POSTED: 20 Jul 2023

What You Should Know About Vascular Occlusion with Lip Filler & How to Avoid It

Understanding the risks associated with any aesthetic treatment is critical but especially when the treatment is on your face. Amongst these risks, vascular occlusion due to dermal fillers is the most serious but thankfully relatively rare if performed correctly. The lips are particularly vulnerable to vascular occlusion with lip fillers. This post aims to provide a comprehensive guide on vascular occlusion caused by lip fillers, how to identify it, treat it and steps you can take to prevent it from happening in the first place.

What is Vascular Occlusion?

Vascular occlusion occurs when a blood vessel is blocked usually by a foreign substance. In the context of dermal fillers, it can occur if the filler is accidentally injected into a blood vessel or if a deposit of filler compresses an underlying blood vessel. Both these scenarios can obstruct blood flow in that area. The lips are particularly at risk due to the dense network of blood vessels within them.

Why is Vascular Occlusion Important?

If left untreated, vascular occlusion can lead to necrosis and tissue death. This can cause skin discolouration and permanent scarring. In rare cases, if the filler is injected in the blood vessel it can migrate up the vasculature and block the vessels that supply the eyes which would cause blindness. It is, therefore, important to take every measure possible to reduce the risk of vascular occlusion. If despite this, occlusion occurs, it is critical that your practitioner identifies and treats vascular occlusion promptly. This early intervention can prevent all these complications.

How does Vascular Occlusion Happen with Lip Fillers?

As mentioned above, vascular occlusion occurs if filler is accidentally injected into a blood vessel or a large deposit of filler compresses a blood vessel underneath. This obstructs blood flow. If it happens in the lips, this suffocates the blood supply to a portion or all of the lip and even surrounding skin. Should vascular occlusion due to lip filler be allowed to progress, the end result is death of the skin and potentially underling muscle and fat in the lips. This can then lead to asymmetry, scarring and skin discolouration. Essentially, if untreated, there can be permanent lip disfigurement.

Signs to Look For

Knowing the signs of vascular occlusion can help in early detection and treatment. This will reduce the risk of tissue death and permanent scarring. Your practitioner will educate you on the signs to look for that might suggest a vascular occlusion. A good aesthetic practitioner will have a low bar for suspecting this and arrange to see you quickly if there’s even the slightest concern. These signs can appear immediately after the treatment or within 24 hours:

  • Intense pain not in line with what you should expect to experience with lip fillers.
  • Blanching (whitening), duskiness or discolouration of the skin.
  • Changes in skin texture such as thickening or firmness.
  • Abnormal swelling (beyond what you should expect)
  • Delayed swelling or bruising more than what is normal for lip fillers.
  • Lips feel cold to touch.

The above signs can affect just a small portion of the lip, all the lip or the skin near the lips. If left unattended, then you can get additional signs like bleeding, numbness, blistering and crustiness which are later signs of vascular occlusion when the tissue necrosis has occurred.

How to Diagnose Vascular Occlusion

Vascular occlusion is primarily diagnosed through physical examination. This normally involves checking the capillary refill time of the lips to give an idea of blood supply, the colour, temperature and firmness of the lips. Your practitioner will also look to distinguish between whether your symptoms are due to vascular occlusion, infection, allergy or if it is just extreme bruising or swelling. Again, any medical professional will have a low bar for suspecting vascular occlusion after lip filler so they may decide to treat if even a small concern.

Vascular Occlusion Treatments

As soon as vascular occlusion is suspected, it needs to be treated as a medical emergency. That means treatment should begin immediately. The main treatment is hyaluronidase injection which is a prescription only medicine and can only be provided by a medical practitioner. This is an enzyme that breaks down hyaluronic acid. When injected into the treated area, it dissolves all of the lip filler. There is initially a lot of swelling with hyaluronidase injection and there can be some bruising. Additional treatments might include warm compresses, massaging the area, and medications like aspirin and glyceryl trinitrate to improve blood flow. Your practitioner will monitor you for several hours to see if there’s any improvement. They will then monitor you for the next few days and weeks to see how you’re progressing and may do additional dissolving of needed.

If you have a severe case of vascular occlusion after lip fillers or if you presented late, then you might need further intervention. This medical intervention can include invasive procedures, medication and even surgery.

Vascular Occlusion beyond the Lips

Though lip fillers have a higher risk of vascular occlusion due to the dense blood vessel network, it can occur with any dermal filler injection. Areas such as the forehead, nose and around the eyes also pose a significant risk due to their closeness to crucial blood vessels that supply the eyes and brain. Dermal filler migrating along these vessels can have catastrophic consequences such as blindness.

How to Avoid Lip Filler Vascular Occlusion

The only way to reduce the risk of vascular occlusion is thorough understanding of skin anatomy, the appropriate products and the correct techniques. This is why you should only see a qualified and experienced medical aesthetic injector. They will also be knowledgeable about identifying early signs that could suggest vascular occlusion and manage these straight away. You should also follow the aftercare advice provided by your practitioner and contact them immediately if you have any concerns.

Lip fillers are a greta way to refresh and enhance your lips. If done correctly, this is a quick and effective treatment. However, you should understand the serious risks of dermal fillers such as vascular occlusion. This will not only help you make informed decisions about whether lip fillers are right for you, finding a qualified and experienced practitioner and seeking help early should there be any worrying signs. Although this is a rare complication, its consequences can be severe. As such, awareness and prompt action are key to managing this risk effectively.

Regardless of whether you choose to have Botox or fillers, don’t forget that great skin comes first! Explore our our online skin clinic if you are interested in prescription-strength skincare for acneskin ageinghyperpigmentation and melasma. Book a virtual consultation with us today and let our doctors create a personalised treatment plan for you.


Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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