It was an unremarkable procedure, the kind of simple wrinkle treatment carried out countless times a day: an injection of filler materials to smooth out the worry-lines on the client’s forehead. The substances involved were conventional and well-tested — Artefill, an FDA-approved dermal filler composed of polymer microspheres, and a widely-used bovine collagen preparation. The patient herself was a fit, healthy woman in her mid-40s. Neither she nor the clinicians anticipated any untoward outcomes.
Yet when the woman opened her eyes after the final injection, she discovered that she could no longer see anything out of her right eye.
Ophthalmologist Dr. Michelle Carle and her colleagues at the Los Angeles based Retina Vitreous Associates Medical Group examined the woman, astonished that such an extremely common procedure could go so horribly wrong. A test called fluorescein angiography was used to get a clearer picture of what had happened. In fluorescein angiography, a harmless fluorescent dye is injected into the blood vessels of the eye, allowing the circulation to be visualized in great detail. To their shock, the ophthalmologists discovered that the circulation in the patient’s eye had become patchy and obstructed. Even very aggressive treatments produced only the most marginal improvement. The blindness was permanent.
As an isolated case this would be worrying enough, but the woman was not alone. Dr. Carle also treated a man in his mid 30s and a woman in her 60s, both of whom had experienced vision loss following routine dermal filler injections.
In the man’s case, he’d received an injection of hyaluronic acid. Everything seemed fine at the time, but the following day he’d noticed a problem with the vision in his left eye. Again, clinicians found that the circulation in his eye had been partially blocked. Even a year later, he was still experiencing vision loss.
The older woman’s case was even more heartbreaking. She’d entered the clinic a healthy woman, expecting to undergo a safe and relatively minor cosmetic procedure: microlipoinjection. She left permanently blind. Unlike the other two patients, her vision loss affected not one but both eyes. The injection of autologous fat into her forehead had somehow resulted in the same obstructed circulation as the other two cases.
Along with her co-authors, Carle submitted an article on the three cases to JAMA Ophthalmology. Commenting on the case, she has pointed out that although the fillers are FDA-approved, this approval only covers their use in the middle of the face. Technically, the use of dermal fillers in the forehead and eye area is an “off-lable” application, and has never been approved by the FDA.
Carle theorizes that in rare cases, some of the filler can escape from its intended location and find its way into the tiny blood vessels that supply the eyes. “While this complication is very rare, it is very significant,” she emphasized. “A bruise will go away, but vision loss is permanent.”