PRIME Journal Vol. 11 Issue 4

HOWTOAVOID, RECOGNISE, ANDTREAT COMPLICATIONS FROM PERIOCULARFILLER INJECTIONS FrancescoP. Bernardini,MD, and MorrisHartestein,MD, discuss thecomplex issues that canarisepost-injection fromtheoculoplasticperspective ABSTRACT Vascular complications occurring from periocular filler injections are extremely rare, and even though the infra-orbital area can be considered relatively safe, a critical revision of what is considered safe should be undertaken in light of its vascular anatomy. According to the authors’ busy aesthetic oculoplastic practices, peri-ocular complications from filler injections are on the rise and concern the lower as well the upper eyelids, and consist of delayed- onset chronic oedema that causes a unique clinical dysmorphism that should be immediately recognised by the clinicians and for which the authors propose an algorithm of treatment. A CCORDING TO A RECENT STATISTIC revealed by the American Society of Aesthetic Surgeons, in the past two decades, non-surgical procedures have increased by 186%. However, as injections are increasing in number and areas of the face they can be used, complications are expected to be on the rise. According to a different worldwide survey, the periocular area is the most requested area of treatment by patients and the second most recommended indication by treating physicians. However, both physicians and patients refrain from a more widespread treatment for fear of visible complications that may alter the aesthetic of such a delicate area, namely lumps, irregularities, long-lasting oedema, and unnatural results. Classifying periocular complications: Vascular Complications Interestingly, despite the close proximity of the peri-orbital area to the eye, the incidence of vascular complications is extremely low. In fact, according to the latest metanalysis of the English literature 1 there are no published events of blindness following infra-orbital filler injection. Despite being a low- risk area for vascular accidents, an extensive knowledge of the vascular anatomy is essential. I often heard well-renowned experts teaching generations of injectors how safe it is to inject deep on the bone with a needle, so I decided to perform a cadaver dissection aimed at evaluating how safe it really was in the infraorbital region, and it turned out that the bone- KEYWORDS Filler complications, eyelid oedema, dysmorphic eyelid I often heardwell-renowned experts teaching generations of injectors how safe it is to inject deep on the bonewith a needle, so I decided to performa cadaver dissection aimed at evaluating how safe it reallywas in the infraorbital region, and it turned out that the bone-deep needle injection is anything but safe in this area. FRANCESCO P BERNARDINI MD, Oculoplastica Bernardini, Genova and Milano, Italy; MORRIS HARTESTEIN MD, Shamir Medical Center, Tzrifin, Israel email francescobernardini@ COVER STORY | September/October 2021 23 | PERIOCULAR INJECTIONS | AESTHETIC FEATURE