Introduction: Even taking all the necessary measures for the non-occurrence of adverse events resulting from the application of hyaluronic acid, the risk of complications will still be present due to anatomic factors. Objective: To report a clinical case of vascular management complications after lip filling performed under conditions considered safe to prevent this type of event.

Case report: Female patient, 27 years old, with the desire to improve the appearance of her lips by filling procedure. The procedure was performed entirely with a 22G canula, with two entry points done near the lip corners. The result of the immediate post-intervention was satisfactory, with no visual alteration of adverse effects. A few minutes after the procedure, it was possible to diagnose the occurrence of a complication related to vascular compression or intravascular filler injection. To prevent tissue necrosis, hyper concentrated hyaluronidase was applied at 15 minute intervals until signs and symptoms were resolved.

Conclusion: In the clinical case reported all instructions for performing a safe lip filling procedure were followed, but this did not prevent the progression to a vascular complication with risk of necrosis. The prompt intervention of the application of hyaluronidase generated excellent and sufficient results for the management of this complication.