Can a cannula be inserted too high for dermal filler treatment? Diagnosed w/ nerve damage due to bad injection technique?(photo)

Thank you for your question. I understand you had half a cc of Juvederm placed in the infraorbital cheek area three months ago, and in the first four weeks after the procedure, you experienced stabbing pain, swelling and inflammation in the area. You’re wondering if the cannula was placed too high, and after visiting a doctor to get a second opinion, you’ve come to the conclusion that there is some permanent infraorbital nerve damage.Before we get into the details of what happened, let me just tell you a little bit about myself: I'm a Board-certified cosmetic surgeon, certified by the American Board of Cosmetic Surgery, and a Fellowship-trained oculofacial plastic and reconstructive surgeon. I specialize in Ophthalmology, or eye surgery, and I work extensively with the eyelids and the orbit lacrimal system. A significant part of my career has been focused on treating orbital disease, orbital tumors, and orbital trauma, so I can certainly speak from a lot of experience, and can give a little context of what you may have experienced, and what to anticipate.First of all, I think the intention of your doctor was to avoid the challenges of using a needle, and to avoid causing any bleeding or puncturing of the anatomy in that area. To ensure this, they used a blunt tip cannula, which is designed to work its way around the tissue and other structures, so it doesn’t pierce through anything like a vessel. However, it is important to understand that even with a blunt tip cannula, it will still meet with some resistance. In this case, it seems that your doctor struggled with the placement, applied a lot of force, and then overshot, although I can’t say this definitively as I was not present during the procedure.The under eye area is where the infraorbital nerve bundle, or neurovascular bundle, is located. Determining whether there is long-term damage to this area is difficult because the trauma seems to have caused some inflammation as well. In addition to this, trauma can take six months to a year to fully heal, so it can be difficult to determine the extent of the damage at this point in time.It is important to understand that the infraorbital nerve can withstand a lot of trauma. To put it into context, this is an area t can get traumatized often in facial fractures and other blunt trauma injuries. This space is also routinely injected with local anaesthesia by dentists, to intentionally create numbness for procedures. I have also seen patients who have been shot, who have been hit with bats, who have been in terrible motor vehicle accidents and had profound issues with the infraorbital nerve, and in spite of that, it heals. It is common for this area to receive quite a bit of trauma and not have long-term injury. In your case, there could have been some localized bleeding, irritation, or swelling, but because it was a blunt instrument, it seems unlikely that any piercing of the nerve or permanent numbness has occurred.In addition to this, 0.5 CCs of filler is not a lot, if you look at the scope of things. One of the strategies to consider is to dissolve the filler, and see if the pressure from the filler is what is causing some of these symptoms. This can be done with the help of hyaluronidase, which is an enzyme that can dissolve hyaluronic acid fillers such Restylane, Juvederm or Voluma, is areas where it is not wanted.That being said, there is an art and a technique to the proper placement of fillers. In our practice, we do a procedure called the Y Lift®, wherein we augment the cheek areas, among others areas of the face, with a blunt tip cannula placed strategically in these areas. There are a lot of vessels and nerves in this submalar space, so it’s usually a matter of trying to get the material in the right place without causing any trauma to the patients.Other options to consider are to visit an oculoplastic or orbital specialist to get a second opinion to make sense of what’s going on; having imaging studies, such as an MRI, done; or simply wait it out and allow it to resolve on its own. As I mentioned before, you can have the material dissolved and perhaps also get a recommendation for anti-inflammatory to help with the inflammation issues. At this point, it’s just a matter of getting the right information from the right source, and so you have the guidance you need.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Your photo seems to indicate the usual area for the infraorbital nerve.  What is the deficit that you are having?  With injury, many people will experience temporary numbness to the cheek and gums.  Usually, this resolves over weeks to months.  Make sure that your original injector is aware of your condition.  Wish you a speedy recovery!

Thank you for your question! Where the cannula enters isn’t the root of the problems you've been facing. It is not the fault of how it has been inserted rather the technique after insertion that has caused the problem. With injury, many people will experience temporary numbness to the cheek and gums.  Usually, this resolves over weeks to months. Make sure that your original injector is aware of your condition. Best of luck!