Dermal Filler Blindness Singapore

Introduction

Dermal fillers have become a cornerstone in medical aesthetic treatments, primarily used to counteract volume loss, enhance facial features, and improve deep lines and skin folds. While they offer transformative results, it's essential to be aware of potential complications. One such rare but critical concern is dermal filler blindness. 

Popular areas for dermal filler injections include:

• Lips: To enhance lip volume, define the lip border, or correct asymmetry.
• Nasolabial Folds: These are the lines that run from the sides of the nose to the corners of the mouth. Fillers can be used to soften these lines.
• Marionette Lines: These lines run from the corners of the mouth down to the chin. Fillers can help reduce their appearance.
• Cheeks: To restore volume, enhance cheekbones, or lift the mid-face.
• Under-Eye Area (Tear Troughs): To address hollows or dark circles under the eyes.
• Jawline: To define or contour the jawline.
• Chin: To enhance or reshape the chin, or correct asymmetry.
• Temples: To address hollowing in the temple area.
• Nose (Non-Surgical Rhinoplasty): To enhance height and definition, lift the nasal tip, or correct minor asymmetry.

What is Dermal Filler Blindness?

Dermal filler blindness occurs when there's an adverse reaction following the injection of dermal fillers. This complication emerges when filler material unintentionally enters blood vessels, subsequently traveling to the retinal artery, leading to an obstruction. The consequence? An abrupt vision loss in the impacted eye.

What Causes Dermal Filler Blindness?

The human face is intricately laced with blood vessels. During the injection of dermal fillers, especially in areas like the forehead, nose, and regions surrounding the eyes, there's a possibility of the needle puncturing a vessel. This means the filler, instead of going into the desired area, gets injected directly into these blood vessels. This filler can then travel and block crucial blood vessels, like the retinal artery in the eye.

The retinal artery is responsible for supplying blood to the retina, the light-sensitive tissue at the back of the eye. This blood supply delivers essential oxygen and nutrients to the retinal cells, allowing them to function properly. When the retinal artery is blocked, the blood supply to the retina is disrupted. Without this vital supply of oxygen and nutrients, the retinal cells become deprived and can start to die off. This cell death can lead to irreversible damage to the retina and result in blindness.

Aesthefill Dermal Filler Blindness Case In Singapore

The first case of dermal filler blindness after Aesthefill dermal filler injection was reported in the Straits Time on 12th September 2023.

What is Aesthefill Filler?

AestheFill is a type of dermal filler based on injectable poly-D,L-lactic acid (PDLLA), developed by REGEN Biotech, Inc. in Seoul, South Korea. Gaining approval from the Korean FDA in 2014, it is specifically formulated to combat the visible signs of aging, such as wrinkles, fine lines, and volume loss.

What sets AestheFill apart from the usual Hyaluronic Acid fillers is its unique ability to stimulate collagen production, a vital protein that maintains skin's elasticity and firmness. As a biostimulator, AestheFill not only provides immediate volume enhancement but also encourages the skin to produce its own collagen for anti aging benefits.

This dual action—immediate filling and collagen stimulation is one of AestheFill's unique selling point.

Can Aesthefill Filler Injections Cause Blindness?

Similar to other types of dermal fillers, blindness can occur if the Aesthefill dermal filler is accidentally injected into blood vessels, leading to blockage of these vessels. These blockages can prevent blood flow to the eyes, resulting in blindness or visual impairment.

Notably, AestheFill is a PDLLA-based dermal filler, setting it apart from Hyaluronic Acid fillers which can be dissolved using the enzyme hyaluronidase. As a result, complications or undesired outcomes from AestheFill can be potentially more challenging to manage and reverse.

Safeguarding Against Dermal Filler Blindness: Possible Precautions

Choose a Qualified Doctor: Always seek treatment from a qualified medical professional with experience in dermal filler injections. They should have a deep understanding of facial anatomy and potential risks.

Use a Cannula: Some doctors prefer using a blunt-tipped cannula instead of a needle for certain injection sites. Cannulas are less likely to penetrate blood vessels, reducing the risk of intravascular injection.

Avoid High-Risk Areas: Some areas of the face, such as the glabella (between the eyebrows) and the nose, have a higher risk of complications. Being extra cautious or avoiding fillers in these areas can reduce the risk.

Aspiration Technique: Before injecting the filler, the practitioner can pull back on the syringe plunger to check if the needle is in a blood vessel. If blood is drawn into the syringe, it indicates that the needle is inside a vessel, and the injection site should be adjusted.

Slow Injection: Administering the filler slowly can reduce the risk of complications. A rapid injection can increase the pressure inside the blood vessel, pushing the filler into the bloodstream.

Minimal Volume: Using the smallest effective volume of filler can reduce the risk of complications.

Knowledge of Danger Zones: The practitioner should be well-versed in the "danger zones" of the face where important blood vessels are located.

Immediate Action: If a patient experiences sudden pain, blanching, or any other unusual symptom during the injection, the procedure should be stopped immediately.

Post-Care Instructions: Patients should be informed about potential signs of complications and advised to seek immediate medical attention if they notice any unusual symptoms.

What Other Side Effects of Dermal Fillers Are There?

Dermal fillers, while generally considered safe when administered by qualified professionals, can still lead to a range of side effects. These side effects can vary from mild and temporary to more severe and long-lasting. Here's a description of potential side effects associated with dermal fillers:

• Bruising and Swelling: These are common side effects and can occur at the injection site. They typically resolve within a few days to a week.
• Redness: The treated area might appear red for a few hours to days after the procedure.
• Pain or Tenderness: Some discomfort or tenderness at the injection site is common and usually subsides within a few days.
• Lumps or Bumps: Some patients might feel or see lumps or bumps under the skin after the injection. These can often be massaged out, but if they persist, further treatment might be required.
• Asymmetry: The treated area might appear uneven or not as expected. This can be due to uneven injection, swelling, or how the filler settles.
• Infection: As with any injection, there's a risk of infection. It's essential to keep the treated area clean and follow any post-care instructions provided by the practitioner.
• Allergic Reaction: Some individuals might have an allergic reaction to the filler material, leading to itching, rash, or hives.
• Scarring: In rare cases, dermal fillers can lead to scarring, especially if there's an adverse reaction or if the skin experiences necrosis.
• Vision Abnormalities: As previously discussed, if the filler is inadvertently injected into a blood vessel, it can travel to the eyes and lead to vision problems or blindness.
• Migration: Over time, the filler might move from the original injection site to another area.
• Skin Discoloration: Some patients might experience a change in skin color (hyperpigmentation) at the injection site.
• Formation of Granulomas: These are inflammatory nodules that can form as the body's immune response to the filler material.

Summary

It's essential to discuss potential side effects with a qualified doctor before undergoing any dermal filler treatment. While many of these side effects are temporary and can be managed, understanding the risks can help patients make informed decisions.