Recognize the blindness risk of facial fillers, particularly around the nose, between the eyebrows, and forehead
More than half of the published vision-loss cases in one review involved nasal injections, followed by the area between the eyebrows, the forehead, and nasolabial folds. Over 80% involved hyaluronic acid. Only about one-fifth regained full vision, roughly one-sixth regained some, and nearly one-fifth had central nervous system complications. No rescue treatment was consistently effective. These case proportions identify serious hazards, not the probability of blindness from an individual injection.
What it takes
No cost to reconsider the site or decide against the procedure.
What you may gain
A review of published cases worldwide identified 48 new cases of partial or complete vision loss after filler injection between January 2015 and September 2018. Injection sites included the nose in 56.3%, glabella in 27.1%, forehead in 18.8%, and nasolabial folds in 14.6%; a case could involve more than one site. Hyaluronic acid was used in 81.3%. Skin changes occurred in 43.8% and central nervous system complications in 18.8%. Ten patients, 20.8%, recovered vision fully; eight, 16.7%, recovered partially; the remainder did not regain vision. Management varied widely, and no treatment was shown to work consistently.
Context & considerations
These are published adverse cases without a denominator of all injections, so they cannot calculate an individual's risk or definitively rank sites by incidence. They show where reported disasters occurred and how limited recovery can be, which is why the evidence is rated B. The original describes trained clinicians' risk-reduction measures: understanding vascular anatomy, selecting blunt rather than sharp instruments where appropriate, using small amounts during withdrawal, and preparing hyaluronidase. These descriptions are not instructions for self-injection and do not make a site risk-free. Verify the institution and clinician as in entry 2, and avoid informal injectors.
Research & references
Beleznay K et al. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthetic Surgery Journal. https://doi.org/10.1093/asj/sjz053