What education does an injector receive about the eye area and how to avoid injecting Voluma into a blood vessel? (Photo)

There is a Dentist in my area who advertises and does seminars claiming to be a Diamond status member with Allergan. Is it a common problem to accidentally inject Voluma into a blood vessel? Allergan does not recommend injecting Voluma into the tear trough area, but lets the doctors use their own discretion as to where they want to inject the product. The FDA approves the product, but who certifies the doctor who makes the decision as to where he or she wants to inject it?

Doctor Answers 7

What education does an injector receive about the eye area and how to avoid injecting Voluma into a blood vessel?

Great question; complicated answer.  I get frustrated when I hear of dentists and other unqualified medical professionals (and non-medical for that matter) performing medical procedures that are not part of their core practice and/or training.  Most injectable companies will sell to anyone that will buy their product so their is no certification for this type of procedure unfortunately.  They may learn by going to a course put on by the company, by experience, or from a training provider.  Most non-core people that do cosmetic injections do so to make money rather than because they are trained to do so. Fortunately, our core governing bodies (American Board of Plastic Surgery, American Board of Medical Specialties, American Board of Dermatology, American Board of Otolaryngology) and legitimate medical societies try to educate patients/consumers to find a appropriately board-certified provider and try to lobby to have stricter legislation on this topic.  Unfortunately, progress still needs to be made in this arena.  The only recognized legitimate board-certification are those listed under the American Board of Medical Specialties; all others (including the American Board of Cosmetic Surgery) are not considered legitimate.  Do your research prior to letting someone perform any medical procedure on you including cosmetic! As for Voluma around the eyes--I don't do it. The product is quite thick and given the thin, fragile nature of the skin/tissue around the eyes there is a high risk that particular product will be visible/palpable.  I tend to use thinner products such as Belotero & Restylane in the periorbital area and have seen great results. Injecting in this area is never risk free and bruising is common BUT intra-arterial injection is a dreaded complication b/c it can cause blindness.  The main way to avoid this is to be vigilant in placing the product deep on the bone and pulling back on the needle prior to injecting to make sure there is no flash of blood suggesting intra-arterial needle positioning.  Good luck!


Boca Raton Plastic Surgeon
5.0 out of 5 stars 15 reviews

Educate Yourself on Experienced Voluma Injectors

Dentists take care of teeth, not tear troughs, and should not be taking care of cosmetic procedures on the skin period. This is not, however, a new problem. But it underscores many fundamental problems that exist out there which I would like to highlight in my response to your question. Board-certified core doctors – dermatologists, plastic surgeons, oculoplastic surgeons, and facial plastic surgeons are the most skilled and educated on cosmetic procedures involving the skin because this is part of what they do daily, part of their training and education, and these are the groups of doctors that understand the anatomy of the skin, what to inject, and where to inject, and more importantly in your case, where not to inject. Injecting Voluma in the tear trough area is not appropriate and the dentist that did this should not be injecting someone around the eye – they need to stick to the mouth and your teeth. It is my same problem with psychiatrists, OB’s, and ER docs that think that this is something that can do easily – it takes skill, education, and training – something that cannot be done at a weekend course, or by having a trainer come into the office for someone to learn from.

The companies that make these products sell to anyone with a medical license – and I bet somewhere behind this dentist, is an MD, most likely not one of the core docs, who is purchasing the product for this dentist. I would strongly advise that you file a complaint with your local medical board, and send the information as well to Allergan – they have a medical affairs department – and let them know that you have had a problem with one of their products injected by someone who should not be injecting their product.

And finally, find a board-certified derm or plastic and let them use hyaluronidase in the area now to get rid of the Voluma in that area as this is not where it needs to be. One can also use a vascular laser to make the bruising go away faster, or leave it resolve on its own, and then get the proper filler, by a proper provider to get your concern taken care of.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Injections and Experience

Voluma is a great injection for immediate lifting of the mid-face. Voluma is not indicated for the area under the eyes.  However, these companies will sell the products, whether it be Botox or Volume to both trained and untrained injectors.  That is why I always recommend that you consult an experienced board certified dermatology with years of experience in facial cosmetic injections for the best results.

Education on blood vessels.

Thank you for your question. Voluma is typically used for facial areas requiring volume such as, cheeks. Training and education varies throughout injectors. All injectors should be aware of major blood vessels. That being said bruising is a common side effect of injections and can take approx. 2 weeks to resolve.

Best, 

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

What education does an injector receive?

I'm sorry that you have had a bad experience.  Unfortunately this is more common than ever as anyone is able to inject whatever they want wherever they want.  It is so important to go to an injector who is reputable with many years of experience.  Its probably safest to go to a specialist who had had formal training in injections during their residency or fellowship.  In any event hopefully your bruising will resolve and leave you with a good result. If not the good news is the voluma can be dissolved with hyalronidase. Good luck.

Katrinka L. Heher, MD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 8 reviews

Filler Injections

It worries me when non core physicians are doing cosmetic treatments.  I suggest only going to someone surgically trained in their residency and fellowship to perform any cosmetic procedures on you.  Doctors use their own discretion and experience, in using the fillers "off label" and it has to be consented by the patient (you).  I typically do all filler injections in the tear trough with cannulas and this makes it much less likely to have any complications.  I suggest going to an expert next time.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Dentists injecting dermal fillers

Personally, it scares me that dentists are injecting dermal fillers and Botox. The reality is there is no specific certification for injectables. I personally don't use Voluma in the tear troughs. Having said all of that. Based on your photo, it appears that you are just bruised.

Sean Maguire, MD
Louisville Facial Plastic Surgeon
4.7 out of 5 stars 20 reviews

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.