I will be having Restylane injected for my under eye hollows. I am so afraid. I worry about retinal occulusion, and blindness. I also worry about long term effects. Can you give me your opinion about the procedure under the eyes? Thank you.
Can Restylane Injections Damage my Eyes?
Doctor Answers 32
Don't have Restylane injection for under eye hollows
Although many doctors use Restylane, Juvederm and other soft tissue fillers to correct under eye hollows, I do not.
Although retinal artery occlusion and blindness is very rare and unlikely (2 cases in the literature), visible lumps under the skin and downward migration of the filler is very common.
The eyelid skin is so thin that the filler is often visible as grey lumps.
More commonly, filler injections for under eye hollows, after 6 months are pushed downward by gravity and the action of the eyelid muscle, and the rim of filler is seen on the rim of the orbital bone beneath the dark eye hollow-this actually makes the hollow look worse.
Many, many doctors disagree with me, but i have seen these prob;lems in patients who have had their filler injections iunde rthe eye done by the 'worlds experts' at filler injection.
If you want to do this be certain you see a widely recognized expert board certified plastic surgeon and have him/her show you before and long term 96 months or longer0 results of his/her patients that they have injected.
In my opinion, the proper procedure to correct under eye hollows is surgical fat grafting--it is permanent and smooth-see reference below.
I really love doing hyaluronic treatments under the eyes. I say this even though I am a facial plastic surgeon who does eyelid surgery every week! I started doing the injections about 4 years ago and have even had the treatment myself about 2 years ago. It is amazing as the results can easily last 2-3 years( if not longer). Although reports of blindness are present in the literature I would recommend that you choose your doctor carefully and consider the background, training and experience to lower the risk of any possible untoward outcomes.
Robert. Gray, MD, FACS
This is EXTREMELY rare...
In the vast majority of patients lower eyelid Restylane injections are extremely safe. Lumps, bumps, contour irregularities, bruising, swelling and skin discoloration can all occur following this procedure, but fortunately blindness is extremely rare.
If you’re concerned about blindness following Restylane injections, further consultation with your injector is appropriate. Your provider should be able to discuss this issue and alleviate your anxiety.
You might also like...
Can Restylane Injections Damage my Eye
There have been reports of blindness from injection of dermal fillers around the eyes in very rare cases . That is why it is important to see a board certified Plastic Surgeon who has experience with these injections.
Blindness from Restylane is highly unlikely
Restylane injections are very safe when performed by someone who has alot of experience working around the eyes, such as an oculoplastic surgeon. It's true that if the material is injected into a blood vessel, this can cause retinal artery occlusion and blindness. I have seen one case described in the medical literature. I always withdraw the needle as I'm injecting so as not to push filler into a vessel. Again, make sure you go to someone experience with injections of Restylane around the eyes and you'll be just fine.
RESTYLANE AND THE EYE
Restylane and other hyaluronic acid derivatives are an effective and time proven substance for correcting under eye hollowing (tear troughs). The usual side effects are bruising, redness, and tenderness that subside quickly. Lumpiness or a blue-tinge to the eyelid skin (Tyndall effect) are other side effects resulting from misplacement of the filler substance.
In extremely rare instances the injectable filler can be inadvertently placed into a vein or artery resulting in a stroke to the retina or optic nerve and permanent blindness. Once again this is an exceedingly rare side effect of treatment.
Restylane under the eyes must be done carefully.
You asked if there was a risk of damage to your vision. I must say yes, there are more risks associated with under eye filler injection than with the more straightforward nasolabial (melolabial) fold injections. 100% for sure only a board certified dermatologist or plastic surgeon experienced in surgical procedures around the eye should be performing this procedure. Many think they can do it, but many run into trouble, ranging from visible filler lumps that never go away, to occlusion of a blood vessel in the area. Be very cautious when selecting your physician.
Blindness from Restylane under the eyes
We are aware of only one "potential" case of blindness relating Restylane to under eye treatments. In this case, there was no conclusive link drawn between the injections and other possible reasons for the blindness.
The "tear trough" injection procedure under the eyes is very safe when done correctly. This means proper placement of the product under the muscle and in the correct location (from the eye). Using a "retrograde" injection technique, the product exits the syringe only as the syringe is being pulled out of the tissue. In this way the injector can easily avoid the retinal occlusion noted.
The outcomes noted by Dr. Seckel seem to be associated with injecting the product "over the muscle" and out of place. The bumpiness described is not present when injection procedures are done under the muscle and with the proper placement.
Restylane Under Eye Damage
Restylane has used as an injectable filler for many years and the product has a proven record of safety. As with any dermal filler there is a very small risk for a vascular injection. This risk can be minimized using a microcannula technique. I prefer to place the product just above the bone and inject while backing the cannula away from the inside of the eyelid. Microcannula technique has the advantage of causing less pain and there is usually less bruising.
Restylane for tear troughs
Injection of hyaluronic acid to improve tear troughs has become fairly standard and is an excellent procedure. However, injecting in that area - like all areas - carries risks including the very rare risk of retinal artery occlusion and blindness that you mention. In fact, the tear troughs are not the area most at risk -- that is the forehead, temples and glabella.
Part of the informed consent process includes your physician reviewing risks with you. Because even the best physician doing everything correctly can have a complication. The key is finding a physician who understands and respects the risks, knows how best to avoid them, and how to deal with them if they occur.
Remember also that we often improve the tear trough by not injecting directly into it, but by injecting into the cheek area. That avoids the appearance of puffiness or bulging under the eyes.
I hope that answer helps. Best wishes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.