In the hands of a very experienced ASOPRS surgeon, how safe are fillers like restylane to enhance upper eyelid contour and hollowness after over corrected upper eyelid surgery? I have read that blindness is a risk. Are there any statistics and why does it happen? Is there any guaranteed way to have the procedure done with 100 per cent chance of blindness not occurring? Are there any other possible side effects to actual vision other than blindness? Does fat transfer carry the same risks? Thanks.
How Safe Are Fillers Like Restylane for Upper Eyelid Area?
Doctor Answers 10
Restylane into upper eyelids isn't recommended
Injections done by any less than experienced injector can lead to problems; however, the eye area is extremely difficult. The skin is thinner and delicate, the swelling needs to be managed and will be more excessive, and there are all sorts of vascular problems that can occur if it's not done by someone with extreme experience in this type of injection. I would consult with your physician on any other possible treatments to resolve your overcorrected upper eyelid surgery. While HA fillers can be dissolved and will have less of a problem than fat transfer, there are still a number of factors to consider and a number of risks.
Dermal fillers not for upper eyelid
The only places I regularly use fillers near the eye are
- in the tear trough/dark under eye circles
- to accentuate the soft tissue and bony prominence immediately below the tail of the eyebrow to give the eyebrow volume and lift.
The only fillers I use around the eye are hyaluronic acid fillers. The main purpose of hyaluronic acid in the skin is to hold onto water molecules. That is what gives volume and firmness to the skin. The more delicate the skin, the greater the risk that swelling will stay for a long time. So injecting fillers into the upper eyelid, besides the danger of injecting into a blood vessel, can also result in a swollen, heavy eyelid for a long period of time.
Yes filler are done in the upper eyelid.
It is critical that the injector have an intimate and detailed surgical knowledge of the anatomy being treated. By respecting the anatomy of the area being treated, complications are avoided. WIthout this detailed knowledge the risk is that the injector will inject filler intravascularly which can have an adverse effect on the circulation. While these treatments are amazingly safe in the right hands, I am not aware of any injector, ASOPRS or not, who guarantees the safety of these treatments. Do not have these services if you are not 100% comfortable.
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Restylane and Belotero for tear troughs
In our practice, we do not treat the upper eyelids. The tear trough area (lower eyelid) is one that is often treated using Restylane or the newer Belotero with purported less risks of Tyndall effect.
Fillers in the upper eyelids
Fillers are not commonly used for the upper eyelids, but are used more commonly in the lower eyelid tear trough region. There are known cases of blindness with injection into a vessel but it is extremely rare.
Fillers for upper eyelids have serious risks, no way around that
In the hands of a very experienced ASOPRS surgeon, how safe are fillers like restylane to enhance upper eyelid contour and hollowness after over corrected upper eyelid surgery?
=== Is the surgeon experienced doing THIS procedure? I would wait until the surgeon has done about 50 of THESE cases.
I have read that blindness is a risk. Are there any statistics and why does it happen?
=== Best ask your surgeon about this.
Is there any guaranteed way to have the procedure done with 100 per cent chance of blindness not occurring?
Are there any other possible side effects to actual vision other than blindness?
=== Yes, bleeding, hematoma, infection, overfilling, unequal results etc. Best ask your surgeon.
Does fat transfer carry the same risks?
===YES, equal or worse. Unlike HA fillers [Restylane, Juvéderm] fat cannot be quickly or easily reversed when things go wrong.
Kevin Smith MD FRCPC Derm. Niagara Falls Ontario
Fat Grafting for Upper Eyelid Hollows - View Photos for Evidence
Fillers Like Restylane and Belotero for the Upper Eyelid Area
- Don't use Juvederm or Radiesse by the eye. Juvederm is well known to be more likely to cause inflammation or swelling ... and Radiesse cannot be dissolved if there is a problem.
- Restylane or Belotero are the safest options
- Make sure the injector is experienced and prepared to dissolve fillers if there is a problem. Anyone who is getting filler should feel comfortable to ask, "Do you have Hyelenex or Vitrase available in the office?" Not all doctors stock it, because it is expensive and goes bad if it doesn't get used (which, hopefully is the case). Sometimes it takes a day or two to get it from a local pharmacy. If your doctor has it available, you can feel comfortable that they've used it before, know what to do and are prepared.
- Yes, the risk is blindness. This is a rare complication, but how rare is hard to tell. Blindness is a risk for any procedure around the eye, including fat transfer.
Restylane and contour around the eyes
There is always a risk when injecting any product, however, certain areas of the face are at higher risk than others. I'm unsure of statistics to date, however visiting the website of the particular filler you're considering is a good place to start. In reality, the incidence of blindness and/or serious side effects are very low, but there are no guarantees either way.
Fillers for upper and lower eyelid hollows
Hyaluronic gel fillers can safely be injected into lower or upper eyelid and brow hollows. The risk of vascular occlusion is extremely low, and in fact, lower than injections in the nasolabial folds. See following link/manuscript and video.