Anatomy of tear trough/eye area when using fillers: How do surgeons know where to inject? Why is this procedure safe? (photo)

Question

A certified plastic surgeon did my TT filler. I was told that the eye area is a very vascular area. The surgeon told me that adding a little filler in that area is safe to do. So I went ahead and had an hyaluronic based filler injection "Juvederm". Two weeks later I hated the tightness and pressure so I had it dissolved. I still have anxiety that I will become blind and that some of the filler could of been placed in a blood vessel since it's by the eye. Why is this procedure even safe to do?

Jason Emer, MD · Answer

Injections to the tear troughs is a safe procedure when seeing a trained practitioner. While vascular occlusion is a risk, it is extremely rare. I recommend injections with cannulas to limit swelling and/or bruising. Keep in mind, a combination approach will give the most improvement to this area. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Munir Somji, BSc, MBBS · Answer

Complications can occur with any medical procedure. Yes there is a risk of blindness with tear trough fillers and studies looking into the incidence of blindness after dermal fillers have flagged this area as a 'danger area'. It is highly unlikely that you will have visual disturbance as a result of your treatment as this is normally an immediate side effect.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question willjmar.
I understand your concern. Fillers are used to restore lost volume in and
enhance the appearance of the face.
The tear trough is the area under the eye. Hollowing commonly occurs in this area, which is a common concern. This can be addressed by restoring lost volume in the area. I prefer to use a soft filler in this area such as Volbella as it does not lead to much swelling (which is undesirable in this area). There are a lot of blood vessels in this area (mostly veins) and bruising is more frequent in this area; in our office we treat bruises with a laser as early as the next day making them resolve more quickly. Often times patients will also have volume loss in the mid-face, directly below the tear trough deficit. In these cases I also use Voluma in the cheeks to provide the structural support for the mid-face and tear trough.
With any injection there is a risk for pain, bruising, bleeding, redness, swelling, tenderness, and infection. Physicians are trained to take precautions to minimize these risks. In addition with fillers there is also the risk of vascular occlusion. This occurs when the product is inadvertently either placed inside of an artery or just beside an artery placing enough pressure on it to block blood flow. Such vascular occlusion is very rare and is reported to occur approximately one out of 100,000 times or so. When this occurs the blood supply to nearby tissues can become compromised and if untreated it can lead to consequences such as death of the tissue, scarring, or in very rare cases irreversible blindness.
Fortunately such cases can be addressed immediately by placing hyaluronidase in the area to dissolve the filler. This dissolves the filler in the case of hyaluronic acid products such as Juvederm, Volbella, and Voluma as well as other hyaluronic acid products. There is even a technique to place the hyaluronidase in the back of the eye if visual changes occur. Symptoms are either seen immediately or within the first few hours. Changes observed in the office include blanching or a whitening of the surrounding area. Symptoms reported by patients include severe pain at rest and visual changes. When addressed promptly, there are usually no permanent side effects.
Overall placement of filler in the tear trough and surrounding areas is very safe. Techniques to avoid such effects include using hyaluronic acid fillers (as they can be dissolved), applying slow syringe pressure, moving the tip of the needle or cannula while injecting, and using small amount of product at a time. It has been proposed that aspiration prior to injection may decrease the risk of intravascular injection. However this has not been shown to be the case as the thickness of the product may preclude flashback of blood into the syringe and the tip of the needle may be moved by a slight amount after aspiration but before injection. Additionally, some say that the use of cannulas decreases the risk of intravascular injection. However such complications have been seen with the use of cannulas and no definitive studies on this have been reported. Cannulas likely decrease the risk of bruising at the expense of decreased precision of placement of the product.

Please consult with a doctor for specific
recommendations.  Good luck!

Anatomy of tear trough/eye area when using fillers: How do surgeons know where to inject? Why is this procedure safe? (photo)

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