Even the best injectors can experience sometimes serious filler-related complications when injecting around the eyes, but there are a few important nuances in technique that not only reduce complication risk but also improve outcomes, according to Robert A. Goldberg, M.D., an oculoplastic surgeon at UCLA’s Jules Stein Eye Institute.
Dr. Goldberg and colleagues found hyaluronic acid fillers generally were well tolerated up to five years in their retrospective review of 147 patients who had received filling in the periorbital hollows, published last year in the Journal of Cosmetic Dermatology.
But short-term complications did occur: 11% of the patients studied had malar edema, 31.3% had blue-gray dyschromia and 30.5% had contour irregularities. In all, 90% of those complications required no intervention.
More serious complications, including blindness, are rare but important, according to Dr. Goldberg.
“We have a Filler Complications Center here at UCLA, and we take referrals from around the country with some of the more difficult complications, including blindness. We just had a case a couple of weeks ago. And we continue to see as many as four cases a year, just from the greater referral area in Southern California. So patients do go blind from injection around the eye or upper face,” he says.
The problem is that serious complications are difficult to predict and avoid.
“I think the medial orbital blood supply may be the most vulnerable [to injection complications], so glabellar and nasal injections may have the highest risk, but we’ve seen blindness from temporal injections and nasolabial injections. So, it can result from injections any place on the face because the facial vessels are so intertwined,” Dr. Goldberg says.
Dr. Goldberg says that he doesn’t think blindness from fillers can be eliminated by any specific technique.
“I think it could happen to the best injectors with perfect technique,” he says.
But there are some techniques that are more likely to cause vision loss. It’s critical to know the anatomy of all the major vessels around the face, including the infraorbital artery, temporal and facial zygomatic and supratrochlear and supraorbital vessels, according to the surgeon.
“Those are the vessels that have a direct connection to the optic nerve vasculature,” Dr. Goldberg says.
Dr. Goldberg reports no relevant conflicts of interest.