The skin turns white and hurts
Signs of vessel blockage: whitening, reticulated purple pattern, gray-bluish tint, color slowly returns after pressing. In a few days, blisters appear, and then the area dies.
Skin necrosis after surgery
CONDITION / FACE
Consequences of fillers and biopolymers.
Complications after fillers are rare, but there are two types. Acute - vessel blockage immediately after the injection: the skin turns white, hurts, vision may deteriorate; this is an emergency. Late - compaction, granulomas, displacement of the filler and deformations of the lips or face, sometimes years later, especially after silicone and other "biopolymers".
CONCEPTUAL VISUALIZATION- What it is
- Problems after injections of gels in the face or lips — from seals to blockage of a vessel.
- How common
- Serious complications are rare; most reactions are mild and transient.
- The most dangerous
- Blockage of a vessel: dying of the skin, blindness, stroke. Pain and whitening of the skin after the injection is urgent.
- It's late
- Densities and granulomas can appear years later, especially after permanent fillers.
01 / WHAT IS ITWhat is
What is
effects of fillers.
Fillers are gels that are injected to fill wrinkles or add volume to the lips, cheeks, and chin. The most common are based on hyaluronic acid: they gradually dissolve, and complications from them are usually treated with the enzyme hyaluronidase, which dissolves the gel.
Other substances in tissues are not absorbed or are absorbed very slowly: liquid silicone, polyacrylamide gel, PMMA (polymethyl methacrylate). They are often called "biopolymers" or permanent fillers. They give more long-term complications, and it is impossible to dissolve them.
Most reactions after fillers are mild and temporary: swelling, bruising. Serious complications are rare. Early ones appear during the injection or in the first hours: vessel blockage, inflammation, incorrect placement of the filler. Late - after months or years: nodules, granulomas, skin discoloration.
Seals from permanent fillers can appear many years after the injection. Doctors far from aesthetic medicine do not always associate them with old injections, so tell your doctor about any fillers, even if they were injected a long time ago.
This page is about gels and solids. Complications after injecting your own fat are described on a separate page.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat can
What can
go wrong
Acute symptoms appear during the injection or in the first hours, late symptoms appear after months or years.
Vision
The most common signs when the filler has entered the vessels of the eye are sudden loss of vision and pain.
Seals and nodules
Hard "balls" under the skin or in the lips. In a review of 66 cases, lip nodules appeared an average of 35.2 months, or 2.9 years, after the injection.
Granulomas
Inflammatory reaction of the body to a foreign substance. A foreign body granuloma was found in most of the examined nodules of the lips; silicone was most often described in such cases.
Moving the filler
The gel is displaced from the injection site. In a systematic review of late complications under the eyes, migration occurred in 7.7% of cases.
Edema and skin color
Prolonged or repeated swelling, change in skin color. Edema under the eyes is the most common late complication (42.3% of cases in the review).
Deformation
Lips or cheeks are uneven, asymmetrical, unnatural in appearance. It is the lips that show the consequences of failed injections the most.
Lip defects and deformations after injuries, bites, removal of tumors (reconstructive cheiloplasty)03 / REASONSWhy do they arise?
Why do they arise?
complications
According to reviews, the main thing is the injection site, the technique and the type of substance, not just the amount of filler injected.
Filler in the vessel
If the gel accidentally enters an artery, it clogs it, and tissues without a blood supply are damaged and die.
Dangerous areas
The most severe complications are described after injections in the nose, between the eyebrows and the forehead. Among the 98 described cases of vision impairment, 38.8% — after injections between the eyebrows, 25.5% — in the nasal area.
Permanent substance
Permanent fillers carry a higher long-term risk. Among the late complications of semi-permanent fillers such as PMMA, under-eye swelling and nodules predominated.
Inflammatory reaction
Delayed inflammatory reactions to hyaluronic acid are rare: 1.1% per year in prospective studies.
Infection
Among the complications for which experts give separate recommendations are infections and biofilm, that is, the accumulation of bacteria on the surface of the filler.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Old seals, granulomas, displacement of the filler or deformations that do not hurt and are not inflamed are a planned situation, they usually do not require emergency care. Another thing is acute vessel blockage: if the skin turns white, blue and painful during the injection or in the first hours, help is needed immediately, because treatment in the first 4-6 hours significantly improves the prognosis. Visual disturbances or signs of a stroke after the injection - call 103.
103 immediately if:
- suddenly stopped seeing in one or both eyes;
- sudden blurred vision during or immediately after the injection;
- severe pain in the eye suddenly appeared;
- sudden double vision during or immediately after the injection;
- the face suddenly turned to one side;
- sudden weakness or numbness of an arm or leg on one side;
- speech was suddenly disrupted;
- confusion or loss of consciousness;
- sudden severe headache.
Do not delay:
Immediately, without waiting: the skin at the injection site has turned white, blue, a reticulated purple pattern or severe pain has appeared - to the doctor who injected the filler, and if this is not possible - to the reception department. On the same day: the area hurts, is hot and swollen - an infection is possible. If this is accompanied by a very high temperature or chills, frequent heartbeat or breathing, confusion - immediately go to the reception department or call 103. In the coming days: new swelling or painful thickening where the filler was once injected, even years later. Planned: old seals, granulomas, displacement of the filler, deformations of the lips or face.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Conversation
What, when and where was administered; the name of the drug, if known. Whether it can be dissolved depends on whether it is hyaluronic acid.
- Review
The doctor evaluates the shape of the lips and face, feels the seal, looks at the skin and signs of inflammation.
- Ultrasound or MRI if necessary
They help to see where the substance lies and how much of it is important if removal is planned.
- Tissue analysis as needed
If the nodule is unclear, it is examined under a microscope; a foreign body granuloma was found in most of the studied nodules of the lips.
06 / TREATMENTHow we treat
How we treat
effects of fillers.
Acute vessel blockage is treated immediately. Late compactions, granulomas and deformations are treated according to plan: first, inflammation, then, if necessary, the substance is removed and the shape is restored.
01
Clogged vessel
immediately
- The skin
- The basis of treatment, if hyaluronic acid was introduced, is repeated injections of hyaluronidase; add aspirin, warm compresses, massage, sometimes hyperbaric oxygenation. Treatment in the first 4–6 hours significantly improves the prognosis: early changes are reversible in up to 80% of cases.
- Vision
- There is no reliable treatment for blindness caused by fillers: most such cases do not recover. In a more recent review, vision recovered in 10 of 60 cases (16.7%); if hyaluronic acid was injected, timely hyaluronidase can help.
- Dying skin
- If the area of skin is still dead, the wound is cared for until it heals, and the defect and scars are repaired later.
02
Condensation and granulomas
Planned.
- Hyaluronic acid
- Complications from it can usually be treated with hyaluronidase injections.
- Granulomas in the lips
- According to a systematic review, most cases were treated with a combination of antibiotics, steroids (in the seal or inside) and surgical excision.
03
Permanent fillers and biopolymers
Silicone, polyacrylamide gel, PMMA.
- Removal
- In a series of 181 patients with complications from permanent fillers in the lips, the substance was removed with a laser injected into the tissue and through small punctures. There was improvement in 95% of patients, complete disappearance of the problem — in 38.7%.
- Surgically
- In a series of 24 patients with complications of polyacrylamide gel in the face, 23 had the gel removed surgically.
- What to expect
- Removal solves the medical problem, but does not always restore the appearance. When most of the substance has been removed, the shape can be improved by other procedures.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
The consequences of fillers and biopolymers at Dr. Valikhnovskyi's Institute of Surgery are treated in the direction of "Complications of aesthetic operations" - in particular, when the injections were made in another place. Acute vessel blockage is treated immediately - by the doctor who administered the filler or the hospital; in case of vision impairment, help is provided by an ophthalmologist and an emergency service. The clinic is responsible for the further restoration of tissues and shape.
CLINIC SERVICE
Treatment of complications of aesthetic operations
Skin necrosis, dehisced wounds, capsular contracture, liposuction irregularities, and gross scarring.
View service
What we do for this condition
- Cleaning the wound and dressing — if the skin area has died after the blockage of the vessel, the dead tissue is removed; small areas on the face often heal under dressings.
- Vacuum therapy — a dressing with negative pressure diverts discharge from the wound and prepares it for closure.
- Perforating flaps — a thin flap on one small vessel covers the defect on the face with a fabric similar in color and thickness.
- Lipofilling — own fat restores lost volume and softens scar tissue.
- Excision of scars — a rough scar is cut out and stitched using another technique; hypertrophic and keloid scars are treated in combination.
- Silicon and fractional laser — scar care from the first weeks and treatment of rough scars.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of your face or lips and everything you know about the injections: what, when and where they were injected.
- ConsultationInspection, assessment of seals and skin; if necessary, ultrasound or MRI.
- PlanWhat should be treated first - inflammation, wound or compaction - and what should be restored later.
- TreatmentDepending on the complication: treatment of wounds and scars, restoration of volume with own fat.
- RecoveryReviews before healing; the final look is evaluated after months.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to be treated at your place if the filler was injected elsewhere?
Yes. The doctor assesses what is now and makes a plan. Remember or find the name of the drug and the date of injections - this is important for treatment.
After the injection, the skin turned white and hurt. What to do?
Immediately go to the doctor who injected the filler, and if this is not possible - to the reception department: treatment in the first 4-6 hours significantly improves the prognosis. If vision has deteriorated, call 103.
The lips have hardened and become uneven a few years after the filler. What is it?
Perhaps a granuloma is a reaction to a foreign substance. In a review of 66 cases, nodules in the lips appeared after an average of 2.9 years. What exactly is wrong with you, the doctor will tell after the examination.
Is it possible to dissolve the filler?
Hyaluronic acid is usually produced by the enzyme hyaluronidase. Silicone, polyacrylamide gel and other permanent substances cannot be dissolved - they are removed.
Can the biopolymer be completely removed?
Not always. In a series of 181 patients with permanent lip fillers, improvement was 95%, but complete in 38.7%. Removal solves the medical problem, and the appearance is then improved with other procedures.
Why did the problems appear after so many years?
Permanent substances remain in the tissues and can cause a reaction at any time. In a specialized center, 84.6% of 401 patients had complications from permanent fillers inserted more than 10 years ago.
Are fillers dangerous for vision?
Blindness is rare, but is the most severe complication and is most commonly reported after interbrow and nasal injections. If vision worsens during or after the injection, call 103.
Sources
18 sources · expert consensus, systematic reviews, patient series and NHSshowCollapse
- Global Aesthetics Consensus: Avoidance and Management of Complications from Hyaluronic Acid Fillers-Evidence- and Opinion-Based Review and Consensus RecommendationsPlastic and Reconstructive Surgery, 2016doi:10.1097/PRS.0000000000002184 ↗
- Treatment of Soft Tissue Filler Complications: Expert Consensus RecommendationsAesthetic Plastic Surgery, 2018doi:10.1007/s00266-017-1063-0 ↗
- Complications of injectable fillers, part 2: vascular complicationsAesthetic Surgery Journal, 2014doi:10.1177/1090820X14525035 ↗
- Guide for Managing Vascular Occlusion Caused by Fillers with Exclusive Cutaneous Involvement: A Review of Diagnosis, Classification, and TreatmentAesthetic Plastic Surgery, 2026doi:10.1007/s00266-025-05104-3 ↗
- Avoiding and Treating Blindness From Fillers: A Review of the World LiteratureDermatologic Surgery, 2015doi:10.1097/DSS.0000000000000486 ↗
- Update in Soft-Tissue Filler-Associated BlindnessDermatologic Surgery, 2020doi:10.1097/DSS.0000000000002108 ↗
- Vascular Complications after Facial Filler Injection: A Literature Review and Meta-analysisThe Journal of Clinical and Aesthetic Dermatology, 2019pubmed.ncbi.nlm.nih.gov/31360292 ↗
- Complications of Nonpermanent Facial Fillers: A Systematic ReviewPlastic and Reconstructive Surgery Global Open, 2021doi:10.1097/GOX.0000000000003851 ↗
- A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity ReactionAesthetic Surgery Journal, 2020doi:10.1093/asj/sjz222 ↗
- Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic ReviewSurgery Journal, 2022doi:10.1055/s-0042-1743524 ↗
- Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic ReviewFacial Plastic Surgery, 2022doi:10.1055/s-0041-1736390 ↗
- Permanent Complications After Dermal Fillers: Risks, Prevention, and Management StrategiesAesthetic Plastic Surgery, 2026doi:10.1007/s00266-026-05989-8 ↗
- An out-patient clinic for filler complicationsNederlands Tijdschrift voor Geneeskunde, 2019pubmed.ncbi.nlm.nih.gov/30638002 ↗
- Filler-induced complications of the lips: 10 years experience with intralesional laser treatment and refinementsJournal of Plastic, Reconstructive & Aesthetic Surgery, 2022doi:10.1016/j.bjps.2021.11.042 ↗
- Complications after polyacrylamide hydrogel injection for facial soft-tissue augmentation in China: twenty-four cases and their surgical managementPlastic and Reconstructive Surgery, 2012doi:10.1097/PRS.0b013e3182589b7d ↗
- Vision lossNHS, 2025nhs.uk/conditions/vision-loss ↗
- Symptoms of a strokeNHS, 2024nhs.uk/conditions/stroke/symptoms ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
The figures on the page are from these sources.
Effects of fillers
bother?
Send a photo of your face or lips and everything you know about injections. The doctor will tell you what can be done and where to start.