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Blindness Caused by Cosmetic Filler Injection: A Review of Cause and Therapy

Carruthers, Jean D. A. M.D.; Fagien, Steve M.D.; Rohrich, Rod J. M.D.; Weinkle, Susan M.D.; Carruthers, Alastair M.D.

Plastic and Reconstructive Surgery: December 2014 - Volume 134 - Issue 6 - p 1197–1201
doi: 10.1097/PRS.0000000000000754
Cosmetic: Ideas and Innovations
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Summary: Vascular occlusion causing blindness is a rare yet greatly feared complication of the use of facial aesthetic fillers. The authors performed a review of the aesthetic literature to ascertain the reported cases of blindness and the literature reporting variations in the vascular anatomy of the human face. The authors suggest a small but potentially helpful addition to the accepted management of the acute case. Cases of blindness, mostly irreversible, from aesthetic filler injections have been reported from Asia, Europe, and North America. Autologous fat appears to be the most frequent filler causing blindness. Some cases of partial visual recovery have been reported with hyaluronic acid and calcium hydroxylapatite fillers. The sudden profusion of new medical and nonmedical aesthetic filler injectors raises a new cause for alarm about patient safety. The published reports in the medical literature are made by experienced aesthetic surgeons and thus the actual incidence may be even higher. Also, newer injectors may not be aware of the variations in the pattern of facial vascular arborization. The authors present a summary of the relevant literature to date and a suggested helpful addition to the protocols for urgent management.

Vancouver, British Columbia, Canada

From the University of British Columbia.

Received for publication December 16, 2013; accepted May 7, 2014.

Disclosure: Dr. Rohrich receives instrument royalties from Micrins Instruments and book royalties from Quality Medical Publishing. He received clinical research grant support from Neodyne Biosciences, Inc., for participation in a clinical trial. No funding was received for this article. The other authors have no financial information to disclose.

Jean D.A. Carruthers, M.D., Clinical Professor \Department of Ophthalmology, University of British Columbia, 943 West Broadway, Suite 820, Vancouver, BC V5Z4E1, Canada

©2014American Society of Plastic Surgeons