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Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 143-144  

Periocular esthetic procedures: Do patients understand the risks?

Department of Ophthalmology, College of Medicine and Health Sciences; Department of Ophthalmology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman

Date of Web Publication11-Oct-2019

Correspondence Address:
Dr. Abdullah S Al-Mujaini
Department of Ophthalmology, College of Medicine and Health Sciences and Senior Consultant, Department of Ophthalmology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ojo.OJO_207_2019

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How to cite this article:
Al-Mujaini AS. Periocular esthetic procedures: Do patients understand the risks?. Oman J Ophthalmol 2019;12:143-4

How to cite this URL:
Al-Mujaini AS. Periocular esthetic procedures: Do patients understand the risks?. Oman J Ophthalmol [serial online] 2019 [cited 2022 Dec 8];12:143-4. Available from: https://www.ojoonline.org/text.asp?2019/12/3/143/268952

The periocular area is one of the most sensitive sites in the human body and is an important component in the maintenance of a youthful appearance. As such, any esthetic procedures in this area should be performed by specialists with the necessary level of expertise. Over the last two decades, the number of patients undergoing esthetic procedures in and around this area – such as neurotoxin injectables, soft tissue augmentation, chemical peels, and laser treatments – has risen dramatically, despite the lack of safety measures and the risk of complications associated with some of these modalities. Accordingly, the question remains as to whether patients are sufficiently aware of the potential complications associated with such procedures.

In general, complications following periocular esthetic procedures can range from minimal and transient irritation to severe and potentially sight-threatening conditions, such as central retinal artery occlusion. According to researchers, the latter complication arises due to a retrograde arterial embolic mechanism owing to extensive anastomosis between internal and external circulatory vessels around the periocular area.[1] Globally, there have been many reports of patients with severe visual impairment or even total blindness secondary to central retinal artery occlusion due to cosmetic fillers, mostly among younger individuals.[2] This can be attributed to an increase in the patency of cutaneous arterial anastomoses in such patients.

Currently, soft tissue fillers are widely used as a relatively safe and noninvasive alternative to surgical methods of facial rejuvenation and/or augmentation. The most popular material for this purpose is a partially cross-linked hyaluronic acid gel, which constitutes over 75% of all esthetic fillers.[3] Although the most common adverse side effects are fairly inconsequential, usually comprising swelling, pain, and erythema around the injected area, bacterial colonization of the filler site can sometimes occur and can be very difficult to eradicate. Critically, vascular occlusion is estimated to occur in 0.001% of patients after this type of therapy; in particular, the glabellar area which is vulnerable to such complications due to its small surface area and condensed blood supply.[4]

In contrast to fillers, botulinum toxin therapy does not usually result in such serious complications; nevertheless, this type of procedure may still result in ptosis and diplopia. Ptosis is estimated to occur in 5% of patients, while diplopia is less common.[5] Although these two complications are fortunately not permanent, they can nonetheless limit activities of daily living for affected patients over a period ranging from several weeks to months.

To minimize the occurrence of such drawbacks and avoid serious complications, specialists intending to perform periocular esthetic procedures should abide by the standard ethics of medical practice and ensure that they have adequate training and anatomical understanding of the periocular area. In addition, patients should receive appropriate counseling so that they are sufficiently informed of potential complications, whether temporary or permanent, before deciding whether to undergo cosmetic therapy. General information regarding the severity and reversibility of such complications and their impact on the patient's quality of life should also be provided.

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There are no conflicts of interest.

   References Top

Klapper SR, Patrinely JR. Management of cosmetic eyelid surgery complications. Semin Plast Surg 2007;21:80-93.  Back to cited text no. 1
Carle MV, Roe R, Novack R, Boyer DS. Cosmetic facial fillers and severe vision loss. JAMA Ophthalmol 2014;1329:637-9.  Back to cited text no. 2
Bacos JT, Dayan SH. Superficial dermal fillers with hyaluronic acid. Facial Plast Surg 2019;35:219-23.  Back to cited text no. 3
Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: Prevention and management. J Cutan Aesthet Surg 2012;5:121-32.  Back to cited text no. 4
[PUBMED]  [Full text]  
Racette BA, Lopate G, Good L, Sagitto S, Perlmutter JS. Ptosis as a remote effect of therapeutic botulinum toxin B injection. Neurology 2002;59:1445-7.  Back to cited text no. 5


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