 (Fig.

What happens if filler hits an artery?

Background: Vascular occlusion during the injection of facial fillers is uncommon, but can result in serious adverse events, including necrosis, blindness, and stroke.

What are the safest areas for fillers?

In the lower two-thirds of the nasolabial fold, injections into the deep dermal and superficial subcutaneous plane are generally safe because most of the facial artery course lies beneath muscle and/or above it but in deeper planes; however, in the upper one-third, the artery can become very superficial.

Which fillers are not reversible?

The other chin fillers including PMMA, Polylactic acid and Calcium hydroxylapatite are not reversible – they cannot be removed.

Who should not get fillers?

You shouldn't get cheek filler if you are pregnant or breastfeeding, or if you have:
  • Allergies to synthetic substances found in some dermal fillers.
  • A bleeding disorder such as hemophilia or thalassemia.
  • Certain autoimmune conditions.

How do you inject filler safely?

The most popular technique is retrograde linear threads which are created when the filler is injected whilst withdrawing the needle. Linear techniques are quite precise. This is key, for example, if augmenting the vermillion border and lip body or superficial dermal lines with crosslinked skin boosters.

When is it too late for fillers?

There's no wrong or right age to start your dermal filler journey, as long as you're a healthy adult of course. Many men and women in their 60s and beyond can benefit from dermal fillers, especially ones like Sculptra that stimulate your collagen for improvement in your skin at its core.

What are the red flags after fillers?

As with any medical procedure, there are risks involved with the use of dermal fillers. Most side effects associated with dermal fillers, such as swelling and bruising occur shortly after injection and many resolve in a few days to weeks. In some cases, side effects may emerge weeks, months, or years later.

How do you know if filler is blocking a blood vessel?

Vascular occlusion warning signs (2): pallor

After the initial injection, the next sign of a problem with a VO is usually pallor. In the case of a true, complete vascular occlusion, pallor is very stark, particularly in lips. There will be a grey patch on the lip that sometimes has zero capillary refill.

How long after fillers does necrosis occur?

The symptoms of ischemia can occur immediately after the injection or several hours after the procedure. Here, the authors report three cases of necrosis after hyaluronic acid injection with the first symptoms presenting only several hours after the procedure.

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