Dermal filler injections are widely used in aesthetic medicine for facial rejuvenation and contouring. Although generally safe, they carry a risk of serious complications such as vascular occlusion, which can lead to tissue necrosis or vision loss. This systematic review aimed to identify and quantify risk factors associated with such events and to propose a practical morbidity-risk assessment tool to aid clinical decision-making. A comprehensive search of PubMed, Embase, and the Cochrane Library identified case series, case-control, and cohort studies reporting confirmed vascular occlusions after dermal filler use. Data were extracted on patient demographics, filler types, injection sites, vessels involved, time to presentation, and outcomes. Risk of bias was assessed using the Joanna Briggs Institute checklist. Statistical analysis was performed using R and SPSS. Fourteen studies involving 31 patients met inclusion criteria. Most patients were female (71%) with a mean age of 42.6 years. Hyaluronic acid (HA) was the most common filler (61.3%). Occlusions were frequently associated with high-risk areas such as the glabella, nose, and nasolabial folds. Involvement of the ophthalmic artery was significantly linked to poor outcomes (OR 9.67, p=0.02), while smaller vessel occlusions had better recovery. Hyaluronidase use in HA-related cases led to over 84% of partial or full recoveries. Key risk factors included filler type, injection site, vessel involvement, and time to intervention. A Morbidity Risk Assessment Tool was developed to categorize patients into low, moderate, or high-risk groups, supporting safer treatment planning. Prompt recognition and intervention, especially with hyaluronidase, are critical. However, reliance on case reports limits generalizability, highlighting the need for standardized reporting and larger prospective studies to refine safety protocols in aesthetic medicine.

Dr. Adham Chakhachiro is a medically qualified doctor and aspiring dermatologist with a strong foundation in internal medicine and aesthetic medicine. A graduate of Imperial College London, he has completed clinical training across multiple specialties, where he is currently undertaking specialist training with the goal of becoming a consultant dermatologist. Dr. Chakhachiro is also an Advanced Aesthetic Trainer at the British Aesthetic Academy, equipping him with expertise in a wide range of cosmetic procedure. His approach combines dermatological knowledge with aesthetic precision, ensuring both safety and natural outcomes. He is the founder of Clinic Platina a Luxury based aesthetics wellness centre in London.  With a keen academic interest in vascular complications associated with dermal fillers, Dr. Chakhachiro is actively involved in research aimed at improving risk stratification and complication management. Through clinical practice, research, and education, he remains committed to advancing standards in both dermatology and aesthetic medicine.