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Brief Report |

Cosmetic Facial Fillers and Severe Vision Loss

Michelle V. Carle, MD1; Richard Roe, MD, MHS1; Roger Novack, MD, PhD1; David S. Boyer, MD1
[+] Author Affiliations
1Retina-Vitreous Associates Medical Group, Los Angeles, California
JAMA Ophthalmol. 2014;132(5):637-639. doi:10.1001/jamaophthalmol.2014.498.
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Importance  Dermal injection of cosmetic fillers can lead to irreversible blindness when injected in the forehead, and this possible adverse effect is not typically mentioned to patients.

Observations  Vision loss from central retinal artery occlusion occurring, after cosmetic facial enhancement, was irreversible in 3 patients. However, 1 patient had a small amount of recovery with aggressive therapy.

Conclusions and Relevance  Cosmetic facial fillers are not approved for use in the forehead, but off-label use for enhancement in this region is common. To our knowledge, there have been no prior reports of blindness caused by filler injected into the forehead. We present findings of central retinal artery occlusion due to fillers in 3 patients shortly after their cosmetic procedures. The filler presumably enters the central retinal artery via the rich external-internal carotid anastomoses and becomes embedded in the retinal tissues, potentially leading to irreversible and severe vision loss. Physicians performing cosmetic enhancement procedures involving facial fillers need to be aware of this potential complication and should include significant vision loss as a possible rare complication.

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Figure 1.
Early and Late Imaging Findings After Injection of a Hyaluronic Acid Filler to the Forehead in Patient 1

A, Color fundus photograph of the left eye demonstrates a partial cherry-red spot in the central macula and scattered intraretinal hemorrhage. B, Fluorescein angiography (FA) of the left eye demonstrates blockage of the inferior branches of the retinal arteries and patchy choroidal nonperfusion. ICG indicates indocyanine green. C, Ocular coherence tomography of the left eye, 1 year later, demonstrates retinal thinning starting just below the fovea. ILM indicates internal limiting membrane; RPE, retinal pigment epithelium.

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Figure 2.
Imaging Findings the Same Day as Injection of Autologous Fat to the Forehead in Patient 2

A, Color fundus photograph of the right eye reveals diffuse retinal whitening and lipid filled arterioles. B, Fluorescein angiography of the right eye in an early frame demonstrates delayed patchy choroidal filling. C, Later frame of the fluorescein angiogram demonstrates incomplete filling of the retinal arteries and patchy choroidal filling.

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Figure 3.
Imaging Findings the Same Day as Injection of Bovine Collagen and Polymethylmethacrylate Microspheres in Patient 3

A, Color fundus photograph of the right eye shows retinal whitening and a cherry-red spot in the central macula. B, Fluorescein angiography of the right eye in an early frame demonstrates patchy choroidal filling and some delayed proximal filling of the arteries on the disc. C, Later frame of the fluorescein angiogram demonstrates incomplete filling of proximal arteries only.

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