2nd Case of Blindness Reversal from injecting Hyaluronidase into the supra-robital notch (Supra-trochlear/Supra-orbital area).

Case studies published by Thai Group.

"Severe vision loss caused by cosmetic filler augmentation; Case series with review of cause and therapy"

Wilai Thanasarnaksorn MD et al

Journal of Cosmetic Dermatology

June 2018;1-7

This review of 6 case studies in Thailand reviews the danger of using cannula's in the nose for augmentation.  5 out of 6 cases of blindness from HA filler were in the nose with cannula's.  

Performing filler injection into the nose is a very dangerous injection technique and Facecoach does not recommend you perform this treatment.

Main points from the Thai blindness case studies -

• 6 cases of blindness from HA dermal filler described
• 4 cases of blindness caused by cannula in the nose
• 1 case in forehead - 25g cannula
• 1 case in the temple - 23g needle
• 5 cases of blindness from cannula - size of cannula in nose - 27gauge, 27 gauge, 25 gauge, size not recorded, 25 gauge.
• Products used included Galderma, Merz filler , Hyacorp filler

What was interesting -

• One REVERSAL of blindness - case 6.  Left eye.  Blindness after temple injection of HA filler.  Injection of Hyaluronidase into the supra-trochlear area.  
• More than 1200 units of Hyaluronidase injected into supra-trochlear area
• Ocular massage (4.5 hours)
• Hyperbaric oxygen (90 minutes)
• Full recovery of vision

"High risk areas include the glabella, nasal region, nasolabial fold, forehead and temple"

"The supra-orbital and supra-trochlear artery are effective locations for hyaluronidase injection due to their location and connections"

​If you haven't read this clinical publication, you should.

Don't let instagram push you into performing nose filler injections.  The risk is high.  Cannula's will not ensure a safe outcome.

What is your current protocol for bedside care in an event of blindness from HA filler?

Is this adverse event under-reported?

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