How Safe is Restylane Between the Eyes?

Question

Bewteen my eyes I have atrophic scarring (tissue lost from cystic acne) made pronounced by frown lines; in other words, the depressed area makes the frown lines look deep.  I plan to get Botox in this area first before I a filler.  I read that filler between eyes can lead to necrosis, blindness, brain clot, etc.  How common are these effects?  How can they be avoided?  Does the fact that I have a scar in that area make the risks more likely because the filler may settle around the scar ("donut" effect) as sometimes happens when using fillers for scars?

Jeffrey E. Schreiber, MD, FACS · Answer

Restylane is great for filling in superficial areas around the eyes and between the eyes in the glabellar region. Yes, there are potential complications with this, but they are very rare. Be sure you are comfortable with the person who is doing your injections. You may want to consider seeing someone who is board certified. As far as scar tissue is concerned, you may want to have your surgeon lift up the scarred areas with a needle first to allow the depressed areas to be elevated by the Restylane. This may help to prevent the "doughnut" effect you're worried about. Good luck!

Jeffrey J. Roth, MD, FACS · Answer

Botox is our first line of defense in our office.  Sometimes there will be deep lines that are still present.  In selected cases one can place juvederm in the area   This should be done by an experienced injector.

Ron Shelton, MD · Answer

This is a dangerous area for thick fillers. Superficial placement of a filler that is not too viscous or thick, can be done; but, I would agree that the Botox should be done first. Give the Botox up to one month after injection to see its results

Michael A. Persky, MD · Answer

Hi Truckg,
Injection of any filler in the glabellar area between the eyebrows must be performed carefully.  The injections should be superficial, and placed slowly.  As you have stated there have been reports of severe complications in this area, but they are extremely rare. 
Your inquiry emphasizes the importance of choosing a well trained, board certified physician to perform your injections.
Good luck and be well.
Dr. P

Richard Baxter, MD · Answer

You are correct to be concerned but in general the complications you describe are very rare. I think the bigger issue is that HA fillers, and any dermal filler for that matter, are not always ideal for filling in scars. The scar tissue can be too dense to allow the filler to expand the space and fill the depression in. Botox forst is the right choice.

Kenneth D. Steinsapir, MD · Answer

Dear Truckg
Injection into the glabellar area can disturb the circulation and cause localized damage to the skin. Generally this results when the material is placed too deep and too much is used. Embolization is certainly described with certain materials causing damage to distant structures including the retina. It is not clear if this is the mechanism for the localized disturbances in the skin following glabellar injection of the hyaluronic acid fillers. The common disturbances that have been reported include localized skin beak down and disturbances to the skin circulation on the nose.  Provided that hyaluronic acid fillers were used, the treatment is injection with hyaluronidase.
Best advise is work with experienced injector in your area.

Monika Soni, MD · Answer

Thank you for your question. Restylane is great filler for superficial areas around the eyes and between the glabellar area. Yes, there is the possibility of complications, but this is very rare. To help prevent the “doughnut” effect your injector can lift up the scarred areas with a needle to allow the depressed areas to be elevated by the Restylane. I recommend discussing your concerns with an expert injector to determine the best treatment plan for you. Best of Luck!

Hardik Soni, MD · Answer

Thank you for your question. Restylane is great filler for superficial areas around the eyes and between the glabellar area. Yes, there is the possibility of complications, but this is very rare. To help prevent the “doughnut” effect your injector can lift up the scarred areas with a needle to allow the depressed areas to be elevated by the Restylane. I recommend discussing your concerns with an expert injector to determine the best treatment plan for you. Best of Luck!

Suzanne Kilmer, MD · Answer

Those side effects are very rare
if performed by a highly trained physician that is aware of the underlying
vasculature and knows how to quickly treat the complication should it actually
occur as rapid treatment mitigates most side effects. Only a small amount
should be injected and you can tell at the time of injection how the scars will
do and most acne scars do really well.

Steven Wallach, MD · Answer

Injecting fillers into the glabellar region such as with restylane or juvederm should be performed cautiously. Yes, there have been reports of complications in this area, and you should use a very well trained doctor.

How Safe is Restylane Between the Eyes?

Answers (12)

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