Cosmetic fillers can cause deadly complications, experts warn, but new technology exposes it

More than five million cosmetic filler procedures are performed in the U.S. each year, but these injectables can potentially block key blood vessels, putting patients at risk of serious harm.

In a study presented this week at the annual meeting of the Radiological Society of North America (RSNA) in Chicago, doctors found that ultrasound technology can detect these dangerous blockages early enough to guide treatment and help prevent lasting injuries.

The researchers analyzed data from 100 patients from six different locations who experienced vascular complications after hyaluronic acid filler injections. All data was collected between May 2022 and April 2025, according to a press release.

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They found that ultrasounds successfully detected vascular occlusion, which is a blockage in a blood vessel that stops normal blood flow.

If this condition is left untreated, it can cause pain, skin damage and scarring, and in severe cases, vision loss or stroke.

“Doppler ultrasound helps doctors see exactly where the filler is, how blood is flowing in real time, and whether blood vessels may have been affected after a cosmetic procedure,” lead researcher Rosa Maria Silveira Sigrist, MD, an assistant radiologist at the University of São Paulo in Brazil, told News Digital.

“The physical examination is still very important, but ultrasound adds extra information that makes the evaluation safer and the treatment more precise.”

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In the study, more than 40% of patients had blockages in the perforating vessels, which are small connecting blood vessels, while 35% had major facial arteries that showed no blood flow.

The nasal region was identified as the highest risk area, as the lateral nasal artery runs along the side of the nose and supplies blood to larger arteries leading to the eye and brain.

“Vascular occlusion after filler injections can lead to devastating results, including skin necrosis, tissue loss, and in the worst cases, blindness and even stroke,” Dr. Anthony Berlet, a board-certified plastic surgeon in New Jersey, who was not involved in the research, told News Digital.

“Once a critical artery (for example, one that supplies the retina or skin) is occluded by a filler or embolus, the damage may be irreversible.”

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In the hands of an experienced, licensed professional using proper techniques, the risk of vascular occlusion should be less than 1%, according to Dr. Samuel Golpanian, a double-certified plastic surgeon in Beverly Hills.

“But if the fillers are performed by someone who is untrained or using incorrect needles or methods, the complication rate can be much higher: 10% to 20%, which is completely unacceptable,” Golpanian, who also did not work on the study, told News Digital.

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Ultrasound helped doctors identify the location of blockages, allowing them to place a dissolving enzyme (hyaluronidase) right where it was needed and avoid using large doses and guesswork.

The researchers suggested that using ultrasound during injection could help prevent injury to blood vessels and allow for faster, more precise treatment if blockages occur.

“Ultrasound should ideally be integrated into care in a way that supports timely decision-making, either as an immediate tool at the point of care in trained hands or to confirm and optimize management once initial salvage therapy has begun,” Dr. Asif Pirani, a board-certified cosmetic plastic surgeon in Toronto, Canada, told News Digital.

To minimize dangerous complications, Pirano (another outside expert who was not involved in the study) emphasized that injectable treatments should be performed by certified specialists with formal training in facial anatomy and complication protocols.

Limitations of the study

Some limitations of the study were noted, including the relatively small sample size (100 adults) and the fact that it has not yet been peer-reviewed.

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“Another limitation we noticed is that the Doppler examination is performed differently even among very experienced specialists,” the lead researcher told News Digital. “This shows how important it is to create clear, standardized guidelines, so that the exam can be performed in a more consistent way.”

“Once a critical artery is occluded by a filler or embolus, the damage can be irreversible.”

Additionally, all study participants experienced significant complications, meaning the findings may not apply to those with milder cases or different types of filler.

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There could also be some degree of geographic bias, as the research was conducted in Brazil, where training standards may differ from those in the US.

Future studies are needed to follow more patients for longer periods of time and track their recovery after ultrasound-guided treatment, the study noted.