The injection of fillers is commonly used to correct aging features of the face and generally is felt to be safe. In particular, the injections of hyaluronic acid (HA) fillers (e.g. Juvederm, Voluma, Restylane..) have increased 16% just in the last year accounting for just under 3 million injections per year. The HA fillers can be placed anywhere there is a perceived paucity of soft tissue and includes disappearing cheeks, a deepening fold, or eye hollowing. Because their use is so widespread, injecting HA fillers in the face has become “routine” with little consideration to risks and complications.
One of the more common phone calls we receive in the office is for injectable fillers under or around the eyes. Hollowing of the eyes is a very noticeable deformity of aging. A little filler in the area should give support to the lower eyelid and fill the soft tissues thereby eliminating thin skin. Eyelids have become a frequent recipient site for HA (gel) injection as injectors looked to push the envelope to get the best results. But the use of injectable fillers around the eyes has always been looked down upon because of the potential risks to the eye.
But as injectors became more cavalier, more complications started to be reported. A common complication was “blue tinged worms” under the skin of the lower eyelid. Fortunately that complication is correctable. But recently at a national meeting, an ophthalmologist reported 3 cases of blindness after HA injection to the lower eyelid. A poll of the attendees at the meeting revealed at least 30 other “unreported” cases. The blindness occurs because the gel is accidentally injected into an artery of the eyelid and travels back to the retinal artery of the eye. A piece of gel lodges in the retinal artery thereby stopping the blood flow to the eye. In most of these cases the filler is injected into the eyelid but even a lip injection reportedly caused a case of blindness. To date the conservative estimate is over 100 cases of blindness after HA facial injections. This does not happen with Botox as Botox is a watery liquid and not a gel (see our June 2012 blog “Fillers vs Botox”).
Patients wonder why I steer them clear from HA injections around the eyes. To quote an Australian eye expert:
“The blindness is instantaneous, permanent, and can be both eyes.
No one has been able to successfully fix that blindness.”
Thomas J. Francel, M.D.
