Dermal facial filler injections to restore a more youthful appearance have become the second most popular cosmetic procedure in the United States behind Botox, according to the American Society of Plastic Surgeons (ASPS). Dermal filler injections are popular because complications are few and usually mild.
However, rare but severe complications can occur when dermal fillers are injected into blood vessels. Problems can include tissue loss, blindness, stroke, erythema, and even death. Avoid direct deep injections into the following areas. Working with an experienced aesthetic medical practice can help avoid serious complications from dermal fillers.
Here are top 7 Danger Zones you need to know before getting a dermal filler:
1. Glabella
The smooth part of the forehead immediately above the eyebrows and between them is the top spot for dermal filler complications and the most dangerous as the supraorbital and supratrochlear arteries are located here. Blockage in blood vessels that feed the eyes can lead to visual impairment and even blindness.
2. Temple
Young people have slightly convex temples, but temporal hollowing commonly occurs with age. This area contains the superficial temporal artery and the middle temporal vein, so providers should inject at least 2.5 centimeters above the temporal arch to avoid injury.
3. Medial Canthus
Soft tissue filler injections in the area where the upper and lower eyelids meet can result in occlusion of the internal carotid site and block blood flow to the eyes or nose. Blocking the angular artery, a terminal branch of the facial artery which supplies blood to the cheeks can cause multiple problems.
4. Tear Trough
The area underneath the eye and just above the cheeks is prone to thin skin, developing a pronounced depression as you age. A good skincare routine can help minimize this area, but many people want something better. Hyaluronic acid fillers, the most commonly used injections, are not advised for patients with very thin skin here or a deep tear trough, as eye problems can occur from improper injection techniques.
5. Nasal Cavity
The internal nose space is dangerous for vascular occlusion because of the network of blood vessels with many along the nasal side walls and the dorsum. The nasal cavity is a popular area for injectable fillers as they help camouflage humps or other irregularities. Nasal skin necrosis is a common complication.
6. Nasolabial Fold
This area comprises the two skin folds on each side of the face running from the nose to the corners of the mouth. A misplaced injection here could affect the facial artery. The lower part of this artery is located in deep subcutaneous tissue, but the upper third is near the surface, branching into the inferior alar artery and lateral nasal artery. Misplaced facial filler injection can result in arterial occlusion in multiple areas, plus limited collateral circulation to the nose and distal arteries near the eyes.
7. Infraorbital Region and Nasojugal Fold
Patients often experience volume loss in the cheeks just below the orbital bones in an area formally called the mala cheek pad. Improper filler injections can negatively impact the infraorbital artery, vein, or nerve. This area also has complicated vasculature, including the maxillary artery, dorsal nasal artery, and transverse artery. Aesthetic providers should attempt lateral injections instead of injecting deep into the area to avoid the nose and eye complications.