Before You Get a Botox Injection or Filler Treatment, You Should Know About Risk of Blindness, Gangrene and Skin Loss

Nearly 16 million minimally invasive cosmetic procedures took place last year in the U.S. That includes nearly 7.5 million botox, and other neurotoxin injections to reduce wrinkles as well as 2.5 million filler injections to shape the face. These enhancements traditionally require a visit to a doctor’s office but as Dr. Tara Narula shows us, new salons are offering injections in a more casual setting — creating potential risks.

Dr. Alan Matarasso, President of the American Society of Plastic Surgeons says most salons are safe, but the treatments involve medical care and “things can happen with medical care.”

Serious complications can occur from dermal filler treatments that go bad.

Dr. Matarasso says risks include skin loss, gangrene, and blindness. Bad things can happen to your face if the injectable filler is accidentally administered into a blood vessel. Even a skilled physician can accidentally introduce filler into a blood vessel. One woman was told by a doctor that she was lucky she didn’t lose her nose when filler entered a blood vessel and caused the affected area of her face, including her nose, to turn purple.

Accidental injection of filler in any blood vessel can cause serious problems with tissue near the eye, forehead, and nose. Clinics must have a standby drug that can unblock blocked blood flow to prevent tissue damage. The tissue rescue drug is known as filler-dissolving medicine. The woman who could have lost her nose was treated at a clinic that didn’t have filler-dissolving medicine on standby. A doctor rushed to the clinic with the emergency drug.

Injectable Filler Safety Checklist

Injector has Credentials

Clinic is prepared for emergencies (with a crash cart and filler-dissolving medicine on standby)

After-Hours Staffing

The worst complication of a filler treatment gone wrong is blindness caused by a periocular embolism of Hyaluronic Acid. The most common dermal fillers are Hyaluronic acid-based fillers. The devastating eye-complication of filler treatment is instant and is associated with excruciating ocular pain (eye pain). An embolism from the filler enters an important artery, blocking blood supply to the eye. According to an article in the Journal of Clinical Aesthetic Dermatology, retinal circulation needs to be restored within 60 to 90 minutes if the retina is to survive. Blindness that occurs is a medical emergency and the patient should be transferred immediately to the nearest hospital eye department.

Treatment involves a retrobulbar injection (behind the eye) of hyaluronidase into the inferolateral orbit (lower, side area near the eye). The treatment is even recommended to be considered by practitioners who have appropriate experience and competence while waiting for paramedics to arrive at the scene of the clinic.

One blindness occurs, treatment is rarely successful.

Hyaluronidases are enzymes that depolymerize or break apart the filler material. Hyaluronidase can be derived from mammalian testes, hookworms or leeches, and microbes.

Signs of blocked blood vessels or “Vascular Inclusion” include a slow capillary refill time after pressing on skin, a dusky or blue-gray-black appearance, and pain and coolness of the skin. If patients are not treated with hyaluronidase within short time period, tissue necrosis (skin death and skin loss) can occur. Experts recommend hyaluronidase “filler-dissolving” medicine be administered within four hours.

Other undesirable complications of filler treatments include the Tyndall effect (a blue tint of skin especially under the eyes), unacceptable cosmetic results, and a delayed onset of lumps or nodules that appear several months after the initial treatment with filler. Allergic reactions are also possible.

Laws vary state-by-state and certification for filler treatments is lacking.

Martyn King, MD, Cormac Convery, MD, and Emma Davies, RN, NIP. This month’s guideline: The Use of Hyaluronidase in Aesthetic Practice (v2.4) J Clin Aesthet Dermatol. 2018 Jun; 11(6): E61–E68.



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