Ask Dr. Barber

Q. I get injections of Restylane® in my cheek fold about once or twice a year. I have never had any issues other than temporary bruising and swelling, however I read an article recently that talked about blindness that can occur as a result of filler injections to the face. I am now too scared to get injections again. The office where I have received the injections has never mentioned that blindness can occur. Are fillers safe, or do I need to stop doing them?

A. Fillers such as Restylane® and Juvederm® are compounds containing hyaluronic acid that is injected into wrinkles, such as where you get yours, the nasolabial fold, and also where there is a hollow area, such as on the cheek for example. Basically, fillers do as their name suggests, fills up a wrinkle or a hollow. The risk that you asked about, blindness, is a well described complication that can occur during the injection process, but fortunately it is extremely rare. In my practice, we have never seen this complication, in spite of having performed thousands of injections over the last decade. The blindness that has been reported with filler injections is unilateral, meaning only on one side, the side that the injection took place on. It is thought that it occurs because some of the injection material is injected into a small blood vessel that is in the area being treated. The pressure of the injection pushes the filler material deep into the blood vessel which, in very rare cases, fills one of the blood vessels that supplies the retina of the eye. The material gets stuck in the even smaller blood vessels in the retina, which stops the flow of blood to a segment of the retina. This causes the retina to develop irreversible hypoxic tissue damage that leads to blindness. The loss of vision occurs almost immediately, and to my knowledge there has only been one reported case where the blindness was reversed with treatment. There is a treatment protocol for trying to reverse the blindness, but unfortunately it has not been successful in most cases. There are recognized techniques during filler injections to minimize the possibility of injecting filler into a blood vessel, but even in the most experienced hands, this catastrophic event has been reported. However, experience does matter with filler injections and you should feel comfortable that your injector has experience and knows the techniques to minimize the chance of this terrible complication. So to answer your question as to whether fillers are safe, they are absolutely safe and millions of injections are carried out every year worldwide with a very low incidence of complications, including blindness. However, just as in almost everything we do on a daily basis, unexpected and unwanted events can occur, and you need to be an informed consumer and weigh the risks verses benefits of the procedure.

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