Cosmetic injections are a great way to rejuvenate certain areas of the face without having to undergo a major invasive cosmetic surgery. They can be done in conjunction with a major procedure such as a facelift, or they can stand alone. Facial injections can be done with dermal fillers or fat to fill laugh lines that run from the outer nostril to the corner of the mouth, or to fill the vertical frown lines in between the eyes.
Cosmetic injections with dermal fillers, such as Juvéderm, Restylane, Perlane, Radiesse, collagen, etc., and fat injections to the face are becoming more and more popular. The demand is high for this type of procedure, and people are getting these types of injections done at younger and younger ages. Women as young as in their 20’s are using cosmetic injections to enhance their lips and cheeks; as the age at which people start getting these injections continues to decrease, it's even more crucial that both the short-term and long-term potential complications are fully understood before undertaking such procedures.
Having fat or dermal fillers injected into the facial area is usually quite innocuous. Normal occurrences after injections of a dermal filler include temporary redness at the site of injection, and perhaps some temporary soreness and swelling. Temporary swelling and soreness are also normal after having fat injected into the face. The swelling after such an injection persists longer than the swelling associated with dermal fillers, and is usually more pronounced. Nodules or lumps under the skin can occur after either dermal filler injections or fat injections. Serious complications after cosmetic facial injections are quite rare, but when they do happen, they are quite devastating. Many people who have facial enhancement with injections may be unaware of the potentially permanent complication that can occur with facial injections, namely blindness.
There are many small blood vessels, specifically arteries, in the forehead and eye area that supply blood to the area. Improper use of dermal fillers and fat injections can lead to the blockage of a blood vessel that supplies blood to the eye. When the blood is prevented from reaching the eye because of the blockage, blindness is the result. This condition is known as retinal artery occlusion (RAO).
According to a study published in the American Journal of Ophthalmology, 12 patients experienced a sudden loss of vision following cosmetic injections to the face, and the prognosis was worse after injections with fat. This was thought to be due to the variation in the size of the fat globules, which can be small, medium or large. Variation in size leads to the blockage of small, medium and larger-sized arteries. Dermal filler particles are smaller and more constant in size, and therefore will potentially block only certain smaller-sized arteries. Consequently, larger arteries will be spared. As a result, the blindness prognosis may not be as bad as the bigger blood vessels, but are still able to deliver blood with oxygen and nutrients to the eye.
There are still some important unanswered questions related to the study. No comment is made on:
- The characteristics of the women in the study: Were they older or younger? Were they predisposed to eye problems?
- The volume of the injectable: How much fat, collagen, or hyaluronic acid was injected?
- The training of the person doing the injection: Who did the injections — a student, a nurse, a medical assistant, or a doctor? Had the person doing the injections been properly trained in how to perform such injections?
In summary, anyone who chooses to have facial injections with fat or with dermal fillers should be aware that prognosis is poor if an artery that delivers blood to the eye area is clogged with fat, collagen, or hyaluronic acid. However, it should be noted that, considering the number of facial injections done, the occurrence of this problem is quite rare — so rare, in fact, that the authors of the study could not estimate an incidence. If it is of any relief, many doctors have never seen the complication, and have only heard of the potential for the complication to occur. Cosmetic injections continue to enjoy an excellent safety profile, and can have very natural effects in the right hands.
Park SW, Woo SJ, et al. Am J Ophthalmol. 2012;154:653-662.