Most filler treatments pass without incident. This article is not an argument that they are dangerous. It is an argument that the questions about complications should be asked before treatment, because at the moment a complication occurs the answers are already fixed and you will have no ability to change them.
The common and self limiting
Bruising, swelling, tenderness and small lumps are common after injectable treatment and usually settle. Slight asymmetry in the early days is normal while swelling is uneven. None of this is what this article is about, and a practitioner should have explained all of it as expected rather than as a complication.
Vascular occlusion, the one that matters
Filler can enter an artery directly, or compress one from outside. Either interrupts blood supply to the tissue that artery serves. If it is not relieved, the tissue can die. In the areas around the nose, the glabella and the periorbital region, the vascular anatomy connects in ways that mean product can travel, and visual loss, though rare, is a documented and catastrophic complication.
The features are typically immediate or early pain that is disproportionate, blanching of the skin, then a dusky or mottled discolouration in a pattern that follows the territory of a vessel rather than the shape of a bruise. Any visual symptom during or after injection is an emergency.
What determines the outcome is time. Recognition within minutes, and treatment immediately, is a different situation from recognition the following day.
What you are entitled to at this stage
- A discussion of serious complications and their management before you consent, not a list read out afterwards.
- To know the product used, its type and whether it can be dissolved.
- To a named contact and a realistic response time for out of hours problems.
- Urgent NHS care for a complication regardless of where the treatment took place.
- To report a device related incident to the MHRA through the Yellow Card scheme.
Any visual symptom during or after filler injection is an emergency. Do not wait for a clinic to call back.
Hyaluronidase, and the regulatory knot
For hyaluronic acid fillers, hyaluronidase is the enzyme used to break down the product, including in the management of a suspected occlusion. It is a prescription only medicine.
That creates the knot at the centre of this sector. An injector who is not a prescriber cannot simply keep it in a drawer for emergencies. They need a lawful route to having it available when needed, and arranging that requires forethought, a prescriber relationship and money. Some practices have it. Others intend to obtain it if the situation arises, which is not the same thing and does not work at the speed required.
So the question has three parts, and all three are necessary. Is hyaluronidase on the premises now. Are you trained to use it in the management of an occlusion. Are you insured to do so. A yes to the first and a no to either of the others is not a complete answer.
We can get hyaluronidase if we need it. In a vascular occlusion, obtaining a prescription only medicine after the event is a delay measured in hours, in a situation where the relevant unit is minutes.
Fillers that cannot be dissolved
Hyaluronidase does nothing for fillers that are not hyaluronic acid. Semi permanent and permanent products cannot be dissolved, and problems with them may require surgical intervention or may not be fully correctable at all.
This is a material difference in risk that should be part of the consultation. Ask which product is being used and whether it is reversible, and treat any vagueness as significant. See what can be reversed and what cannot.
Delayed complications
Not everything appears immediately. Delayed onset nodules, inflammatory reactions and infections can present weeks or months after treatment, sometimes triggered by an unrelated illness or another procedure. Biofilm and low grade infection are recognised phenomena in this field.
The practical implications are two. First, a practitioner should be contactable and willing to see you long after the treatment, not just during the first fortnight. Second, tell any clinician treating you later that you have had filler and where, because a delayed nodule can be mistaken for something else entirely.
Who is actually able to treat a complication
In the best case, the treating practitioner recognises it immediately and manages it, because they know exactly what was injected and where. That is why contacting them first is usually right.
Where they cannot be reached, or where the response is inadequate, NHS emergency services are the route, and for any visual symptom that is the route regardless. It is worth understanding that an emergency department may not routinely hold hyaluronidase and may not have practitioners experienced in filler complications, which is precisely why the question about on site availability matters so much before treatment.
Take the product details with you. A clinician who knows the product, the volume and the site can act faster than one working from a description.
How to ask without sounding alarmed
Ask it as a process question. What is your protocol if there is a vascular event. A competent practice answers with a sequence: stop, assess, hyaluronidase, warm compress, massage, aspirin considerations, repeated dosing, escalation criteria and referral. The specifics are clinical, and you are not assessing them. You are assessing whether a protocol exists and is at their fingertips.
A practice that has one will tell you about it at length. A practice that has not thought about it will tell you that complications do not happen with their technique.