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Skilled Injectors Part II

Posted: 6:00 a.m. Sunday, July 30, 2017

By Anita Mandal, M.D.
Question: Thank you, Dr. Mandal, for the very informative article you wrote last Sunday on fillers and blindness. I had fillers injected into my face a year ago and went blind in one eye. My plastic surgeon sent me to a neurologist and a cardiologist, but no one ever figured what caused me to go blind, until I read your article. The day of my filler treatment, by the time my husband brought me home, I could not see at all through my right eye. I went to a reputable plastic surgeon and can’t believe he had no clue that his treatment could cause blindness. I’ve had fillers to my face many times in the past without a problem. How did things go so wrong this time?
Answer: I’m sorry that you suffered this serious complication from an elective, cosmetic procedure. It’s unfortunate that the surgeon did not realize blindness is a known adverse effect of injectable filler treatments. The reality is that serious complications can occur from just about any procedure or medication, and patients need be fully aware of even the most serious risks, even if those risks are rare.

In today’s cosmetic industry, with the explosion of less invasive, quick recovery procedures, there is the faulty public perception that filler treatments don’t carry as significant risks as a surgical facelift because fillers are less invasive than facelifts. The truth is that injectable fillers may be less invasive than a facelift but, make no mistake, they are still an invasive medical procedure on the face. Further compounding this misperception is the alarming number of less qualified doctors marketing injectable fillers and competing through clever marketing strategies and competitive prices. While there’s nothing wrong with marketing, this unqualified pool of “filler doctors” shifts the focus away from the fact that injectable filler treatments are a medical procedure with attendant risks and the value of a thorough evaluation and medical history. When the serious nature of a procedure is downplayed, patients may be more inclined to be less selective about the qualifications and skill of their injector than when looking for a facelift surgeon.

“Less qualified” can refer to both non-plastic surgeons such internists, emergency room physicians, and the like, that have found their way into the cosmetic field, but also to certain plastic surgeons. The former lacks any formal, legally recognized training or board certification that qualifies them as experts on facial anatomy and injectable facial filler treatments. The latter are certain plastic surgeons who are board certified and look good on paper and focus on surgery, yet offer injectable fillers in order to be competitive, but believe fillers are simple and that anybody can do a good job. The fact is that learning how to do an injection is simple; you don’t even need to be a doctor. What many patients fail to understand is that these common, quick fix “lunchtime procedures” are still medical procedures with risks that, in rare cases, can be serious.

A skilled injector should ideally have the same level of knowledge and technical skill as a facelift surgeon in order to achieve an optimal aesthetic result with the lowest risk. Seek a facial plastic surgeon, not just a “filler doctor”, who not only has the proper training and board certification to understand the facial anatomy and complex blood supply, but also one who doesn’t just look good on paper but is a step above in performing a high volume of injectable fillers with superior knowledge of the various ways in which the tissues react to the large variety of fillers on the market and a familiarity with the full scope of complications.

Do you prefer a highly skilled injector with extensive knowledge of facial anatomy and filler physiology or do you want a “filler doctor” that you can more readily find in med spas or at a general, non-specialist doctor’s office? What level of risk are you willing to accept when undergoing a quick, immediate gratification procedure? You will likely pay more for a board certified Facial Plastic Surgeon who is also a superior injector, but may be in safer hands with a higher level of skill and experience.


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