Attention to filling applications: “Blindness can develop, if not intervened in time, it can be permanent”

While it is stated that the interest in aesthetic applications in Turkey and in the world has increased, experts emphasizing the necessity of performing the procedures in competent hands under appropriate conditions, “There are too many applications, it should be done under the control of a specialist physician, and the risks should be explained to the patients. Nodules and discharge can occur on the faces of patients and the patient can walk around for months in this way. Blindness can develop as a result of filler injections, and if you do not intervene in time, blindness can become permanent. People should apply to reliable centers after thorough research, “he warned.

While it is stated that the interest in aesthetic applications in Turkey and in the world is increasing, experts express the necessity of performing the procedures in appropriate areas in competent hands at every opportunity. Istanbul University Cerrahpaşa (IÜC) Cerrahpaşa Faculty of Medicine, Department of Skin and Venereal Diseases Faculty Member Prof. Dr. Zekai Kutlubay and Prof. Dr. Cemil Taşcıoğlu City Hospital Dermatology Department Education and Administrative Officer Assoc. Prof. Dr. İlteriş Oğuz Topal also warned people who are considering having aesthetic procedures. Prof. Dr. Kutlubay also gave information about the treatment process they followed while intervening in their faculties with Interventional Radiology Specialist Prof. Dr. Fatih Gülşen for those who faced complications after aesthetic applications. Stating that the procedures should be performed by experts in appropriate areas with products approved by the Ministry of Health, Assoc. Prof. Dr. İlteriş Oğuz Topal said that there may be tables that can go up to blindness after filling applications, and that people should carefully choose the points where they will have the procedure.

“We both intervene and treat cases”

Explaining that they carry out treatments for patients who apply to them with various complications after the procedures, Dermatology Specialist Prof. Dr. Zekai Kutlubay stated that the patients are first examined with ultrasound and it is observed in which region the problem occurs and whether it leaves a different damage. Prof. Dr. Kutlubay said, “At Cerrahpaşa Medical Faculty, we both intervene and treat such situations, which we call complications. In Botox, people appear with some complications such as asymmetries, facial paralysis, disproportionate eyebrows and eye opening, but there is something called botulism that we are afraid of in botox. Very, very rarely, unfortunately, we can also see it. Restriction of movement, difficulty in breathing due to paralysis of the respiratory muscles, inability to move or what we fear the most; There are some case reports of entering the intensive care unit and even losing their lives. We mostly deal with filling complications. Filler injections can be made in different parts of the face, neck or body. Abscessing, some purulent discharge on the face, tissue loss due to vascular occlusion, which we call necrosis in the skin, can also occur. What we smell is vascular occlusion, the skin actually rots and dies due to this. Fortunately, we have not seen it so far, but it is also in the literature, blindness can develop as a result of filler injections. If you do not intervene in time, blindness can become permanent. In some patients, we see that after the filling is done, it can be displaced, or it can appear under the skin in the form of masses such as nuts or walnuts. It may be necessary to either remove or dissolve them. What we do in Cerrahpaşa is that after determining where the filling is under ultrasound with a radiologist and the type of complication caused by the filling, we enter with special needles to remove it and inject dissolving substances there, and if necessary, we can direct it to a plastic surgeon to remove it. When you do not place the filler in the right spot or when you accidentally inject the filler into a vein connected to the veins leading to the eye, the filler you inject with this pressure gradually clogs the eye vein. Immediate vision loss occurs. If you intervene immediately, the ideal is to intervene within 4-5 hours. If you intervene within a maximum of 24 hours and dissolve that outgoing filler, you save the patient's vision, but if you do not intervene on time, permanent blindness can unfortunately develop. Have the right filler injected in the right place, do not go and have it filled in different places because it is very cheap. If the person feels a severe pain while filling, if there is a sudden whitening with severe pain at the moment of filling, followed immediately by a bruising, it means that there is a problem with a vein. If there is some loss of vision, a blackening or a problem in vision in the style of a fly flying, it is absolutely beneficial for the person to be intervened immediately.”

“They may want very exaggerated procedures, it may increase the risk of complications”

Emphasizing that the risks that may arise from the applications should be explained to people, Dermatology Specialist Assoc. Prof. Dr. İlteriş Oğuz Topal said, “Botox, fillers, PRP, mesotherapy applications are highly preferred by patients recently. We have more female patients, but we also have male patients. The age range is very variable, now young people have started to have a little more procedures. Patients can also apply at a very young age, I recommend them to have the procedure at a slightly older age. They may want very exaggerated procedures, I explain to my patients that too many applications can cause facial deformities and increase the risk of complications. Recently, some non-physicians have started to perform such applications. When there are complications, these patients are usually left unattended and referred to physicians. Applications should be performed under the control of a specialist physician. There are too many applications, the number has increased recently, and patients should know that they may face some risks after such applications. There may be cases such as droopy eyelids after Botox applications. After filling applications, some reactions, redness and swelling may occur at the injection site. The complication we fear the most is actually necrosis (tissue death), tissue nutrition can be disrupted. If the vein that feeds the tissue is treated, we may encounter some structures that we call scars there.”

“The most extreme example is blindness, urgent intervention is very important”

Stating that they may encounter serious situations after filling applications, Assoc. Dr. Topal continued his words as follows:

“The most extreme example of this is actually blindness. Especially after glabella (the area between the two eyebrows) and nasal filling applications, if we inject these materials into the vascular structures here, there are vessels that they share in common with the eye. As a result of these materials going there, it may result in congestion in the eye vessels and blindness. Such risks should also be explained to patients. In general, patients are injected directly without being told about this risk. Nodules may form on the patients' faces. Discharges called pus can occur and the patient can walk around like this for months. There may be permanent deformities, unfortunately, there are patients I have encountered from time to time. Tissue loss is ultimately irreversible, there may be cases such as raised scars on the face and loss of the wing of the nose. Sometimes we can also see tissue loss after inappropriate injections in the lips. Patients should apply to reliable centers after thorough research. If the patient describes an abnormal pain to us at the beginning and we see a pallor in the application area, we can actually prevent this complication if we intervene. There are some materials that dissolve this filling material. It is very important to intervene the patient immediately. I saw nasal necrosis in a patient with nasolabial filling, there was tissue loss on the wing of the nose. She was a middle-aged woman and the deformity was permanent. That patient impressed me a lot, she was a patient I had seen recently and had a procedure at a beauty center. Because there was no early intervention, such a permanent deformity had developed. It is a situation that also affects the psychology of the patient, that patient is not working now, she said that she did not want to go out in public.”