Anatomic Danger Zones for Facial Injection of Soft Tissue Fillers

Injectable Fillers

Injectable soft tissue fillers are currently very popular in aesthetic dermatology, and are useful for replacing facial volume that is lost during the aging process. With experienced and well-trained injectors, fillers can help patients achieve a youthful, refreshed appearance. However, complications can arise when injectors are not experienced or are using products that have not been approved by the US Food and Drug Administration.

Aside from local side effects such as swelling, tenderness, pain after injection, scarring, formation of granulomas, change in the color of the skin, infections, masses and tingling has been reported after filler injection. The most dreaded complication is the injection of soft tissue fillers into the blood vessels of the face. This can cause rare but serious adverse effects such as tissue death and blindness if the filler blocks the arteries that feed the eye.

The following are areas that are high risk for filler injections:

  • The forehead and glabella, or the area between your eyebrows.
  • The cheeks at the smile lines and below the eyes
  • The nose
  • The temples
  • The area around the mouth

Signs that the blood vessels may be compromised include whitening of the skin, darkening of the skin, bruising, intense pain, and redness in the pattern of blood vessels. Among the 60 cases since 1988 reported of filler injected into the artery that supplies blood to the eye, patients have complained of eye pain, headache, dizziness, nausea, eyelid droop and loss of vision.

Because of the seriousness of these adverse filler effects, we always recommend choosing an experienced, well-trained injector who has intimate knowledge of the blood vessels of the face, who uses steps to minimize these risks, and who knows how to manage vascular compromise if it should happen. When used correctly and safely, soft tissue fillers can be a useful tool to help patients maintain a healthy and youthful appearance.

Contact Maggie Chow, MD, PhD or any of SBC’s Board Certified providers to answer any questions you may have.

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