A structured approach with Swiss cheese model to reduce vascular adverse events of filler injections

Background: Filler injection is among the most popular nonsurgical aesthetic procedures worldwide. Though relatively noninvasive, filler injection can lead to severe vascular adverse events. Even though the incidence is rare, it may cause devastating and irreversible outcomes. A Swiss cheese model has been widely applied for risk analysis and management approach in medical field.Aims: In this review article, we adopt the Swiss cheese model and create a structured approach to prevent severe vascular complications caused by filler injections.Methods: We reviewed the current literature regarding the knowledge and techniques of preventing vascular adverse events in the filler injection.Results: We propose four structured strategies in this model to reduce the risk of severe vascular adverse events of filler injections, including clinical facial anatomy, safe filler injection principles, real time imaging and auxiliary instruments, and implication of checklist.Conclusion: This review provides clinicians a structured approach before and during the filler injection procedure to reduce the risk of vascular adverse events and improve its safety and outcome.