Master. Doctor Phan Ngoc Huy of Dermatology Hospital Ho Chi Minh City, speaking on the sidelines of the Southern Aesthetic Dermatology conference on 29/3, emphasized that vascular occlusion from filler injections is a rare but severe complication. As unregulated beauty procedures proliferate, this adverse event has become an alarming reality. As of 3/2023, global medical literature recorded 511 cases of blindness due to filler injections.

The facial vascular system is complex, with many small branches directly connected to the ophthalmic and cerebral arteries. Incorrect injections can introduce filler into blood vessels, causing acute occlusion, leading to tissue necrosis, permanent vision loss, or cerebral stroke.

According to Doctor Huy, the three highest-risk areas, often referred to as "death traps", are the glabella, nose, and forehead. Additionally, the nasolabial folds, periorbital area, and temples also require precise technique. Individuals with prior facial surgery, trauma, or underlying conditions like clotting disorders or autoimmune diseases face higher risks due to altered anatomical structures.

Ocular complications often manifest immediately or within the first 10 minutes post-injection. Retinal infarction can occur just 12 to 15 minutes after tissue ischemia. Consequently, the "golden hour" for salvaging vision is very narrow, optimally within the first 60 to 90 minutes. For skin, ischemia also begins quickly, rapidly progressing to necrosis and leaving permanent scars if circulation is not restored promptly.

A case of filler injection-induced vascular occlusion admitted to Dermatology Hospital Ho Chi Minh City. *Photo: Hospital provided*

Emergency attention is necessary when unusual signs appear, such as rapidly worsening and spreading pain; pale, purple, or mottled skin in the injected area due to rapid blood pooling or slow capillary refill. More dangerously, blurred vision, vision loss, double vision, drooping eyelids, facial weakness, or difficulty speaking indicate that complications have affected vision and nerves.

A dangerous mistake is to passively wait for symptoms to resolve, losing the "golden hour" and risking necrosis. If vascular occlusion is suspected, do not self-administer hot or cold compresses or massage the injected area based on anecdotal advice. Furthermore, do not return to substandard spas for "dissolving" injections, as this wastes crucial emergency time, exacerbates complications, and risks overlooking potential neurological issues. Instead, seek immediate medical attention at a hospital with a dermatology or aesthetic surgery department for prompt management.

"Many people mistakenly believe that checking the label and packaging of filler products is sufficient to ensure safety", the doctor stated. In reality, even a genuine, expensive product can lead to blindness or necrosis if injected incorrectly, in the wrong anatomical layer, or by an untrained individual.

Doctor Huy advised that filler injection is a medical procedure, not a typical spa service. It should only be performed at a legitimate medical facility by a specialized doctor, with emergency equipment readily available to manage complications.

Le Phuong