Is it possible to have intravascular necrosis showing two weeks to a month or so after fillers? (Photos)

Question

I had botox on forehead & around crows feet & radiesse in nasal folds & marionette lines in May. About a month later, I had filler added to checks. 2 weeks later I noticed slight blanching on checks coming & going on forehead. Why would I be getting this on the forehead when all I had was botox there? I have a little blanching on checks too. Derm says massage face. No aspirin - that would break filler particles I also now have blue veins now showing by the temples. Thoughts?

Muhammad Mirza, MD (license suspended) · Answer

Thank you for your question. It's hard to say. I would suggest following up with your injector.  Best regards, Dr. Mirza

Jason Emer, MD · Answer

Occlusion happens immediately after injection. This needs an in-person evaluation. I recommend following up with your cosmetic dermatologist. Best, Dr. Emer

Anteneh Roba, MD · Answer

Necrosis caused by  post intravascular injections of fillers appears way before two weeks. Signs and symptoms are very specific. Your skin changes are not related to intravascular injection of fillers.Eels

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. It would not be possible to have intravascular occlusion weeks or months after filler or Botox placement.  Some patients who are prone to a red coloration to their face during exercise for example can have areas of blanching where the Botox was administered but this typically resolves within the two weeks it takes for the Botox to set up.  Based on your pictures it does not appear that anything as serious as an occlusion is occurring.  Hope this helps.

Thuy Doan, MD · Answer

Thank you for your question. Luckily based on your pictures, this is not necrosis. Necrosis would be black and purple in color. Plus you would have pain associated with it. Blanching should improvement with time. If not, get it reverse with hylenex. Hope that helps. Best Dr. Thuy Doan. Atlanta

Jessica H. Kim, MD, FAAD · Answer

Signs of vascular occlusion typically occur immediately after filler placement and not in 2 weeks.  It is also characterized by significant pain.  I would recommend following up with your injector.  Looking at photographs before and after treatment will give you an idea what your baseline skin appearance is.  It is not unusual to start noticing things on your skin that had always been there after aesthetic procedures.

Shaun Patel, MD · Answer

Vascular occlusion would present sooner then 2 weeks after filler treatment. I think the best thing to do is followup with your injector in person to determine what is going on. Again, this does not look like vascular occlusion.

Camille Cash, MD · Answer

Occlusions occur as the product is injected and is visible almost immediately.  I recommend returning to your injector for an evaluation of the area to determine what may be causing your symptoms.

Melvin Elson, MD · Answer

Intravascular injury occurs immediately during the injection process and is not delayed at all. something else is causing your symptoms so check again with your dermatologist in person not on the phone

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Is it possible to have intravascular necrosis showing two weeks to a month or so after fillers? (Photos)

Answers (9)

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