Why is filler in the glabella area so risky?

Question

I have a deep divot that has not been able to be fixed by Botox alone. I really need filler to help the area smooth out the divot. Seems like most people do not recommend getting filler there for the risk of blindness. But how often does that happen? Are there any other safer alternatives? Of safer fillers out there?

Glenn Murray, MBBS · Answer

Hello,

Glabella dermal filler is considered particularly risky due to its complex vascular anatomy. This region is rich in blood vessels that connect directly to the ophthalmic artery, which supplies blood to the eyes and surrounding structures. Inadvertent injection into these vessels can lead to severe complications, including blindness.
The glabella contains the supratrochlear and supraorbital arteries, which are branches of the ophthalmic artery. These arteries have limited collateral circulation, meaning that if they become obstructed, there is little alternative blood flow to compensate.

It is very important to choose an experienced practitioner for this treatment.

Eric M. Joseph, MD · Answer

There are reported cases of blindness with HA fillers when they are used in the Glabella area. In our practice, we specialize in the use of microdroplet Silikon-1000, a permanent filler. With Silikon-1000, necrosis and blindness never occur since the size of a Silikon-1000 molecule is smaller than that of a red blood cell. Thank you for your question. Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

Without a photo and a bit more history, I can only comment in the most general of terms. The concern for the use of filler in the glabella region is due to the richness of the vasculature in the region and its connection with retinal vessels. Subcision, which I have been performing routinely since 1995, works well for elevating and smoothing all kinds of indented scars and divets in all locations from all causes whether from acne, trauma, infections, surgery, etc.  What's more it has a several decades' long efficacy and safety record in all skin types. So, this may for you be the way to go.  That being said, when properly injected, and with an appropriate, injections of filler in this region (as well as in the forehead) can be safely administered. I not only routinely do so for my patients who require it, but have done so for myself and for my family members. This is not a region to be left to hands of an inexperienced injector accsustomed to using plain Juvederm or simple Restylane for treating ordinary smile lines. You would be wise to consult with a board certified, cosmetic dermatologist with extensive experience in both subcision and in filler use for the glabella.  Hope this helps and best of luck.

Darren West, MD · Answer

The glabellar area is risky for filler injection due to the proximity of vascular structures and the increased risk of vascular occlusion. Fortunately, the actual occurrence of vascular occlusion is rare. However, even a low risk of such a catastrophic complication makes it such that this in not considered a safe area for injection of filler. A couple of options to try would be smooth PDO threads or PRP/PRF. These can be used individually or together and work well with Botox.

Why is filler in the glabella area so risky?

Answers (4)

Answer: Filler in the Glabellar Area

Answer: Filler in the Glabellar Area

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Why is filler in the glabella area so risky?

Answers (4)

Answer: Filler in the Glabellar Area

Answer: Filler in the Glabellar Area

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Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.