Vascular Occlusion Following Dermal Filler Injections: A Systematic Review of Clinical Evidence and Emergency Management

Background/Objectives: Vascular complications associated with dermal filler injections are rare but potentially severe, particularly when ocular or neurological structures are involved. Current evidence on pathophysiology, clinical management, and prevention remains heterogeneous. This systematic review aimed to synthesize available clinical evidence on vascular occlusion related to dermal filler injections, focusing on clinical presentation, management strategies, and preventive approaches. Methods: This systematic review was conducted and reported according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (ID: CRD420261323578). PubMed/MEDLINE, Scopus, and the Cochrane Library were searched for studies published between January 2015 and February 2025. Clinical trials, observational studies, case series, and case reports describing vascular complications following facial dermal filler injections were included. Study selection and data extraction were performed independently by two reviewers. Risk of bias was assessed using RoB 2.0 for randomized trials, the Newcastle–Ottawa Scale for observational studies, and Joanna Briggs Institute checklists for case reports and case series. Due to methodological heterogeneity, results were synthesized qualitatively. Results: A total of 1922 records were identified, and 91 studies met the inclusion criteria. Vascular complications were primarily related to intravascular embolization or external vascular compression. Hyaluronic acid fillers accounted for most reported events and were associated with more favorable outcomes owing to enzymatic reversibility with hyaluronidase. Cutaneous ischemia represented the most frequent complication and generally resolved with early high-dose hyaluronidase administration, whereas ocular and neurological events were less common but frequently resulted in permanent deficits. Imaging-guided approaches, particularly ultrasound-assisted techniques, emerged as promising tools for both prevention and targeted management. Conclusions: Vascular occlusion following dermal filler injections represents a time-critical clinical emergency requiring prompt recognition and intervention. The available evidence supports a time-dependent therapeutic model in which early treatment appears to improve cutaneous outcomes, whereas ocular complications remain associated with poor prognosis despite aggressive rescue strategies. Complications related to non-hyaluronic or permanent fillers and autologous fat appear to be associated with more limited therapeutic options and a higher risk of irreversible damage. The certainty of evidence is limited by heterogeneity of study designs and the predominance of descriptive and observational reports.