Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money.

3. Facial fillers should avoid the bridge of the nose, glabellar area, and forehead — and never opt for unregulated clinics just to save money.

Cost: No cost at all. You simply choose a different injection site, or skip the treatment altogether.

In plain terms: Between 2015 and 2018, 48 new cases of partial or total vision loss following filler injections were reported worldwide. The nose was the most common site of complications, accounting for 56.3% of cases; followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was used in over 80% of these cases. Only 20.8% of patients regained full vision, while 16.7% saw partial recovery; the rest remained visually impaired. Nearly 20% also developed complications affecting the central nervous system. Currently, no single treatment has been proven consistently effective for reversing these effects, so prevention remains the only reliable option.

Benefit: Data compiled from all published case reports worldwide show that from January 2015 through September 2018, 48 new instances of partial or complete vision loss occurred after filler injections. The nasal region accounted for 56.3% of incidents, followed by the glabellar area at 27.1%, the forehead at 18.8%, and the nasolabial fold at 14.6%. Hyaluronic acid was identified as the filler material in 81.3% of cases. Skin changes appeared in 43.8% of patients, while central nervous system complications arose in 18.8%. Ten patients (20.8%) fully recovered vision, eight (16.7%) partially recovered, and the remainder did not improve. Researchers concluded that treatment approaches varied widely across studies, and no single method has been demonstrated to reliably restore vision.

Evidence grade: B

Sources: Beleznay K et al. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. <https://doi.org/10.1093/asj/sjz053>

Notes: These figures were derived by manually tallying each reported case across medical journals. They reflect only the number of patients experiencing complications, not the total number of injections performed; thus it is impossible to calculate the exact probability of blindness per injection. The B rating reflects this limitation. Reputable clinics naturally employ standard risk‑minimization practices: mapping vascular pathways beneath the injection sites, using blunt‑tip needles instead of sharp ones, administering small amounts of filler while slowly withdrawing the needle, and keeping hyaluronidase on hand. All these steps must be carried out by trained physicians — which is precisely why unregulated providers should be avoided. Before proceeding, verify that the clinic holds proper licensing and that the attending physician is qualified, as outlined in Section 2 of this chapter.