As long as I aspirate and go slow, I’ll avoid a vascular occlusion.

Still relying on aspiration to avoid vascular occlusion? That’s not safety—it’s aesthetic theatre, and the data proves it.

Dr. Harry Singh

Dr. Harry Singh Author - UK's No1 Aesthetic Mentor

Let me just light this dumpster fire of a belief real quick.

If you’re still doing that dramatic plunger pullback ritual like it will part the Red Sea and save your patient’s arterial flow, you’re not practising safely. You’re performing aesthetic theatre. And the audience? Probably a Complications WhatsApp thread, where injectors go to emotionally process after they’ve turned someone’s lip into beef jerky.

Let’s stop pretending aspiration is the golden ticket to complication-free injecting. It’s not. The data proves it. Clinical outcomes prove it. And let’s be honest—you probably already know it, but it’s more comforting to believe the lie than confront the fact that your needle might be the problem.

Reality Check: Let’s Beat You Over the Head with Some Facts

Here’s what the actual evidence says:

Vascular Occlusion Risk is Low... But Not That Low

Erasmus University Clinic (filler complications centre): 1 in 6,558 VO risk overall
Adjusted for under-reporting, most sources agree on a range of 1:2,000 to 1:10,000, with some going lower (but they’re often fluff studies from biased training academies).
Other documented rates:
Necrosis from collagen: 9 in 100,000 (0.009%)—and 50% happened in the glabella, your favourite death zone
Dermal filler VO rate (some studies): as low as 1 in 100,000 (0.001%)

But let’s stop cherry-picking the unicorn stats. If you inject long enough, you’ll get a VO. Or your patient will.

Tool Time: Cannula vs Needle – And It Ain’t Close

The stat that should slap you out of your comfort zone:

That’s a 77.1% REDUCTION in occlusion risk by switching to a cannula. Let that sink in.

This isn’t a minor improvement. It’s not a “personal preference.” It’s a borderline malpractice risk if you ignore it, especially in high-risk zones like:

So if you’re still jabbing needles into the nose and glabella because you “like the control,” maybe shift that control to your insurance premiums.

Stop Worshipping Technique Alone – EXPERIENCE Matters

This stat gets buried but it’s vital:

Also—28.6% of 370 dermatologists surveyed had experienced at least one
VO. Let that normalise your fear, but also your standards

Let’s Talk Fillers: Some Are Riskier Than Others

Another thing most injectors don’t want to hear:

Other stats worth digesting:

So next time someone goes “Oh but HA is reversible so it’s safer”—tell that to the patient with a grey nasal tip at 5pm on a Friday who now needs dissolving, aspirin, oxygen, and your weekend.

TRUTH BOMB: Aspirating Is a Ritual, Not a Safety Protocol

Let’s kill this myth dead Aspirating is:

A needle inside a vessel may not flash blood, especially with viscous fillers. So if you’re relying on aspiration to avoid VO, you’re gambling, not injecting clinically.

REAL-WORLD SAFETY PROTOCOL: What I Actually Recommend

No BS. No gimmicks. Just what actually protects you (and your patients):

1. Ditch the needle in danger zones

Nose, glabella, nasolabial folds = cannula only
25G or 22G blunt tip 2.

2. Slow, controlled microbolus injections

0.05–0.1ml per deposit
Constant needle/cannula movement
Avoid bolusing like you’re caulking a window

3. Know your anatomy

Injecting without understanding anatomy is like driving blindfolded through a school zone

4. Keep Hyalase in arm’s reach

Not locked in a cupboard
Not “I’ll just order it if needed”
Use BTC protocols if you’re clueless, or better yet, build your own
With actual evidence

5. Train until you're bored

VO odds drop dramatically with experience. If you’ve done under 200 treatments, your risk is still high. Stay humble.

Final Thought: Your Confidence Is Killing Someone’s Skin

Let’s cut the crap. Injectors keep quoting low complication rates to avoid confronting their bad habits. But if you’re doing 10+ cases a week, you will see a VO eventually.

The difference is whether you:

A. Knew it was coming and were prepared
B. Froze, panicked, and pretended it was “just bruising”

This isn’t fear-mongering. This is clinical literacy.

If you don’t want to end up in a tribunal hearing trying to justify why you injected said filler into a nose with a 30G needle and a prayer—ditch the myths, follow the data, and start acting like safety isn’t optional.

Question of the Week:

Are you still aspirating because you believe it works… or because it helps you sleep at night?

References (Pick One. Use Them All. Just Read Them.)

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