Blindness, Stroke Among Hidden Risks of Cosmetic Fillers, Researchers Warn

Cosmetic fillers have become one of the most popular non-surgical beauty treatments, used to plump lips, smooth wrinkles and reshape facial contours. But as the number of procedures rises worldwide, researchers

are warning that the risks—including blindness, stroke and permanent tissue damage—are more serious than many people realise.Hyaluronic acid fillers, the most common type, are generally considered safe. They are gel-like substances that naturally occur in the body and help keep the skin hydrated. Yet even with experienced injectors, complications can happen because of the complex network of blood vessels running through the face.A new study presented at the Radiological Society of North America (RSNA) meeting highlights why understanding these risks matters more than ever. In 2024 alone, the United States saw more than 5.3 million hyaluronic acid filler treatments. India is also witnessing fast growth, with over 2.2 lakh injectable procedures—including fillers and Botox—performed by plastic surgeons in 2023.

What Makes Fillers Risky

One of the most dangerous complications is vascular occlusion. This occurs when filler accidentally enters or compresses a blood vessel, blocking blood flow. Without enough circulation, the surrounding skin and tissues start to die—a process called necrosis.If not treated promptly, the consequences can be disfiguring and permanent.“Vascular occlusion events in the face can be devastating. If not properly treated, they can cause necrosis and facial deformation,” warned study author Dr. Rosa Maria Silveira Sigrist from the University of São Paulo.In the most severe cases, the filler can travel through connected blood vessels. Because the arteries in the nose link to both the facial blood supply and the blood vessels serving the eye and brain, a misplaced injection can even trigger blindness or stroke.

What the Research Shows

Dr. Sigrist’s team reviewed cases from six medical centres, examining 100 patients with suspected filler-related complications using vascular ultrasound, a tool that shows real-time blood flow.They found:

• 42% had blocked blood flow in small perforator vessels
• 35% had blocked flow in major facial arteries, especially the lateral nasal artery

These findings reinforce why the nose is considered one of the highest-risk areas for fillers.

Ultrasound Could Make Fillers Safer

Currently, the standard treatment for vascular occlusion is hyaluronidase, an enzyme that dissolves hyaluronic acid. But many clinicians still inject it “blindly,” guided only by outward symptoms like skin colour changes or pain.The study argues that ultrasound can dramatically improve safety.“With ultrasound, we can target the exact location of the occlusion,” Dr. Sigrist said. “This allows us to use smaller, more precise doses of hyaluronidase and improves treatment outcomes while reducing complications.”Ultrasound can also be used before and during filler procedures to help injectors locate major arteries. This could lower the risk of accidental injection into a blood vessel and reduce the need for large filler volumes.

Why This Research Matters

The face has a far more complicated and unpredictable network of blood vessels than other parts of the body. Because these patterns vary significantly from person to person, even skilled injectors cannot always predict where complications may occur.To address this, Dr. Sigrist’s team developed a framework to help radiologists identify common ultrasound patterns associated with filler complications and recognise which arteries are involved. Their goal is to speed up diagnosis and prevent long-term injury.As cosmetic fillers continue to grow in popularity, the researchers hope their work will push clinics to adopt ultrasound as a standard part of both injecting and treating filler procedures—making beauty treatments safer and reducing the risk of life-changing harm.