Your next trip to smooth out crow’s feet or fill in smile lines could look a little different.
Experts are urging clinics to perform ultrasounds before injecting cosmetic fillers into patients’ faces — a step they say could make the popular procedure safer and more precise.
The push follows new research raising concerns about a rare but serious complication linked to the treatment that can lead to skin loss, blindness or even stroke.
The dangerous risk, called vascular occlusion, happens when dermal filler material like hyaluronic acid blocks blood flow in the arteries.
Most of the time, the effects are minor, like redness or bruising. But in severe cases, things can escalate quickly, according to the American Board of Facial Cosmetic Surgery.
“Vascular occlusion events in the face can be devastating, because, if they’re not properly treated, they can cause necrosis and even facial deformation,” Dr. Rosa Maria Silveira Sigrist, an attending radiologist at the University of São Paulo in Brazil, said in a statement.
Sigrist recently led a global study looking at filler-related vascular complications in 100 patients across six clinics — including radiology, dermatology and plastic surgery facilities — between May 2022 and April 2025.
Using ultrasounds, the researchers found that 42% of patients had no blood flow in their perforator vessels, which connect the surface arteries of the face to deeper ones.
In about one-third of cases, the main blood vessels had no blood flow, a problem closely linked to the lateral nasal artery in the nose.
The nose is particularly tricky for injections, Sigrist explained, because its blood vessels connect to the main facial arteries and to the arteries leading to the eye. When something goes wrong, blindness or stroke can occur.
To treat vascular occlusion from fillers, clinicians often inject hyaluronidase, an enzyme that dissolves hyaluronic acid.
Looking ahead, Sigrist recommends using ultrasounds during this procedure.
“If injectors are not guided by ultrasound, they treat based on where the clinical findings are and inject blindly,” she said. “But if we can see the ultrasound finding, we can target the exact place where the occlusion occurs.”
“Rather than flooding the area with hyaluronidase, we can do guided injections that use less hyaluronidase and provide better treatment results,” she added.
Sigrist also noted that ultrasounds can be used to guide the cosmetic filler injections themselves, helping injectors place the gel-like substance more precisely. This means less filler is needed and the risk of complications is lower from the start.
The timing couldn’t be more relevant.
Cosmetic fillers have exploded in popularity in recent years, with over 5.3 million Americans using hyaluronic acid fillers in 2024 alone, according to the American Society of Plastic Surgeons.
Fans praise the injections for their ability to instantly boost facial volume, smooth wrinkles and create a more radiant look without surgery.
Serious adverse events, like vascular occlusion, are rare. One clinical review found that less than 0.05% of cosmetic injections resulted in any degree of vascular blockage. Most of these cases were minor and resolved without lasting effects.
Former “Shahs of Sunset” cast member Lilly Ghalichi wasn’t so lucky.
Within hours of receiving a small amount of under-eye filler in 2021, the reality TV star’s skin turned red and darkened. At first, it looked like a bruise, but it quickly worsened.
Ghalichi was rushed to the hospital, where doctors injected her with hyaluronidase to restore blood flow to the area and prevent permanent damage.
“After over 1,200 units of dissolving solution, 24 hours of no sleep and endless doctors I can’t thank enough that helped me, I’m so lucky to say they dissolved the filler stuck in my blood vessel,” she wrote in an Instagram story, documenting the ordeal.
Even after such a frightening experience, Ghalichi admitted she might consider fillers again in the future.
“It’s hard doing what I do for a living, the pressure, unrealistic expectations of beauty, aging as a woman in general,” she wrote. “I’m not sure how I’ll feel 5 years from now to say ‘never’ right now.”
