Dermal Filler: Top 11 Danger Zones

Using dermal fillers to reduce facial lines and wrinkles and restore a more youthful-looking appearance has become one of the most popular minimally invasive cosmetic procedures to combat aging. According to the American Society of Plastic Surgeons (ASPS), dermal filler injections are the second most popular nonsurgical cosmetic procedure in the United States behind Botox.

Facial filler injections have become popular because complications are uncommon and usually mild when an experienced medical professional administers the injections. Nevertheless, rare but severe complications can occur, especially involving accidental dermal filler injection into blood vessels. Severe complications that can occur include:

• Tissue loss
• Erythema
• Blindness
• Stroke
• Death

Avoiding Dermal Filler Complications

Dermal fillers can harm your health if you don’t select an experienced aesthetic medical practitioner. Following the procedure, patients can expect bruising, swelling, and tenderness in the treated area. Blockage or constriction of blood vessels are serious complications that can lead to damaged tissue, cellular death in nearby organs, also known as tissue necrosis, and sometimes visual impairment or blindness, along with embolisms, or clot fragments, traveling to other areas of the body. Providers must know how to avoid intravascular cannulation, injecting filler into a vein or artery in lay terms.

Yet, some areas of the face are more prone than others to experience problems from soft tissue facial filler injections. The following areas are the top 11 facial danger zones where problems can occur from improper injecting techniques.

1. Glabella

This is the smooth part of the forehead immediately above the eyebrows and between them. Even though it is one of the most popular areas for dermal fillers, it is also the most dangerous as the supraorbital and supratrochlear arteries are located here. These vital arteries supply blood to the muscles and skin of the scalp and have little to no adjoining circulation. The danger zones in this area occur when dermal fillers flow backward into the ophthalmic artery. Blockage in vessels that feed the eyes can lead to visual impairment and, in some rare cases, have caused blindness.

2. Temple

Younger people have slightly convex temples that transition smoothly to the forehead and cheeks. Temporal hollowing commonly occurs with age. This area contains with superficial temporal artery and the middle temporal vein. Providers should perform injections at least 2.5 centimeters above the temporal arch to avoid injury.

3. Medial Canthus

The area where the upper and lower eyelids meet is called the medial canthus. Soft tissue filler injections in this area can result in occlusion of the internal carotid site and block blood flow to the eye area or nose. The terminal branch of the facial artery, called the angular artery, is located here, supplying blood to the cheeks. Blocking the blood flow in this area can cause multiple problems.

4. Tear Trough

The tear trough is the area underneath the eye and just above the cheeks. Because it is prone to thin skin, this site develops a pronounced depression as patients age. Hyaluronic acid fillers are the most commonly used injections in this area. Injectable treatments are not advised for patients with very thin skin in this area or deep tear troughs, as eye problems can occur from improper injection techniques.

5. Nasal Cavity

The internal nose space is a dangerous area for vascular occlusion because of the network of blood vessels contained within. Many lie along the nasal side walls and the dorsum. The nasal cavity is a popular area for injectable fillers as they help camouflage hums or other irregularities. Nasal skin necrosis is a common complication.

6. Nasolabial Fold

Commonly known as the smile lines or laugh lines on the lower face, these are the two skin folds on each side of the face that runs from the nose to the corners of the mouth. Technically, this area separates the cheeks from the lips. This area poses a different danger for dermal filler injections as a misplaced injection could cause affect the facial artery. The lower part of this artery is located in deep subcutaneous tissue, but the upper third is near the surface, where it branches into the inferior alar artery and lateral nasal artery. Thus, a misplaced facial filler injection could result in arterial occlusion in multiple areas, plus limited collateral circulation to the nose and the eyes” distal arteries.

Patients should consider other cosmetic treatments for the nasolabial fold as using facial fillers in this area can lead to an unnatural look termed “monkey mouth.”

7. Infraorbital Region and Nasojugal Fold

This area is located just below the orbital bones, with patients often suffering volume loss in the “apple of the cheek,” formally known as the malar cheek pad. Improper filler injection can negatively impact the infraorbital artery, vein, or nerve. This area also has complicated vasculature, including the maxillary artery, dorsal nasal artery, and transverse artery. Instead of injecting deep into the skin, your provider should attempt lateral injections to avoid the nose and eye complications.

8. Temporal Fossa

This area is the shallow depression on either side of the face. The danger here comes from accidentally injecting filler into the superficial temporal artery or a middle temporal vein. Experienced aestheticians will perform a safe filler injection in the superficial subcutaneous tissue just below the dermis while applying pressure just above the beak of the eyebrow as the frontal branch of the superficial temporal artery runs deeper n this area. Injecting dermal fillers in the wrong site can lead to blindness or vision problems.

9. Oral Commissure

The corner of the mouth where the upper lip meets the lower lip is the oral commissure and is frequently the place where aestheticians perform deep direct injections that can block the main facial artery and cause various impairments. Injections in the wrong place in this area can affect the inferior labial artery and the superior labial artery as they make their way toward the nose. The inferior labial artery supplies blood to the lower lip and mucous membrane, while the superior labial artery divides into the alar branch and nasal septal.

10. Chin and Jawline

This area in the lower face is where the facial artery branches from the external carotid artery on its way up to the oral commissure. Inexperienced providers may not pay enough attention to where the facial artery enters the face, even though the chin has become a popular area to restore youthful volume. Your aesthetician should place dermal filler injections parallel to the base of the jaw.

11. Anterior Medial Length of the Ear

The area around the ears is prone to wrinkling and signs of aging. Many people don’t like the appearance of droopy lobes if they have worn heavy earrings for years, yet this area also presents a dermal filler danger zone as the external carotid artery comes up from the neck. Your provider should avoid deep injections into the masseter or parotid gland if you want a hyaluronic acid filler injection near the ears.

Choose an Experienced Aesthetic Practice for Dermal Filler Injections

Most patients will only have mild side effects after receiving dermal filler injections. Thorough knowledge of the facial anatomy allows practitioners to avoid danger zones for dermal fillers and place them in the correct areas. Although facial vasculature differs from person to person, experienced aesthetic medical practitioners avoid improper injecting techniques to lessen the chance of severe consequences.