Singaporean aesthetic clinic experts share insights on filler-related blindness risks

SINGAPORE: In July of this year, Singapore witnessed its first reported case of blindness resulting from dermal filler usage, when a woman lost her vision after receiving a dermal filler injection.

On the 20th of July, a woman underwent a procedure involving AestheFill, a South Korean dermal filler renowned for its temporary wrinkle and skin fold reduction properties, at a Redhill clinic.

As reported by The Straits Times, a source familiar with the incident confirmed that the patient was a Singaporean woman in her thirties.

Prompted by a complaint received on July 29th from Parvus, the distributor of AestheFill, the Ministry of Health (MOH) and Health Sciences Authority (HSA) promptly initiated an investigation into the case.

The regulatory body is currently probing whether there were any defects related to product batches that may have compromised product safety and quality.

Distributor’s investigation unveils dermal filler’s role in woman’s vision loss

According to the findings of the product distributor’s investigation, the accidental injection of the dermal filler into the bloodstream resulted in the woman’s vision loss.

Providing further insight into the incident, a Parvus spokesperson revealed, “The outcome of our investigations indicates that the complication was caused by a blood vessel occlusion (or blockage) during the procedure, which, in turn, was caused by an inadvertent administration of the product into the bloodstream.”

The Parvus spokesperson refrained from divulging additional details about the incident, citing patient confidentiality.

Meanwhile, the Singapore Medical Council is closely monitoring the situation and is prepared to take appropriate action as needed, pending the conclusion of investigations by MOH and HSA.

The Parvus spokesperson strongly advised individuals contemplating aesthetic treatments of this nature to exclusively seek consultations from qualified medical practitioners who have received proper training in dermal filler administration.

“It is crucial to discuss any concerns with your healthcare provider and to fully understand the inherent risks associated with any medical procedure,” he added.

“We are continually investing in training and best practices to ensure that the risks are minimised.”

In response to CNA’s queries on 19 September, Parvus clarified that AestheFill remains safe and approved by Singapore’s Health Sciences Authority (HSA). The company expressed its active cooperation with HSA’s ongoing investigation and reiterated its commitment to product quality and patient safety.

“We are actively cooperating with the HSA in their ongoing investigation, and we maintain that product quality and patient safety are our utmost priorities.”

The spokesperson stated that the batch in question had undergone a comprehensive evaluation in accordance with Korean Food & Drug Administration (KFDA) manufacturing standards and complied with the ISO 13485 quality management system.

AestheFill has been registered in Singapore since October 1, 2021, with dermal fillers classified as Class D medical devices, the highest-risk category, in Singapore.

Expert Insights on filler-related blindness risks

Meanwhile, Dr Siew Tuck Wah and Dr Phoon Yi Shan, both Medical Directors at Radium Medical Aesthetics, a Singaporean aesthetic clinic, recently took to social media to share their insights on filler-related blindness.

While acknowledging the rarity of complications, including blindness, from filler injections, both doctors emphasized the importance of practitioner expertise, encompassing facial anatomy knowledge, safe injection techniques, and the use of clinically proven filler products.

Dr Siew, who is also the clinic’s founder, highlighted the potential for filler-related blindness with any filler type, including hyaluronic acid and biostimulators.

However, he emphasized that such incidents are extremely rare, with a reported occurrence rate ranging from 1 in 100,000 to 1 in 1,000,000 cases.

“It occurred because if you accidentally entered (the filler) into the artery, it can block the arteries supply of the eye.”

Dr Siew pointed out a critical detail: blindness resulting from filler injections typically manifests immediately during the procedure. Therefore, if a patient received a filler injection a day or a week ago without any issues, there’s no need to be concerned about suddenly going blind.

Certain areas of the face pose a higher risk for such complications, including the nose, glabella (the area between the eyebrows), temples, forehead, and nasolabial folds (the lines running from the nose to the corners of the mouth).

“Which is why I always explain extensively to my patients that there is such a risk.”

To minimize this risk, he employs safe injection techniques such as slow injection, using the correct product, and avoiding excessive product injection.

“More importantly, your injector needs to be trained and know the anatomy of the face, and know where the blood supply of the face runs.”

“In my practice, I also use an ultrasound machine to scan my patients before I even put a needle into the face, so that I can map out where the arterial supply is, and avoid those areas.”

In the event of a complication, Dr Siew stressed that quick action is essential, as there is a narrow therapeutic window. Immediate referral to an eye doctor is crucial.

Dr. Siew concluded by advising individuals considering filler injections to thoroughly understand all the associated risks, even though severe complications are rare.

@drsiew

Blindness from filler Injections – do you need to be worried? Here’s everything you need to know. #fillers #fillercomplications #fillerinjection #dermalfillers #Drsiew #drsiewtuckwah #blindness #fillerblindness #ultrasound #singapore #restylane #juvederm #belotero #teoxane #radiesse #sculptra #ellanse #aesthefill

♬ original sound – Dr Siew – Dr Siew

Dr Phoon stresses safety measures for filler injections

Dr Phoon Yi Shan, also a Medical Director at Radium, expressed empathy for the affected patient and extended best wishes for her recovery.

She acknowledged that complications, although rare, can potentially occur in the hands of even the most skilled practitioners.

Complications can range from mild issues like swelling or bruising that resolve within a few days to severe complications such as skin necrosis or blindness, which affect less than 1% of patients.

“This happens when the filler is injected into the blood vessel, obstructing the blood flow.”

“If this is an artery supplying the skin, skin necrosis can occur, but the worst case scenario is when an artery supplying the eye is blocked, leading to blindness.”

To minimize risks, Dr Phoon emphasized the importance of a deep understanding of facial anatomy, careful avoidance of danger zones, and the use of safe techniques and clinically proven filler products with good safety profiles.

“We also have to know exactly what to do if complications arise, as immediate bedside treatment can prevent devastating consequences.”

Dr Phoon also noted that at their clinic, they use ultrasound imaging before injections to visualize blood vessels for added safety.