Risk Factor Analysis for Vascular Occlusions After Dermal Filler Injections: A Systematic Review and Meta-Analysis.

Abstract

This systematic review and meta-analysis investigate the risk factors associated with vascular occlusions following dermal filler injections, a rare but serious complication in aesthetic medicine. Fourteen studies involving various filler materials and injection sites were analyzed to identify patient and procedural variables influencing clinical outcomes. The most frequently used filler was hyaluronic acid (HA) (61.3%), and most complications occurred in female patients (71%). Anatomical regions with complex vasculature, such as the glabella, nose, and nasolabial folds, were most commonly implicated. Recovery outcomes were significantly influenced by the specific vessels involved, with occlusions in smaller arteries showing a better prognosis. Timely recognition and intervention were associated with improved recovery, with delays beyond five days correlating with permanent deficits. Hyaluronidase use in HA-related occlusions yielded high partial or total recovery rates with an 84.2% success rate, reaffirming its role as a first-line treatment. Based on the analysis, a morbidity risk assessment tool was developed to stratify patients into low-, moderate-, and high-risk categories, offering practical value for clinical decision-making. The findings underscore the importance of anatomical precision, prompt intervention, and standardized treatment protocols.