Sulaiman Mahmood
Introduction
The 21st century has seen a sharp rise in the use of non-surgical cosmetic procedures, such as dermal fillers and botox injections. Their immense popularity can be attributed to their promise of facial rejuvenation, ease of access, and minimal downtime. However, as their use has surged, so too have their complications. Given the delicate neurovascular anatomy surrounding the eye, improper injection techniques or product migration have led to serious adverse effects including vision loss, diplopia, and ptosis. This article aims to highlight some key ophthalmic risks associated with cosmetic procedures and consequently highlight the importance of awareness and preventative strategies.
Dermal Fillers
Dermal fillers are composed of substances like hyaluronic acid and are frequently used to smooth wrinkles, restore lost volume, and enhance contours in the face. Despite their generally safe profile, improper administration in high-risk areas like the nasal region can result in ischaemic complications.
Vascular Compromise and Loss of Vision
Severe or permanent complications of dermal fillers are primarily caused by vascular compromise, particularly in vulnerable anatomical areas like the nose, nasolabial folds, forehead, and eyebrows (1). The ophthalmic artery is responsible for supplying critical structures in the eye such as the retina and extraocular muscles. If dermal filler is inadvertently injected into branches of this artery, it can cause vascular occlusion. This in turn can cause ischemia and total or partial vision loss, as well as diplopia (1, 2).
In order to prevent vascular occlusion, clinicians can aspirate the syringe before injection and avoid high-pressure bolus injection (3). Moreover, recognising symptoms early and administering hyaluronidase (to dissolve filler) sooner, warm compresses, and hyperbaric oxygen therapy can help to mitigate these ischaemic complications (2).
Ptosis and Eyelid Swelling
Migration of filler material and local inflammation can lead to ptosis and periorbital swelling. The accumulation of filler material in the upper eyelid or periorbital region can cause asymmetry and functional impairment (4). Treatment involves cold compress, corticosteroids, and hyaluronidase injection.
Botox and Ocular Side Effects
Botox temporarily paralyses facial muscles and is therefore widely used to reduce wrinkles. Although generally considered safe, when injected near the periocular region, it can affect the extraocular and eyelid muscles leading to ophthalmic complications.
Diplopia and Loss of Vision
The infiltration of Botox beyond the intended site can cause unintended paralysis of the rectus or oblique muscles, resulting in double vision (5). While diplopia from Botox is usually temporary, it can still be distressing for patients and impact daily activities.
Additionally, improper Botox injection has been linked to temporary vision impairment and can contribute to dry eyes as it can disrupt eyelid function (5, 6).
Careful dosing, precise injection, and patient education on side effects are essential to reduce risks.
Conclusion
As non-surgical cosmetic procedures continue to gain popularity, awareness about their potential complications becomes more important. Dermal fillers and botox are generally safe but can still cause severe adverse effects such as vision loss, diplopia, ptosis, and dry eyes if improperly administered. Preventative measures like aspiration before injection, early recognition and injection of hyaluronidase, and patient education can reduce the risk or severity of these complications. Ultimately, patient safety should remain the highest priority in any procedure.
References
1. Oranges CM, Brucato D, Schaefer DJ, Kalbermatten DF, Harder Y. Complications of Nonpermanent Facial Fillers: A Systematic Review. Plastic and Reconstructive Surgery – Global Open. 2021;9(10):e3851.
2. Mehta P, Kaplan JB, Zhang-Nunes S. Ischemic complications of dermal fillers. Plastic and Aesthetic Research. 2022;9(0):57.
3. Helmy Y. Non-surgical rhinoplasty using filler, Botox, and thread remodeling: Retro analysis of 332 cases. Journal of Cosmetic and Laser Therapy. 2018;20(5):293-300.
4. Alharbi MM, Dlaim MSB, Alqahtani JM, Alkhudhairy NS, Almasoudi SM, Alajmi NT, et al. Ophthalmic complications of periorbital and facial aesthetic procedures: a literature review. Cureus. 2023;15(7).
5. Skorochod R, Nesher R, Nesher G, Gronovich Y. Ophthalmic adverse events following facial injections of botulinum toxin A: A systemic literature review. Journal of Cosmetic Dermatology. 2021;20(8):2409-13.
6. Ricci LH, Navajas SV, Carneiro PR, Söderberg SA, Ferraz CA. Ocular adverse effects after facial cosmetic procedures: a review of case reports. Journal of Cosmetic Dermatology. 2015;14(2):145-51.