Signs of skin necrosis after filler injection

Dr. CKI Be Thu Thuy, Department of Aesthetics, Tam Anh General Hospital, Hanoi, said that filler injection is a minimally invasive beauty method, reducing sunken areas, creating contours and rejuvenating the face quickly and safely. However, this method still has the potential for complications, the most serious being tissue necrosis, which can leave scars, cause loss of aesthetics, and even affect the function of important areas of the face.

Dr. Thuy explained that necrosis is mainly due to filler accidentally entering the blood vessel or compressing the vessel, blocking the blood flow that provides oxygen and nutrients to nourish the tissue. This condition occurs when filler is injected into the wrong blood vessel or injected in too much volume, causing the filler to compress the vessel. Areas with a complex vascular system such as the nose, nasolabial folds, lips, and areas around the eyes are easily at risk.

Wrong layer injection technique, rough needle use, rapid injection, lack of aspiration check, and failure to control the direction of needle movement also increase the risk of embolism. Some other factors such as using poor quality filler, injecting at an unqualified facility, performing it in non-sterile conditions or the injector not understanding facial anatomy can all lead to necrosis. At this time, the patient will have the following symptoms.

Reduced sensation on the skin

This is an early sign of filler entering the blood vessels, blocking blood circulation or compressing nerves in the injected skin area. The injector may feel numbness, tingling or a marked decrease in sensation when touching the injected skin area compared to surrounding areas.

The injection site is red and swollen for a long time

Swelling and redness are normal reactions after filler injection in the first 24-48 hours. However, if the skin area continues to swell, redness, and burning do not subside after 2-3 days, it is an abnormal warning sign. The redness can spread along the blood vessels and gradually turn purple due to lack of oxygen in the tissue, signaling necrosis.

Severe and prolonged pain

Dr. Thuy said that injecting filler with proper technique only causes a slight stinging sensation and a slight tightness for a short time. But if after injection, the pain gradually increases and deepens with each pulse, this is an abnormal sign. If the pain persists, does not respond to painkillers, and is accompanied by a feeling of stiffness, cold skin or numbness at the injection area, it may be a sign of a blood clot. Patients should not wait for the pain to subside but should immediately go to a medical facility.

Skin discoloration

Changes in skin color are characteristic signs of tissue necrosis. When blood flow is obstructed, the skin initially becomes pale and colder than the surrounding area. After that, the skin gradually turns purple-blue or dark red in a mesh pattern. This is the stage of severe tissue ischemia, if not promptly intervened, tissue will begin to die. Areas with a rich vascular network such as the nose, nasolabial folds, and lips often show the most obvious discoloration.

The injection area has ulcers

This is a late sign and also the clearest evidence of necrosis after filler injection. When the tissue dies, deep ulcers begin to appear on the skin’s surface, blisters containing yellow fluid or blood, causing pain and burning. These lesions can spread quickly and cause severe infections, which can leave permanent scars despite aggressive treatment.

Headache, blurred vision

In some cases, systemic symptoms may appear such as headache, dizziness, nausea or blurred vision. The condition often occurs when filler enters important blood vessels around the eyes or brain. If not treated immediately, the patient may face the risk of permanent vision loss.

To prevent necrosis when injecting fillers, Dr. Thuy advises people to choose a reputable facility, well-trained doctors, medical-standard sterile injection procedures, and filler products of clear origin. At the same time, beauticians need to be examined carefully before injecting, avoiding injections in areas that are too dangerous or have a history of complications.

After injection, you should monitor closely for the first few hours and follow proper care instructions. Pay attention to the signs that appear early in the first 24 hours, because this is the “golden time” to intervene and reverse tissue anemia, according to Dr. Thuy. When any unusual symptoms appear, you should immediately go to a medical facility to be evaluated by a qualified doctor and come up with an appropriate treatment regimen. If delayed, it can cause tissue necrosis to spread, causing scarring that is difficult to treat and requires surgical intervention.