Some people are willing to go to great lengths (and expense) to get rid of their wrinkles, if only temporarily…so they visit a dermatologist for cosmetic filler injections intended to restore a smoother, more youthful appearance to the skin. That’s their prerogative, I guess. But I do want to warn such people about a potentially devastating side effect of such wrinkle treatments—a side effect that doctors typically do not caution patients about. It is irreversible vision loss.

You read that right. Some people, in their quest to look younger, literally go blind on the spot, according to a new report published in JAMA Ophthalmology. Here’s the story…

Cosmetic Filler Cautionary Cases

Cosmetic fillers are sometimes called “liquid face-lifts” because a fluid—usually a product made with hyaluronic acid, collagen, the patient’s own fat or some other material—is injected into the folds of the skin to smooth out wrinkles and creases. The effects generally last for a few months until the filler material is absorbed into the body. Filler injections are the second-most-common minimally invasive cosmetic procedure, after Botox injections, with nearly two million filler procedures performed per year in the US.

In the new report, ophthalmologists in Los Angeles described the cases of three patients they saw who experienced vision loss after receiving filler injections…

  • An otherwise healthy woman in her 60s immediately lost all vision in her right eye after getting fat injections around her hairline. Her eye doctor was not able to reverse the blindness.
  • A woman in her 40s got a collagen injection to smooth out forehead creases. When she opened her eyes afterward, she couldn’t see out of her right eye at all. After aggressive treatment by her ophthalmologist, she regained a slight ability to perceive light with that eye.
  • A man in his 30s noticed some loss in the visual field in his left eye the day after getting a hyaluronic acid filler injection in his forehead. Three weeks later, when there was no improvement, he went to the eye doctor…one year later, his vision was still impaired.

The Danger Explained

The ophthalmologists who reported these problems suspect that the injections can plunge the filler material into a crease or fold with such force that the filler winds up where it doesn’t belong. It enters the bloodstream and gets into an artery that feeds the eye. Tiny bits of filler then block the retinal artery and/or become embedded in the retina, leading to potentially severe and seemingly irreversible vision loss.

Why are filler injections legal if they can have such devastating consequences? Well, the various types of fillers are FDA-approved for use in the lips and/or areas around the nasolabial folds (the creases that run from the nose to the corners of the mouth). Though the fillers are not specifically approved for use in the forehead, doctors are permitted to use approved drugs “off-label” (in ways other than those that are specifically approved)…even when the safety of such usage has not been established. In injecting cosmetic fillers into patients’ foreheads, many doctors do just that.

Also, in some cases, product manufacturers may be misleading consumers into believing that it’s OK to use the product anywhere on the face. For example, the Web site for the hyaluronic acid filler Restylane says that the product “can be used to add volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth.” Using the term “such as” implies that it’s fine to use the material in other areas of the face besides the nasolabial folds—which a consumer might conclude means around the forehead and eyes. In the fine print under “Important Safety Considerations,” Restylane’s manufacturer warns that “the safety or effectiveness of treatment in areas other than nasolabial folds and lips…has not been established in controlled clinical studies.” But that’s in the fine print. No mention is made of potential blindness.

In their report, the eye doctors say that this side effect is rare. Still, the fact that three such patients were recently seen at one single ophthalmology practice makes me wonder whether it occurs far more often than anyone realizes. In fact, digging deeper, I found reports of 44 additional cases of vision loss after filler injections, a significant number of which were in the glabella—the part of the forehead in between the eyebrows where cosmetic surgery patients try to get rid of their “scowl lines.”

Self-defense: The authors of the new report suggest that doctors who perform filler injection procedures should make patients aware of this potential complication. That’s an understatement! In my view, doctors should simply not inject cosmetic fillers where they are not proven to be safe. And as for patients, I certainly wouldn’t want to risk my eyesight for a few months of smoother skin…and I urge my readers not to do so, either.