A Procedural Approach to Minimize the Risk of Embolization of Blood Vessels with Soft-Tissue Fillers

Background: Soft-tissue filler injections are amongst the most widely used treatments in nonsurgical facial rejuvenation. Although generally deemed safe, rare catastrophic side effects are regularly reported in the literature, the most devastating of which is irreversible blindness. The avoidance of these serious vascular events is of the utmost importance during soft tissue filler injections. Objective: This article suggests a procedural protocol to greatly minimize the risk of embolization of blood vessels with soft-tissue fillers. Discussion: Extensive cadaver studies have shown significant inter-individual and intra-individual variations in vascular anatomy. Hence, detailed knowledge of anatomy, albeit very important, is not always sufficient to prevent the accidental cannulation of major arteries. Furthermore, the recent inclusion of xylocaine, a known vasodilator, in several proprietary filler substances, may increase the probability of intravascular injection. Hence, avoidance remains the single most important factor in preventing the dire outcomes of vascular complications with filler substances. Conclusion: The outlined treatment recommendation, if diligently followed, may greatly minimize the risk of intraluminal injection with soft-tissue fillers.