How rare is it for nose filler to block a blood vessel, and how is it avoided?

Nose filler is often thought of as a simple treatment, but the nose is one of the places on the face where blood vessels call for the most care. I’m not saying this to frighten you. Knowing how rare it is and where it happens helps you know what to ask when choosing a treatment.

If filler gets into a blood vessel or presses on it so that blood can’t flow, the skin supplied by that vessel can turn white or develop dark red blotches, and it becomes very painful. In rare cases, filler can travel back into the vessels that supply the eye, causing loss of vision.

In 2015, Canadian researchers gathered 98 cases of vision problems after filler reported worldwide up to that time. The area between the eyebrows (glabella) was the most common at 38.8%, followed by the nose at 25.5%. When the same researchers gathered 48 new cases reported in 2015–2018 in 2019, the nose had become the most common site at 56.3%, and 81.3% of the fillers involved were hyaluronic acid fillers. This seems to reflect how widely hyaluronic acid filler has come to be used, rather than it becoming especially more dangerous. These numbers include only reported cases, so we can’t tell what proportion of all treatments they represent. The researchers also described it as rare.

The problem is what happens when it does occur. Vision was fully restored in 20.8% of cases, and no treatment worked consistently. The situation is somewhat different for the skin. Hyaluronic acid filler can be dissolved with a drug (hyaluronidase), and physicians’ consensus recommendations say that results are better the sooner the early sign of the skin turning white is noticed and the more fully the dissolving drug is given. However, these recommendations concern the skin, and the same effect has not been confirmed for vision. One researcher wrote that even for experienced physicians, no area of the face carries zero risk.

That’s why I approach nose filler from the start in a way that disturbs blood vessels as little as possible. I use only as much as is needed, don’t push a large amount in at once, and avoid the paths where blood vessels run. In Nose LINE ON, I first build the structure with LSCO and add only as much filler as is lacking, because using less filler is in itself a safety measure.

If you notice any of these changes after treatment, contact the clinic that treated you right away: the skin of your nose or between your eyebrows turns white or develops a net-like blotchy pattern, pain gets worse over time, or your vision becomes blurry or you can’t see well. A vision problem is not something to wait hours on.