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Where Not to Get Fillers: High-Risk Injection Sites

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Dermal fillers can enhance facial features and address signs of aging, but not all areas are safe for treatment. High-risk zones for fillers include regions with intricate vascular networks that, if compromised, can lead to severe complications such as tissue necrosis, infections, and even blindness or stroke.

Understanding these danger zones is crucial for anyone considering filler injections. This article outlines the common complications associated with certain facial areas and emphasizes the importance of seeking experienced professionals for such procedures.

Recognizing High-Risk Zones for Dermal Fillers

Identifying areas with a higher risk of complications is a critical step before undergoing dermal filler treatments. Knowledge of facial anatomy helps in recognizing these zones and understanding the associated risks.

Glabella Region (Supraorbital and Supratrochlear Arteries)

Risks of Arterial Occlusion and Blindness: The glabella region, located between the eyebrows, is a high-risk zone for arterial occlusion due to the presence of the supraorbital and supratrochlear arteries. These arteries have limited collateral circulation, making them vulnerable to blockages caused by filler injections. Arterial occlusion can lead to skin necrosis and, more alarmingly, if the filler material travels retrograde into the ophthalmic artery, it can result in sudden, irreversible blindness. The proximity of these arteries to the skin’s surface requires injectors to exercise extreme caution and precision during treatments in this area to prevent such devastating outcomes.

Tips for Safe Injection Practices: To minimize the risk of complications in the glabella region, practitioners should adhere to safe injection practices. This includes thorough knowledge of the vascular anatomy, using blunt-tip cannulas instead of needles, and injecting slowly with low pressure. Aspiration before injection is crucial to ensure the filler is not entering a blood vessel. Additionally, practitioners should apply gentle pressure and massage the area to distribute the filler evenly, avoiding overcorrection which can increase the risk of vascular compression. Patients should be informed about the signs of vascular occlusion and instructed to seek immediate medical attention if they experience any visual changes or skin discoloration post-procedure.

Periorbital Area (Medial Canthus and Infraorbital Region)

Ophthalmic Artery Complications: The periorbital area, encompassing the medial canthus and infraorbital region, is another high-risk zone due to its proximity to the ophthalmic artery. Complications in this area can have severe consequences, including vision loss. The infraorbital artery, a branch of the maxillary artery, is particularly at risk during filler injections. If the filler obstructs this artery or its branches, it can lead to ischemia and necrosis of the surrounding tissues. Additionally, the intricate vascular network around the eyes means that even small amounts of filler can travel to the retinal artery, posing a risk of blindness.

Safer Injection Techniques and Areas: To reduce the risk of ophthalmic artery complications, injectors should use safer injection techniques and areas. This includes avoiding deep injections near the infraorbital foramen and staying lateral to the infraorbital artery. Using a cannula can reduce the risk of penetrating deep vessels, and a layered approach can help in achieving the desired aesthetic outcome while minimizing the volume of filler used. It is also advisable to inject in small regions and to massage the area gently to ensure proper distribution of the filler. Patients should be monitored closely during and after the procedure for any signs of vascular compromise.

Oral and Perioral Area (Lips and Nasolabial Fold)

Facial Artery Considerations: The facial artery plays a critical role in the vascularization of the oral and perioral area, making it a region of concern when injecting fillers. The artery’s course along the nasolabial fold and its branches supplying the lips must be respected to avoid intravascular injection, which can lead to significant complications such as embolization or occlusion. Practitioners should be familiar with the typical pathway of the facial artery and its variations to minimize the risk of adverse events. Techniques such as aspiration before injection and the use of cannulas can help reduce the likelihood of vascular injury.

Avoiding the Wet/Dry Border of Lips: The wet/dry border of the lips is a delicate area for filler injections due to the dense presence of blood vessels. To avoid complications such as vascular occlusion or the formation of nodules, injections should be performed with care. Practitioners are advised to avoid overfilling and to use a technique that ensures the filler is placed superficially, avoiding the deeper vessels. Patients should be informed about the potential for swelling and the importance of post-procedure care to ensure optimal healing and aesthetic outcomes.

Nasal Area (Nasal Augmentation and Alar Groove)

Risks of Nasal Tissue Necrosis: Nasal tissue necrosis is a serious risk associated with fillers in the nasal area, particularly during non-surgical rhinoplasty procedures. The vascular supply to the nose is complex, and accidental injection into an artery can lead to occlusion and subsequent tissue death. The skin of the nasal tip, alar region, and columella is especially susceptible due to its limited blood supply. Signs of impending necrosis include blanching, pain, and skin discoloration, which require immediate medical intervention. To prevent such risks, practitioners must have a detailed understanding of nasal vascular anatomy and exercise caution when injecting in this region.

Contraindications for Nasal Fillers: Certain conditions serve as contraindications for the use of nasal fillers. These include previous rhinoplasty, as the altered anatomy can increase the risk of vascular complications. Active skin infections or inflammatory conditions in the nasal area also preclude the use of fillers. Patients with clotting disorders or those on anticoagulant therapy may have an elevated risk of bleeding and should be evaluated carefully. It is important that practitioners conduct a thorough medical history review and assess the anatomical structure of the nose before proceeding with filler injections.

Frequently Asked Questions

What are the most dangerous areas to get facial fillers?

The most dangerous areas for facial fillers are the glabella, nasal area, periorbital region, and lips due to their complex vascular networks and risk of serious complications like vascular occlusion and blindness.

How can I ensure my filler treatment is safe?

Ensure your filler treatment is safe by selecting a qualified and experienced practitioner, discussing the risks, and ensuring the use of FDA-approved fillers.

Are there any FDA-approved fillers for body contouring?

Yes, there are FDA-approved fillers for specific areas of body contouring, but injectable silicone or fillers for large-scale body contouring are not FDA-approved and can be dangerous.

What are the signs of vascular occlusion after filler injections?

Signs of vascular occlusion include skin blanching, discoloration, pain, and in severe cases, vision changes or signs of stroke.

Can I get fillers if I have an active infection?

No, you should not get fillers if you have an active infection at the injection site as it can exacerbate the infection and lead to further complications.

Why is the glabella region particularly risky for fillers?

The glabella region is risky for fillers due to the presence of arteries that have a direct connection to the eye's blood supply, increasing the risk of blindness if occluded.

Can dermal fillers cause blindness?

Yes, dermal fillers can cause blindness if injected into or around the arteries that supply blood to the retina, though such cases are rare.

Are there any areas where fillers should never be injected?

Fillers should never be injected into areas with complex vascular structures without proper expertise, such as the glabella, deep nose, and areas with an increased risk of vascular occlusion.

Conclusion

Dermal fillers can offer significant aesthetic improvements, but they must be used with caution. Understanding the high-risk zones and potential complications is essential for both practitioners and patients. By choosing experienced professionals, using FDA-approved products, and being aware of the signs of complications, the risks associated with dermal fillers can be minimized, ensuring a safer and more satisfying outcome.

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References:

Lafaille P, Benedetto A. Fillers: contraindications, side effects and precautions. J Cutan Aesthet Surg. 2010 Jan

https://doi.org/10.4103/0974-2077.63222

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.