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 STFs 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. While the incidence of vascular compromise remains low, more cases are appearing, mainly due to the increased use of STFs and more advanced indications being performed by a greater number of practitioners worldwide [1-3]. Two main types of ischaemia are discussed in this article: retinal ischaemia (potentially leading to blindness) and peripheral ischaemia (potentially leading to tissue necrosis and scarring).