Most of the complications associated with hyaluronic acid filler use are mild, transient and reversible. Serious complications due to vascular occlusion include cutaneous necrosis and blindness, which although rare can occur due to the compression of the vessel or direct intravascular injection. Injection related side effects are the most commonly seen, which are usually transient. Vascular occlusion is the most severe complication associated with hyaluronic acid filler injection. A thorough understanding of the facial vascular anatomy reduces the risk of vascular occlusion. Early identification of a vascular occlusion and a prompt intervention can significantly decrease the risk of long term sequelae. 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