Q. Can Restylane fillers under the eyes cause a central retina occlusion? A. Blood vessel are tubes that start at the heart and branch in smaller and small diameter until you cannot see them as capillaries carrying platelets, red cells, white cells and other nutrients to all the structural cells in the body; and then increase in size back to the heart. Some vessels go “straight” and end at a capillary. Others are circular vessels called collaterals circumventing blood flow in the event there is a blockage. The face has many collaterals particularly around the eye. These collaterals feed blood or take away blood from inside of the skull behind the eye where the blood vessels tend to be “straight”. If a blood clot stops the flow of blood in a vessel, it is called a thrombus. If another object, say a filler, fat or air enters the blood stream and causes the vessel to occlude, this is called an embolus. The advent of fillers, including: fat, Restylane, Perlane, Juvederm and dozens of others new injectables used in the rejuvenation process has enhanced the appearance of millions of people. Unfortunately, the very rare but perfect storm for a filler embolus can occur when injecting lines, creases and folds around the eye, lip nose and other areas where there are “straight” vessels. While retinal artery embolus is a devastating complication, it is also a very rare occurrence. Injection devices and techniques including: - 1 blunt cannulas
- 2 depth of injection
- 3 pressure of injection
- 4 amount of filler injected
- 5 aspiration test
- 6 and many other considerations in the use of injectibles.