What vascular occlusion is
Vascular occlusion (VO) happens when dermal filler blocks or compresses a blood vessel, cutting off blood supply to the tissue it feeds. Left unrecognised, it progresses to skin ischaemia and necrosis. If filler enters or occludes a retinal artery, it can cause irreversible blindness. It is uncommon, but every injector must be able to recognise and manage it without delay.
Why it dominates filler consent
Under Montgomery, the materiality of a risk is not only about how often it happens, but how much it matters to the patient. A rare risk of blindness or facial necrosis is exactly the kind of risk a reasonable patient would want to know about. That makes VO the defining disclosure of filler consent. When a claim is built, the first question is simple: were they warned, and can you prove it?
What consent and the record must show
- The risk of vascular occlusion was named and explained, not buried in a list.
- The patient was told the warning signs to report: disproportionate pain, blanching, a mottled or dusky skin colour, and any change in vision.
- There is a written emergency protocol, and the patient consented to emergency management including high-dose hyaluronidase.
- Aftercare instructions gave the patient a route to urgent contact, and that route is documented.
Preparedness the record should reflect
UK complication guidance (including the CMAC guideline on hyaluronic acid filler-induced vascular occlusion) expects every injector to carry adequate hyaluronidase on site, to hold a written VO protocol, and to know their route to emergency ophthalmology. A defensible file shows not only that the risk was disclosed, but that the clinic was ready. The paperwork you did before the treatment is what answers the claim after it.
The ophthalmic emergency
Filler-induced visual loss is an ophthalmic emergency, and the window to act is short. This is where aesthetic and ophthalmic practice meet. Our ophthalmology programme, led by an oculoplastic surgeon and expert witness, exists precisely because the periocular region is where the stakes are highest.
Where this sits
Every material risk below is a Montgomery disclosure and, where an alternative exists, a McCulloch one too. If it was discussed, it needs to be on the record. See how the standard rose in the interactive timeline, and how a claim actually unfolds in Anatomy of a Claim.
Related: Dermal filler consent · Ophthalmology overview · Botulinum toxin consent · Anatomy of a Claim