‘It’ finally happened… A scary filler complication: Vascular Occlusion

Photo: Shows the bottom lip looking pale and following the application of pressure. The skin does not return to its usual pink colour very quickly. This is a sign of a blockage in the artery.

Last week, was the week ‘it’ finally happened!

As a registered nurse working in aesthetics I cannot stress enough how important it is to choose a practitioner who is a registered nurse or doctor. Last week I got the chance to stare straight into the frightening face of aesthetics when something goes wrong!

It was a ‘normal’ Wednesday in my busy aesthetics clinic in Chesterfield, Derbyshire. I welcomed my next customer who had booked for a subtle lip enhancement using dermal fillers. Jane was a little apprehensive as she had never had a dermal filler treatment before. Whilst reassuring her, I highlighted the risks, as I always do, explaining if she wasn’t comfortable going ahead with the procedure we could reschedule for another day. Jane decided she wanted to go ahead. Following the application of numbing cream to her lip area we went ahead with the procedure. Everything was going fine, her top lip, which had significant collagen loss looked beautiful after the injections to restore and subtly plump. I was feeling really happy with the result and knew Jane would love the look of her rejuvenated lip.

I moved into volumising the lower lip. It was looking good. I carried out an injection into the middle of the lower lip and I suddenly had an alarm bell ringing in my head, ‘This does not look like it should. The lip looks pale.’ I pressed the lip and released, my immediate thoughts were, ‘oh no!’ (Actually they were something a little more like, ‘Oh s*#t!’) As the lip didn’t look pink when I released the pressure. So, now I knew I was in the middle of an aesthetic emergency. The filler I had injected into the lip had entered an artery and was starting to block the blood circulation to the lip and chin. This is something that can happen with every single dermal filler injection at any time (please be reassured it is a rare risk). However after 7 years of aesthetic nursing it was the first time this had happened to me!

I quickly explained to Jane that the rare event I had discussed with her prior to her treatment was taking place and that I needed to take prompt action to dissolve the dermal filler, ensuring that the blood supply to her lip was restored. I worked quickly using National Emergency Guidance which is available to medical professionals. Unfortunately for Jane this meant multiple injections of filler dissolvent into her lip which can be quite uncomfortable.

After an hour of injecting dissolvent, applying heat and massaging the lip colour had returned to normal and I was happy to let Jane go home with a review early the following morning. I must admit, that at this stage I was breathing a huge sigh of relief!!

I finished off in my clinic and went home. I took my dog for a run to clear my head and process what had just happened. On returning from my run I messaged Jane to ask how she was. Her response was, ‘I’m fine but my chin has veins running through it.’ This was not a good sign and could be indicative that the artery blocked with filler had not been completely cleared. Without wanting to panic Jane, who was now tucked up for the night, I firmly told her I needed to see her again that night. Jane agreed to meet me back in clinic. I must admit, when I saw her I was not encouraged by what I saw. Her lip looked pale and her chin looked strangely ‘marbled’. Back to the couch we went after explaining further dissolvent was needed! Five vials of dissolvent later and getting close to 10pm I was finally happy that Janes’ blood circulation had been fully restored. We both went home, both feeling exhausted, and glad that the past few hours were over.

I reviewed Jane the next day and following days, although a bit bruised her circulation had been fully restored and I was happy to discharge her from daily reviews.

What happened to Jane on Wednesday is something that can occur every time a dermal filler treatment takes place. Unfortunately it is one of the risks of this treatment. If, or when this happens, the blockage needs to be dealt with quickly to avoid serious complications which will occur very quickly. This emergency situation has taken 7 years to happen to me and in this time, I have carried out over a thousand dermal filler treatments.

Vascular occlusion (which is what this emergency is called) is one of the reasons I campaign for legislation to ensure dermal fillers are only ever performed by registered medical professionals. Time and time again, I advise that dermal fillers are MEDICAL procedures , they are NOT a beauty treatment. Facial injections should only EVER be carried out by registered healthcare professionals for so many reasons but the biggest reason of all is that it gives you assurance and protection from physical damage to your face and psychological damage which would follow this.

Because Jane choose me to carry out her dermal filler treatment it meant that she had a registered nurse who knew how to manage and resolve this situation efficiently and effectively.

Unfortunately I frequently hear of similar cases which are not dealt with and the patients suffer long lasting facial injury as the person injecting them does not have knowledge of vascular occlusions or how to treat them. Currently within the UK absolutely anyone can set up a business injecting fillers and Botox into your face, there is no legislation, aesthetic practice is like the Wild West.

‘Cheap fillers’ are never cheap, there will always be a risk of a bigger price to pay, if it’s cheap and looks too good to be true – give it a big swerve. When things go wrong with your treatment you need to be sure that your injector is a nurse, doctor or has a medical registration and will be with you every step of the way until the problem is resolved.

I’m pleased to say that I have now discharged Jane from her daily reviews. Her skin health is restored to normal and she is considering the next stage of her facial rejuvenation package.