I received an email from a client this weekend referencing an article which ran in the New York Post on July 7th. She asked, “Should I be scared?”
The article, “Doctors warn popular cosmetic procedure may cause blindness”, written by Rebecca Sullivan, addresses some of the worst, and rarest, complications with injectable fillers.
One of these very rare complications is blindness. There have been approximately 100 cases documented of blindness related to the injection of dermal filler world wide. These cases, statistically, are extremely rare. The incidence has been highest when injections have been performed deep in the glabella area. (between the eyes) There have also been cases involving injections into the nasolabial folds and the nose itself. When filler is injected deeply it can be introduced to one of the facial arteries and then can make its way to the retinal artery, resulting in blindness. Blindness has not been reversible in the documented cases. This rare adverse event has been reported with the injection of autologous fat and dermal fillers, such as hyaluronic acid fillers. (Restylane®, Juvederms®, for example) The occlusion of an artery can also cause soft tissue damage or tissue death (necrosis) . Although, still very rare, there have been more cases of this adverse event reported than blindness. Infections have also been reported and are also very unusual.
Just the prospect of any of the above can make someone think twice before pursuing facial injections. Here are a few pieces of information to put you at ease as a patient.
- Seek out a provider with experience and an extensive understanding of facial anatomy.
- Seek out a provider at an established and reputable office, ideally with a physician on site.
- Ask your provider if they have hyaluronidase in the office. This is an enzyme which breaks down hyaluronic acid fillers. If can be utilized in an emergency, but most often is used in outcomes that the patient or provider want to reverse.
- Know that the majority of complications (such as swelling and bruising) are mild and self limiting.
Even in the hands of the most experienced injectors, risk still exists.
As a provider:
- Know your facial anatomy!
- Avoid deep injections in high risk areas.
- Have an emergency protocol and kit available should the need arise. (hyaluronidase, nitro paste, ASA)
- Aspirate before injecting.
- Inject slowly
- Only place boluses on periosteum.
- When appropriate, utilize a cannula, especially in high risk areas of the face.
I have seen several references to this article on social media. I think it is important to inform the public that facial injections have a long and safe track record. I think that the article referenced does shed light on the fact that facial injections are not without risk and a patient should be educated and informed. Choosing a provider wisely is so important.
But, in the right hands, you should not be scared!