Background Soft tissue filler is commonly used for facial contouring. However, incorrect use can lead to severe ocular complications. Even though filler injections are quite different from fat grafts, they are considered similar procedures. However, to date, there are no proven preventive measures or treatments for blindness secondary to soft tissue filler injections. Objectives This literature review aimed to investigate visual compromise secondary to soft tissue filler injection and discuss the related vascular anatomy, pathophysiology, and prevention of ocular complications of soft tissue filler injections. Methods A literature search until July 2018 was performed for reports on visual compromise after filler injections. We evaluated the previous literature and eliminated cases using fat grafts and unknown fillers. Results A total of 50 reports of filler‐induced visual compromise were identified. Analysis of these cases showed that the procedure with greatest risk was nasal augmentation, followed by glabellar wrinkle treatment. Within the last 3 years searched, 35% of reported cases involved treatment of the nose. There were no reports of blindness from injections into the temple or chin and relatively few case reports involving forehead injections. Conclusion The most common injection site associated with blindness in a previous report was the glabella; however, the most common site currently associated with blindness due to filler injections was the nose. Extreme caution is necessary when performing nasal augmentation or glabellar wrinkle correction using soft tissue fillers to avoid the branches of the internal carotid artery.

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Background: Soft-tissue necrosis caused by vascular compromise is a frequent and troublesome complication of hyaluronic acid filler injection. Hyaluronidase has been proposed as a treatment for this condition. This study aimed to determine the effective dose and administration interval of hyaluronidase injection in a skin necrosis animal model. Methods: New Zealand rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. Hyaluronic acid filler (0.1 ml) was injected into the central auricular artery to create an occlusion. Three rabbit auricular flaps were injected with 500 IU of hyaluronidase once (group A) and three flaps each were injected at 15-minute intervals with 250 IU of hyaluronidase twice (group B), 125 IU of hyaluronidase four times (group C), 100 IU of hyaluronidase five times (group D), and 75 IU of hyaluronidase seven times (group E), all at 24 hours after occlusion. No intervention was administered after occlusion in the control group. Flap fluorescence angiography was performed immediately after hyaluronidase injection and on postoperative days 2, 4, and 7. Flap necrotic areas were analyzed. Results: All control and experimental flaps demonstrated total occlusion after hyaluronic acid injection. The average total survival rate (positive area/total area ×100 percent) of control flaps was 37.61 percent. For experimental groups, the average total survival rates were 74.83 percent, 81.49 percent, 88.26 percent, 56.48 percent, and 60.69 percent in groups A through E, respectively. Conclusion: A better prognosis can be obtained by administering repeated doses rather than a single high dose of hyaluronidase.