I post a lot about safety with medical aesthetics, adequate experience and qualifications as well as aftercare protocols with the clinic you choose. 

Why does this matter? I was in a surgical training program between 2002-2011 and did it full time for most of those years. Practice and training absolutely matters and cannot be disregarded. 

At the same time, there are some common myths I hear all the time, and because I post about vascular occlusions to help raise awareness, it often puts people off, including some of my own patients.

As always, it remains absolutely optional, but it is hard, if not impossible, to rejuvenate volume loss in a face without volume via either fillers or fat. So if a patient is adamant they would not consider fillers for volume replacement,  realigning expectations may be needed. 

In saying that, when I hear people say they’d only consider fillers to certain parts of the face due to risk in other parts, I feel it is my job to correct medical misinformation, same as when medical aesthetics is passed off as “just beauty” with no risk. 

So what do statistics and the evidence tell us? 

For an indication, I looked at a recent article published in the dermatological journal JAMA Dermatology 2021; 157(2):174-180

The authors conducted a study looking at outcomes among a chosen cohort: 

• 370 dermatologists followed for a year between August 2018 and August 2019.
• average experience between them was 22 years in practice
• Between them, 1.7 million syringes of filler were injected. 

Their findings in summary: 

1. The risk of vascular occlusion (VO) using a needle or cannula was 1: 5000 syringes used. 

Overall risk using a needle was 1: 5410/syringe 

Overall risk using a cannula 1:40882/syringe

The authors emphasised that the choice of use of needle or cannula is nonetheless clinician dependent, and based on their experience, the area being injected as well as the anatomy of the patient. 

2. VO can occur at any part of the face. Some areas are considered higher risk but no part of the face is no-risk eg lips, as many commonly believe 

In this study, lips and the nasolabial folds (nose to mouth smile lines) were the most likely areas to be occluded.

Highest risk areas include filler around the mouth, the nose, the frown lines. 

3. Participants with > 5 years of experience had a 70.7% lower risk of VO than those with less experience. 

By ten years of experience, this risk had evened out. 

Risk of VO twice as high in someone with < 5 years experience. 

As we know with surgical training, repetitive practice leads to fewer complications over time. 

4. 85% of VO had no longterm consequences 

Most VOs, if caught and treated in time, did not lead to any longterm problems such as scarring or deformity. 

5. Highest rates of VO at lips and nasolabial folds 

A common misconception is the notion that lips are low/ no risk and that risks of fillers, including of blindness, which is rarer still, is only with filler to the rest of the face. In practice, the literature indicates that lips are among the most common areas to have VOs. 

6. Highest level of severity at the forehead 

The riskiest areas to inject remain the areas around the lips, the nose and the forehead, and so it makes sense that if this happens, the highest likelihood of complications from a procedure is injecting these areas, especially the frown. 

Take Home Message? 

Experience trumps almost everything else, and the overall risk is still very low of a VO, and of blindness even lower but more catastrophic. Experience does not simply mean someone who has been doing this for 5 or more years, but also, in my opinion, someone who is safe, and has protocols in place, with followup and aftercare for more risky procedures so that nothing major is missed, and someone who can open the clinic up at 2am for you on a Sunday if needed. 

So please, choose wisely. Price should not be your main determinant, and it’s better to have no treatment than to risk it with an inexperienced clinician.

As I always say, medical aesthetics should be reassuringly expensive because it’s your face and side effects, while rare, can be catastrophic. 

Source : JAMA Dermatology 2021; 157(2):174-180

doi:10.1001/jamadermatol.2020.5102