It is not approved for use in persons under 21 years of age. Common side effects of facial fillers include swelling, bruising, pain, itching at the injection site, and headache. Accidental injections of facial filler into blood vessels can occur anywhere on the face, but an FDA analysis of studies and reported problems found that it was more likely to occur between the eyebrows and nose, in and around the nose, on the forehead and around the eyes. The most serious complications of soft tissue augmentation include retinal artery occlusion and cerebral embolism.
These have been observed mainly with fat injections, but have also been observed with hyaluronic acid products. Fortunately, these are extremely rare; however, the risk increases as the volume of injections and the number of injections increase. Decreased visual acuity, pain in the orbit, headache, nausea, dizziness and ptosis may indicate a major problem and should be taken care of immediately. If any of these symptoms occur, you should go to an ophthalmology office immediately.
Treatment with hyaluronidase, warm compresses, application of nitropaste and aspirin may be considered. Vision loss, when it occurs, is usually permanent. Collaboration with an ophthalmologist is crucial in these patients. Before treating the glabella, nasolabial fold or lacrimal canals, it is essential to have a lot of experience and anatomical knowledge to minimize the risk of vascular compromise.
Sometimes anti-wrinkle injections can cause a tension headache for 24 hours after the injection. This usually happens from the frown line, as once the muscle starts to relax and you try to frown, as you normally do, it can create a little tension since you can't frown like you used to. Most people who have never been treated before may experience this (I personally do), but after a couple of treatments, the muscle is already relaxed and prevents you from frowning so you are less likely to frown as much after the initial treatment. In addition, the skin will look the same as it did before injecting the fillers once the filler dissolves.
Sometimes too much facial filler product may have been placed in the recesses of the lower eyelid creating an overfilling effect that can make the area look more puffy. Often HA facial fillers can still be seen in the area under the eyes for many years after they were injected (in some cases this can happen five years later or more). To minimize this swelling I place 1 to 1½ cc between both hands knowing I'll probably need more but the extra padding is placed at the follow-up visit in 1 month. The Tyndall effect may occur in some patients who have been injected with hyaluronic acid facial fillers into an area.
Chronic inflammatory conditions affecting the eyes and surrounding areas may predispose patients to prolonged swelling of the lower eyelids. As noted above some hyaluronic acid products tend to spread more than others after being injected and these products may not be the ideal choice for treating tear canal or lower eyelid voids. For people who have deeper sunken eyes, the appearance of hollow areas under the eyes can also affect light reflectance patterns of the face and can make entire area around eyes appear darker by creating undesirable shadows. Normal structures usually found in this area include skin of lower eyelid, eyelid muscle and tissue that covers bone of eye socket.
In recent years tear rejuvenation has become more popular procedure as many people seek to improve appearance of dark circles under eyes without time or financial commitment of surgical rejuvenation. For this reason addition of small amounts of facial filler volume can have much more significant impact than expected. Although most significant complications with facial filler injections under eyes (lacrimal rejuvenation) are uncommon in general; unfortunately they can occur as with any facial filling procedure even if injection was performed by qualified and expert injector. In addition due to delicate and complex anatomy around eyes not all injectors that can take syringe and perform facial filler injections are qualified with specific knowledge and advanced technical expertise necessary to perform this procedure properly and effectively.
If facial filler product is placed too shallow on skin or on top of muscle layer product may settle with abnormal appearance and may appear bulky swollen or uneven. Although there is core group of physicians who are traditionally trained in these treatments for aesthetic enhancement this also includes many other types of doctors who were originally trained in other specialties and who may not have same training or extensive experience in delicate anatomy of eyelid or similar areas of face.
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