Dermal Fillers: When they go wrong

Before deciding to have dermal fillers, it is imperative to require an understanding of the risks, the side effects and what your practitioner can do, when dermal fillers go wrong.

Always ask your practitioner about their practice and safety procedures.

When you book a dermal filler consultation, at “Alverez Aesthetics,” you will automatically receive an email. It will contain information on dermal fillers, including all the benefits and risks.

At both your consultation and appointment, I will go through and explain these risks, side effects, and complications to you.

I will ask you to sign a consent form that confirms you fully understand the treatment you are having and its risks and potential complications before any treatment takes place.

 Are dermal fillers safe?

Although dermal filler procedures are safe, like all cosmetic or medical procedures, they also come with risks. As your practitioner, I do everything I can to reduce, avoid and inform you of risks throughout your time with me.

The common risks and side effects may or may not affect everyone in the same way; this is dependent upon your sensitivity and response to treatments.

What are the common risks and side effects?

Pain or stinging

This can occur when the injection is performed.


Slight bleeding can often occur at the site of injection points.


Bruising can occur and on rare occasions, bruising can be severe and can persist.


Numbness of the area can occur following an injection.


Itching of the area can occur following an injection.

Localised swelling

Localised swelling in the injection site can cause redness and feel tender.

Common side effects listed below are expected to resolve spontaneously within the first few hours or days of treatment; treatment dependent. However, can persist longer.

What are the uncommon risks and side effects?


Infection may occur within a few days, weeks, or months following treatment.


The treatment area can become inflamed.

Skin discolouration

Discolouration may occur within a few days, weeks, or months following treatment.

Allergic or sensitivity reaction

Symptoms can include itching at the injection point along with a rash, red itchy welts, wheezing, asthma symptoms, dizziness or faintness, and abscess formation.

Prolonged swelling

This may occur early or present, after several weeks.

Persistent lumps, nodules, or bumps….

A foreign body reaction is known as ‘granuloma’ presenting as lumps or nodules

Vascular Occlusion

The blood supply to the skin may be interrupted by swelling or unintentional injection into a vessel, causing pain, skin damage and scarring.

Acne-like formations

Can occur around the injection site area.


Though infrequent, transient visual disturbance or permanent blindness has followed injectable cosmetic treatment.

It is therefore essential that you address all your questions to your physician before committing to any treatment, including the above complications and any other concerns you have.

What if I have a special occasion to attend?

Allowing time for common reactions, such as bruising and swelling, to reduce and fade is advisable.

What happens when dermal fillers go wrong?

 Dermal fillers can go wrong in a few diverse ways. Asymmetry is one of the more common issues. Lips can be wonky, and Tear Trough hollowing can be overfilled. These are, relatively, easy fixes. 

Some people come to my clinic to correct overfilled lips, and I do this by dissolving the original filler.

How do you dissolve dermal filler?

We use a product called Hyaluronidase; this is an enzyme that breaks down the filler. Hyaluronidase is injected into the area where the filler is and dissolves. Some fillers, especially the cheaper ones, can be more challenging to break down. Therefore, the patient may need to have more than one treatment to dissolve it entirely.

Hyaluronidase is a prescription medication; all practitioners should have this in their emergency kit, and it is crucial to ask your practitioner if they have it before you commit to having any dermal fillers. If they do not have this in their clinic? I would strongly recommend that you do not have the treatment done.

It is imperative to research your practitioner and their procedures before committing to a treatment.

Why would you need to dissolve dermal filler?

The most important reason we would need to dissolve filler is if there were any complications such as Vascular Occlusion.

Vascular Occlusion

 A vascular occlusion occurs when a vein or an artery gets blocked by filler. These events are always in the back of our minds as practitioners and something we all try to avoid. 

However, these complications do sometimes happen and can be challenging to recognise. Look at the picture below. Would you think there was anything wrong? 

This is a picture of a vascular occlusion during dermal filler treatment of the nasolabial line (nose to mouth lines).

My colleague recognised the change in the colour of the patient’s skin in the nostril area. It looks slightly mottled compared to the rest of the skin, which can sometimes appear as bruising.

Further assessments were completed to check the blood flow and it was positively identified as a vascular occlusion. My colleague took immediate steps to resolve the issue, with my support, and the patient’s blood flow returned; there was no damage caused to the tissues. 

The video shows how the colour returns when pressed. This is a good sign as previously, the skin remained pale after compression, indicating reduced or no blood flow to the area. Therefore, a vascular occlusion had occurred.

How do we resolve a vascular occlusion?

When a vascular occlusion is identified; there is a blockage in a vessel, and we must dissolve the filler and allow blood to flow back to the area. To do this, we used a product called hyaluronidase (Hyalase).


This product breaks down the hyaluronic acid in the dermal fillers.

When hyalase is injected in the area, the filler will break down quickly, and the blood will start to flow.

The video shows how quickly this can happen, and the filler dissolving into a fluid.

Hyalase can carry high risks of allergic reactions. Therefore, your practitioner needs to be able to recognise signs of any reactions including, anaphylaxis. They must have the correct medication and protocols to manage such an event.

What happens if this does not get sorted?

The tissue in the surrounding area will start to die due to the lack of oxygen-filled blood getting to the site. The damage can track up the blocked vessel and cause a considerable extent of damage, permanent scarring, and even amputation. 

The infographic demonstrates what occurs when the practitioner does not treat an occlusion promptly. 

Vascular Occlusions can occur when the dermal filler is injected into a vein or an artery and stops blood from flowing to the skin. If left untreated, the skin will die, and the patient can be left with severe lifelong injuries.

Are there other ways dermal fillers can go wrong?

The lips are the treatment area that usually requires fixing. Too much filler, incorrectly placed, or poor-quality filler can cause lumps and bumps, which can migrate out of the lip border.

Before dissolving 

After dissolving

After correction

I have new patients come into the clinic to have their old lip filler dissolved. We can then start again using one of the premium fillers, at Alvarez Aesthetics, to give them a more natural, defined lip.

Ask your practitioner questions

 In my experience, of being both an Aesthetic Nurse Practitioner and a prescriber, I have learnt that there are a lot of people who trust their practitioner at face value.  They later arrive at my clinic asking if I can fix their previous treatment; that was either not administered correctly; or the product used was of poor quality, or an incorrect product choice was made by the previous injector. 

Do not trust the shop window; wearing a white coat does not make someone qualified. It looks good so it must be? No, not always.

Some people fear asking their practitioner questions about the treatments they have, their practitioner’s credentials because they do not want to offend.

Please see my credentials in the About Me section on my website

I cannot stress this enough how important it is to ask! Ask and ask again!

If you are undergoing any dermal filler treatment, ask your practitioner what training they have had on complications management.     

? Do they give you clear information and guidance about your treatment and its side effects that may affect you following your treatment?

? Do they discuss the products they are using and why?

? Do they discuss the products they have in the clinic, to enable them to treat you for any complications that can occur during or after treatment?

If not?   I strongly suggest you make your excuses.


Need more information?

Why not book a consultation with me at my clinic in Penistone, Sheffield? Follow the link: