{"id":24096,"date":"2023-02-01T15:12:18","date_gmt":"2023-02-01T23:12:18","guid":{"rendered":"https://www.realself.com\/news\/?p=24096"},"modified":"2023-10-12T16:47:40","modified_gmt":"2023-10-12T23:47:40","slug":"risky-dermal-filler-areas","status":"publish","type":"post","link":"https://www.realself.com\/news\/risky-dermal-filler-areas","title":{"rendered":"Doctors Say These Are the 5 Riskiest Areas to Get Filler"},"content":{"rendered":"

Fillers<\/a> offer something that almost no other minimally invasive cosmetic procedure, injectable or otherwise, can: instant gratification. Both patient and provider can see the results right away, in real time—something that even the beloved Botox<\/a> can’t provide. Not to mention that fillers can do so much more than fill<\/a>. Doctors can utilize different types of fillers, amounts, and injection locations to achieve a variety of different desired end results, notes Dr. Carlos Wolf<\/a>, a double board-certified facial plastic surgeon in Miami.<\/p>

Most of the time, the potential side effects from injectable fillers are minimal and temporary, with swelling and bruising being the most common. However, fillers<\/a> do come with some very real risks. Vascular occlusion<\/a>, caused when the filler is inadvertently injected into a vessel or compresses it, can happen anywhere on the face, points out New York City board-certified dermatologist Dr. Jeremy Brauer<\/a>. This can result in anything from tissue death (aka necrosis<\/a>) to irreversible blindness or stroke. Granted, these complications are rare; research<\/a> has put the incidence of vascular compromise at 0.05%. <\/p>

The best way to mitigate risk is to find an experienced, licensed provider who knows both how to inject properly—and what to do if things go awry. “It’s critically important that the injector not only is well trained but also has the capability to reverse a problem should it arise,” says Dr. Wolf. (To that point, all injectable fillers can cause vascular occlusion, but hyaluronic acid formulations can be reversed via an enzyme known as hyaluronidase<\/a>.)  Still, no one is immune from running into a problem. “These complications can happen with the best of injectors. The tricky thing with fillers is that you’re injecting blindly. You can have a sense of where the vessels are, but you can’t see them,” points out Dr. Catherine Chang<\/a>, a board-certified plastic surgeon in Beverly Hills, California. She also adds that the risk level isn’t necessarily the same in every injection spot, referring to it as “a tiered system.” Below, we ranked the five areas doctors say are the riskiest.<\/p>

1. The glabella<\/h2>

The glabellar lines—colloquially referred to as the ‘11s’ in between your brows—are a traditional and common spot for neurotoxin injections. Filler can be used here as well, but all the doctors we spoke with agree that it’s the most dangerous area on the face in which to do so.  As a general rule, the closer to the eyes you’re injecting, the more likely that a vascular occlusion can cause blindness, based simply on the anatomy of the face. (It comes down to the proximity to the ophthalmic artery, which supplies the retinal artery.) And in the glabella, there are two main arteries that have a direct connection to the ophthalmic artery, says Dr. Wolf. Inadvertently injecting filler into one of these can ultimately end up occluding the retinal artery, which is what leads to blindness. It’s so risky that he doesn’t even inject in this area. Dr. Chang will, but is quick to note that it’s as a last treatment option. “I will occasionally inject filler here, but it’s not something I immediately jump to, because of this potential risk. I’ll try everything else first, from increasing Botox frequency and concentration to lasers, before going to filler,” she says. <\/p>

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2. The under-eyes<\/h2>

Anywhere around the infraorbital area is risky, although the closer you get to the nose and the dorsal nasal artery—located on the bridge of the nose and also connected to the ophthalmic artery—the more that risk goes up, Dr. Wolf says. The issue with injecting under-eye filler<\/a> is that it tends to be done more in the medial part of the under-eye (rather than the lateral portion, closer to the side of the face)—which is fairly close to this artery.<\/p>

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