Vision Complications With Non-Dissolvable Fillers: A Case Lesson

A 2023 case report from Taiwan describes a young woman who lost much of the vision in one eye seconds after a filler injection between her eyebrows. The filler was not hyaluronic acid, so there was no enzyme that could dissolve it. The takeaway for patients is not that fillers are dangerous for everyone, but that the type of product, the area treated and the injector's preparation all matter, especially in the frown area.

Why this case was published

Blockage of an eye artery after a cosmetic filler is one of the rarest and most serious complications in aesthetic medicine. Most published cases involve hyaluronic acid filler or fat. This report was written because, as far as the authors could find, it was the first described case linked to poly-D,L-lactic acid (PDLLA), a newer collagen-stimulating injectable used in some countries.

PDLLA belongs to a family of "biostimulator" products that work differently from hyaluronic acid. Rather than filling space with a gel, they are designed to prompt the body to build its own collagen over months. Availability and Health Canada authorization of specific products in this family vary, and patients should never seek injectables from unregulated sources. You can read more about how these products compare in our article on biostimulators versus hyaluronic acid.

What happened

The patient was 23 years old and two months postpartum, with no previous eye problems. During an injection to the glabella (the vertical "11" lines between the brows), she felt burning over her right forehead, then lost vision in her right eye within seconds. She also had dizziness and repeated vomiting.

She was first seen at another hospital, where no treatment was given, and reached the eye team about five hours after symptoms began. By then, she could only see hand movements at close range in the affected eye. Eye scans showed several small branches of the retinal artery blocked by what the doctors believed were particles of filler.

She was treated with eye-pressure-lowering drops, eye massage, high-dose steroids, blood-thinning and blood-vessel-widening medicines, and later a long course of hyperbaric oxygen. Over two months, her vision improved partly but did not return to normal, and some damage to the retina remained visible on scans.

Why the glabella is a higher-risk area

The skin between the eyebrows is supplied by small arteries that connect back to the artery feeding the eye. The authors suggest the filler travelled backward through one of these vessels, then forward into the retinal circulation. This is the same pathway described in most reports of vision loss after fillers.

The report cites an earlier review of 98 similar eye-artery blockages, in which the glabella was the most common injection site, followed by the nose, the smile lines and the forehead. These are areas that many training programs already treat with extra caution.

Why "non-dissolvable" changes the picture

When hyaluronic acid filler blocks a blood vessel, clinicians can inject an enzyme called hyaluronidase to break the gel down. This is the backbone of standard emergency treatment, as described in our article on vascular occlusion safety.

Collagen stimulators, calcium-based fillers and fat do not respond to this enzyme. If they block a vessel, treatment has to rely on supportive measures to protect tissue and improve blood flow, and there is no way to remove the product quickly. This is one reason many clinicians prefer reversible hyaluronic acid filler, or no filler at all, in the highest-risk zones. Our guide to dissolving filler explains which products can and cannot be reversed.

How strong is this evidence?

This is a single case report. It tells us that this complication can happen with this type of product, and it describes one treatment approach and its result. It cannot tell us how often it happens, whether PDLLA is riskier than other fillers, or which of the many treatments given actually helped. The improvement she had may reflect the treatments, natural recovery, or both.

The authors also note that the manufacturer reported no serious adverse events across about 16,000 treated patients over four years. That figure comes from the company rather than independent research, but together with the rarity of published cases, it suggests this complication is uncommon. Rare, however, is not the same as impossible.

What it means for you

• Know what product is being used. Ask whether it is hyaluronic acid or another material, and whether it can be dissolved.
• Ask about the area. The frown lines are often treated with a neuromodulator instead of filler. The authors themselves suggest relaxing the muscle first before considering filler there.
• Report unusual symptoms immediately. Sudden vision changes, eye pain, severe headache, dizziness, or skin that turns pale or blotchy during or after treatment needs urgent attention, not a wait-and-see approach.
• Time matters. This patient lost precious hours before treatment. The paper notes that restoring blood flow is generally hoped for within a few hours, so knowing where to go matters.

Questions to ask at your consultation

• Which product do you recommend for this area, and is it reversible?
• Would a neuromodulator or skincare be a reasonable alternative here?
• What is your emergency plan if a blood vessel is affected, and what should I do after I leave?

At HealthPark, these questions are part of the conversation before any injectable treatment, and some people are better served by a different approach or by no treatment at all.

Frequently asked questions

Is vision loss common after filler?

No. It is considered very rare. However, it is serious enough that injectors are trained in prevention and emergency response, and patients should be told about it during the consent process.

Are collagen-stimulating injectables unsafe?

Not necessarily. They have their own uses and evidence. The key difference is that they cannot be dissolved, so product choice and injection area need careful thought.

Can hyaluronic acid filler cause the same problem?

Yes, it can. The advantage is that the enzyme hyaluronidase can be used promptly, although even then outcomes for the eye are not assured.

If you are considering filler, a consultation is a chance to talk through which areas and products suit your goals and what safety steps are in place.

Source

Wang I, Lin HJ, Tsai YY, Chen WL, Lin CJ, Chen SN, Hsieh MC, Wan L, Tien PT. Multiple branch retinal artery occlusions following the new facial cosmetic filler (poly-D,L-lactic acid) injection: a case report. BMC Ophthalmology, 2023. Read the study