Kevin C. Smith, MD (retired)

In the hands of a very experienced ASOPRS surgeon, how safe are fillers like restylane to enhance upper eyelid contour and hollowness after over corrected upper eyelid surgery?
=== Is the surgeon experienced doing THIS procedure? I would wait until the surgeon has done about 50 of THESE cases.

I have read that blindness is a risk. Are there any statistics and why does it happen?
=== Best ask your surgeon about this.

Is there any guaranteed way to have the procedure done with 100 per cent chance of blindness not occurring?
=== NO.

Are there any other possible side effects to actual vision other than blindness?
=== Yes, bleeding, hematoma, infection, overfilling, unequal results etc. Best ask your surgeon.

Does fat transfer carry the same risks?
===YES, equal or worse. Unlike HA fillers [Restylane, Juvéderm] fat cannot be quickly or easily reversed when things go wrong.

Kevin Smith MD FRCPC Derm. Niagara Falls Ontario

The FDA only approves what a drug or device can be ADVERTISED FOR, but the FDA [and the Canadian equivalent] do not control what a drug or device is used for once it is on the market.

The reason why additional perfectly reasonable indications for drugs and devices are not sought is that it can cost $10,000,000 or more [and take a number of years] to run the studies and deal with the legal hassles in order to be allowed to ADVERTISE a drug or device for a particular purpose, and in a lot of cases it is not worth it to the drug or device company to spend that time and money.

The physician is responsible for what a drug or device is used for.

Kevin C Smith MD FRCPC [Derm.] Niagara Falls Ontario

Allergan Canada does not use reps to teach injection technique.

I am an instructor for Allergan, and physicians like me teach other physicians and demonstrate injection techniques for BOTOX®, Juvéderm® and Voluma®.

For example, I will be teaching for Allergan in Halifax, Montreal, Toronto and Winnipeg over the next couple of months; and I have taught for Allergan in Australia, New Zealand, Mexico, Thailand, etc etc in the past.

I think that the same situation exists in the US and other jurisdictions.

Kevin C Smith MD FRCPC [Derm.] Niagara Falls Ontario

BTX-A [BOTOX, XEOMIN, Dysport] can cause excessive relaxation of the forehead muscles, leading to BROW PTOSIS [drooping of the eyebrow]; and if BTX-A gets down into and relaxes the levator muscle which lifts the eyelid, your can get LID PTOSIS.

There are a number of other medical conditions which can cause similar symptoms, so if the problem has persisted for three months I would certainly want to see a neurologist to have those other problems ruled out.

Occasionally in older people separation of the levator muscle from the tarsal plate in the upper eyelid can cause a permanent droop of the eyelid. This is a random problem which has nothing to do with BTX-A. If that turns out to be the cause of your problem, it can be easily corrected by an ophthalmological surgeon.

Kevin Smith Niagara Falls Ontario

While it is possible that you could get a headache after BTX-A [BOTOX, XEOMIN, Dysport] injection -- for example, if the needle touched the underlying bone -- there are a number of unrelated medical conditions which could cause the symptoms you are complaining of, so if I were you I'd return to the doctor who injected you, and if necessary also see your family doctor for assessment and/or referral to a headache specialist.

Most BTX-A [BOTOX, XEOMIN, Dysport] is either taken up by the nerve endings or washed away by the circulation in the first hour after treatment, so as a practical matter I tell my patients there are NO restrictions on their activity after the first hour.

Fillers tend to be very stable after the first day, so a facial two days later should not be an issue, unless the injected area is still swollen, or is tender or bruised.

Better get your treatment records from whoever injected you, to make sure of the product.

Hyaluronidase ONLY works on hyaluronic acid [HA] products like Restylane and Juvéderm -- that is one of the safety features of the HA fillers -- they can be rapidly and easily reversed by injection of hyaluronidase.

One mark of a high quality injector is that they will have hyaluronidase in their offices at all times, ready for immediate use.

Having said all that, there are MANY things that can cause lumps and bumps, so if the problem has not responded [or if the filler was not HA] then you might need to see a dermatologist or plastic surgeon experienced in the use of fillers for assessment and treatment.

Kevin Smith MD FRCPC [Derm], Niagara Falls Ontario

A bit of BOTOX® on the other side, in the right place, could restore the symmetry of your face by relaxing the corresponding set of muscles on the other side of your face. I sometimes do this for patients of mine whom I am treating for post-herpetic neuralgia [PHN] on the face and forehead. If I expect that they will get some muscle relaxation, I will often treat the opposite side of the face on the same day as I am treating their PHN, in order to prevent asymmetry.

Your doctor may or may not be able to do this for you, or if your problem is quite mild you might prefer to just wait.

You can, to a limited degree, speed up recovery of the relaxed muscles by exercising them as hard as possible for 5 minutes, 5 times a day.

Kevin Smith MD FRCPC Niagara Falls Ontario

Your symptoms do not sound as though they are related to BOTOX® [or other fomulations of BTX-A including XEOMIN® and Dysport®], and the duration of your problem far exceeds the duration of effect of BOTOX® [which in that area would be usually 3-4 months, and almost always less than 6 months].

There are a number of other medical conditions, unrelated to treatment with BTX-A, which might account for your symptoms. If I were you I would get worked up for your problem by your family doctor or internist.

BOTOX® generally affects muscles within a 1 - 1.5 cm radius of the injection site, so it is VERY unlikely that your symptoms are related to BOTOX® for headache.

You might have some unrelated problem, or perhaps it is just the power of suggestion where some people [after reading the package insert for a drug] start to feel that they are having some or all of the symptoms listed in the package insert.