HOW TO RESPOND TO VISION PROBLEMS RESULTING FROM FACIAL FILLERS

Blindness from facial cosmetic fillers – a rare but serious complication – needs to be managed as a medical emergency, with the patient triaged immediately by an Emergency Department to the ophthalmology team.

The increased uptake of cosmetic fillers has seen rising numbers and a broad range of health professionals administering injectables. Not only are cosmetic physicians, surgeons and dermatologists administering these procedures, but so too are allied health professionals, nurses and GPs increasingly focusing their practice on medical aesthetics.

“We have seen a tenfold increase in non-invasive cosmetic facial fillers over the past 10 years in Australia,” explained Dr
Angelo Tsirbas, aesthetic oculoplastic surgeon at Macquarie University Hospital and a lecturer in the Faculty of Medicine
and Health Sciences.

“In Sydney, in particular, receptiveness to facial fillers has been stronger than in other parts of the country. With the rise
in numbers, an increase in complications is inevitable.”

Recent media coverage has brought to light the rare complication of vision loss resulting from facial fillers. Yet, given the rapid
and diffuse growth of the industry, there remains a lack of awareness amongst providers about how to respond to loss of vision
and there are not yet standardised guidelines.

Awareness around how to treat vision problems caused by dermal fillers, if and when they occur, is essential,” said Dr Tsirbas,
who is a thought leader on the management of filler induced complications and vision loss and is working with colleagues in
the Australian Society of Cosmetic Dermatologists and Australian Society of Aesthetic Plastic Surgeons to develop the guidelines for emergency treatment when vision loss occurs.

“It’s very rare, for vision loss to occur, but if it does, it happens instantly and time is of the essence. Much like a stroke, there
is a window of opportunity to treat a patient before permanent blindness sets in.

“The team administering the facial filler procedure must act quickly and get the patient to an Emergency Department where they should be triaged to the ophthalmology team immediately.

“This means it’s also important for Emergency Departments to understand that if a patient presents with vision loss from a facial filler procedure, medical staff must act immediately and put the patient into the hands of an ophthalmology
team.”

Hyaluronic Acid (HA) gel is the most common filler material used in these procedures with blindness occurring when the needle inadvertently pierces the arterial circulation and causes an embolus to the eye. Treatment is complex and targeted towards resolving the blockage.

Dr Tsirbas is developing a registry of vision loss complications so that more accurate data is available.

He will speak on vision loss and filler complications at the 2019 Australian Society of Cosmetic Dermatologists in Sydney
later this year, as well as at the Global Aesthetic meeting in Miami in October.

Facial fillers and the potential complication of vision loss: Reduce the risk and put a plan into place

Training in correct injection techniques and a thorough knowledge of facial anatomy is critical to prevention of vision related
complications. Every injector and clinic needs to have a plan in place for correct management if vision loss occurs. Dr Tsirbas is developing a management protocol to help standardise options for potential complications.

A good relationship with a cosmetic oculoplastic colleague is vital to ensure best practice guidelines and management
protocols are adhered to.