Are There Dangers with Under Eye Filler?

After hollowness following a lower bleph, I decided to fill with restylane. The hollowness is actually in the fat pads under eyes laterally, not tear trough. I used a reputable doctor I heard mentioned on this site. He has done a lot of this and I believe he injected from rim area, not directly into fat pad area. I have now read that this is a dangerous area above the rim to fill. Is the danger only at the time of injection, or do I still have to worry that some permanant damage was done.

Doctor Answers 4

Dermal fillers around the eyes

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are used frequently and without problems  Yes, there are some bizarre stories that you hear but if you didn't have a problem at the time of injection, you are fine.  Your product will slowly dissipate and be gone in several months.  The needles used to inject the are designed to have a side port to minimize the risks for intravascular injections and if you continue with this, make sure they are using the special needles.  Bottom line, don't worry about anything at this point... you are good.

Fillers along under eye region

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Most fillers are FDA approved only for masolabial folds, and all other locations are off-label. The lower eyelid area can be more difficult because of the increase bruising that can develop, and because the skin is very thin the potential for seeing lumps.

This is not precisely true what you have read.

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Every cosmetic procedure has some risk.  Some risks are are higher than others.  The risk of going blind in one eye after eyelid surgery is approximately 1 in 30,000 to 1 in 50,000.  Exact numbers are impossible to determine.  The risk of going blind from a periocular Restylane treatment including under eye hollow treatment appears to be much lower than this but definitely not zero.  There were altogether 12 million filler treatments last year.  Precise numbers of individuals who lost vision after such a treatment is not published.  Many of these cases are litigated and for that reason do not really become part of medical research.  However, the number seems to be quite small, perhaps on the order of 10 to 12 cases or less.  Not an epidemic but not zero either.  Some treatments seem to increase the risk of potential complications.  This includes glabellar treatment, upper eyelid treatment, and aggressive medial treatment.  Several years ago I published the Deep Fill methods which uses the bony orbital rim as a landmark for under eye treatment.  This landmark is relatively free of vascular structures and provides a method of placing filler into the under eye hollow while avoiding the major vascular structures which could compromise blood flow.  Filler can be floated into the superficial orbicularis oculi and this method also appears realtively safe.  The greatest theoretically risk is intravascular injection into the angular artery and vein.  These vessels are located deep to the orbicularis and superficial to the bone medial to the medial corner of the eyelids.  Knowledge of the anatomy is very important in making a safe treatment.  However, no one can guarantee zero risk.  The risk is at the time of the injection.  Now that you have been treated, you can breath a sigh of relief.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Periocular Filler Injections

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Peri-ocular injection of fillers are an off-label use of FDA fillers. Nonetheless they have been used in this area quite effectively.  The most commonly reported risk and side effects include prolonged swelling depending on the filler used, infection, skin injury, lumpiness, visibility of the filler, and embolization into one of the eyes blood vessesl causing blindness. The use of blunt tipped microcannulas and improved techniques have made these risks much less.  Most patients experience very good results.  If you did not have any complications from the treatment, you are unlikely to have any long term problems with restylane.  All the best.

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