soft tissue fillers

part 1:

Authors: Jani van Loghem, Pieter Siebenga and Job Thuis

vascular complications part 1: prevention

Vascular complications from the use of soft tissue fillers can be devastating. In the first of a two-part series, Jani van Loghem, Pieter Siebenga and Job Thuis discuss how to avoid these adverse events.

Keywords: vascular complications, prevention, soft tissue fillers


In the past decade, the number of aesthetic procedures with soft tissue fillers (STFs) has increased dramatically. Although the outcome profile is mostly favourable, the number of adverse events (AEs) is increasing as STF use becomes more commonplace. The vast majority of STF-associated AEs are transient and mild in intensity and need little medical intervention.


However, vascular complications are considered as one of the most severe, yet rare, complications following treatment with STFs and require immediate and appropriate medical treatment. Depending on the extent of the intravascular embolus, the clinical effect can range from asymptomatic to devastating and life changing.

Blindness is considered one of the most severe AEs after STF injections and can occur after a STFs enters one of the arterial connections between the central retinal artery and the extraorbital arteries.


Cadaver heads were injected with dye material and soft-tissue fillers at multiple aesthetic facial sites on the supraperiosteum and subsequently dissected for observation of dye and filler placement.


The non-traumatic cannula technique resulted in product being confined to the deep anatomic layers. In contrast, with the sharp needle technique, material was placed in multiple anatomic layers, from the periosteum to more superficial skin layers. For both techniques results were consistent for all facial sites.
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