Objectives: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols.

Introduction: A systematic literature review spanning 2018–2024 was conducted, analyzing case reports and studies on filler-related blindness, including seminal works by Lazzeri et al. (2012) and Kim EG et al. (2014). Data from a 2024 Aesthetic Surgery Journal review, identifying hyaluronic acid in 76% of cases, informed the focus on high-risk zones (nose, forehead, glabella) and treatment efficacy. Techniques such as hyaluronidase administration and intra-arterial interventions were assessed using clinical outcomes from peer-reviewed sources and ISAC Group World Guidance.

Materials / method: Management hinges on rapid recognition (within a 10-15-minute reperfusion window) and hyaluronidase administration, with the supraorbital method— championed by Dr. Treacy since 2013—preferred over retrobulbar injections (effective in only 5.3% of cases). A 2022 case by Nguyen et al. demonstrated vision recovery from no light perception to 20/50 using intra-arterial hyaluronidase and thrombolysis, highlighting advanced rescue potential.

Results: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols. Treatment efficacy hinges on rapid intervention within a 10-15-minute reperfusion window. The supraorbital hyaluronidase method, now favoured after being championed by early advocates,

Conclusion: Dermal filler-induced blindness, though an infrequent complication, remains a critical concern in aesthetic medicine due to its severe impact on patient quality of life. This analysis highlights that vascular occlusion, particularly in high-risk zones like the nose, forehead, and glabella, can be mitigated through rigorous anatomical training, refined injection techniques, and prompt emergency protocols. The shift toward cell-free interventions, such as hyaluronidase administration via the supraorbital approach and emerging intra-arterial therapies, offers hope for improved outcomes

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Objectives: This lecture aims to provide participants with an advanced understanding of diagnosing and managing vascular complications that may arise from dermal filler injections. It will cover the significance of thorough patient assessments, effective injection techniques, the use of hyaluronidase in reversing complications, and the necessity of having emergency protocols in place. By the end of the lecture, participants will have enhanced knowledge and skills to minimize patient risks, effectively manage vascular complications in a timely manner, and improve overall patient outcomes.