Vascular occlusion
If an artery is accidentally blocked during filler injection, the skin area supplied by that artery is deprived of oxygen. Early signs: unexpected severe pain, pale or purple skin, bluish net-like veins ("livedo reticularis"), symptoms beyond the injection site. Skin necrosis can develop within hours; skin loss occurs within 48 hours.
Emergency management: high-dose hyaluronidase enzyme (the enzyme that dissolves HA filler) is injected into the affected area and along the course of the vessel. Warm compress, aspirin, nitroglycerin ointment, sometimes hyperbaric oxygen. The patient may require immediate referral to a hospital.
Attention:Hyaluronidase enzyme should be immediately accessible in every aesthetic clinic. The understanding of "it will be brought if needed" is unacceptable. Patients can ask about this point when choosing a clinic — professional clinics provide clear answers to this question.
Filler nodules and granulomas
Nodule: a visible or palpable lump resulting from uneven distribution or clumping of the filler. Usually noticed immediately after injection or within weeks. Treatment: massage, sometimes dissolution with hyaluronidase.
Granuloma: a delayed inflammatory reaction of the body to the filler; can appear months or even years later. Steroid injection, 5-FU, sometimes surgical excision may be required.
Botox complications
Ptosis (eyelid drooping): due to involvement of the levator palpebrae muscle. This is a temporary condition lasting 2-4 weeks. Treatment: apraclonidine drops (Iopidine) lift the lid.
Asymmetry: incorrect dose or wrong injection point. Usually correctable with a supplementary injection after 2 weeks.
Headache: common after the first session but resolves within 48 hours. If persistent, other causes should be investigated.
Warning signs for the patient (requiring urgent intervention)
- Unexpected severe pain after injection
- Dramatic change in skin color (purple, pale, net-like veins)
- Vision disturbance, double vision, pain
- Severe facial burning or loss of sensation
- Difficulty breathing (allergic reaction)
- Progressive redness + fever at the procedure site