Dr. Sam Lam Plastic Surgery Forum

Hello Dr Lam!!!!

I once read (here, I think?) that just like botox is not safe (or at least tricky to use) in certain areas, the same applies for injectable fillers. I have the impression that the area between the eyebrows could be dangerous in the hands of the wrong doctor because of the important... vessels? nerves? that are in the area. What areas of the face would you say are not safe for fillers, at least not in "average good doctor" hands? (versus very experienced hands).
Apparently nasolabial folds are safe, so are lips, cheeks (malar area), base of the nose... what about the forehead, the sides of the nose (I mean sides of nostrils and sides of cheeks and anywhere near the eye too), undereye area? (I know you fill the undereye area, but your results are excellent while other docs, way too many, leave disasters -like bags).

What area has nerves or vessels you'd rather advice someone NOT in your hands to not get filler on?

Hugssssssss

unfortunately, almost every place of the face carries risk with an inexperienced injector. however, you are right, between the eyes is the #1 dangerous area. when i do that area, the patient must be highly selectively chosen (i.e., not have a vascular risk and also be a worthy candidate, i.e., have a severe enough deformity to merit the treatment), only injected with hyaluronic acid, which is reversible, given my cell phone #, and asked to call with any skin changes. the real risk here is necrosis. unfortunately, most doctors out there (probably greater than 98%) do not carry both nitropaste and hyaluronidase, which in my opinion are very important to have no matter what injection you do so that you can manage a complication immediately and evert disaster should one arise. i always try to pull back on the syringe to make sure that i am extravascular (outside of a vessel). the next most dangerous area is under the eyes because of rare vision risk. make sure that you are either using cannulas or injecting superficially with a flash back of the needle before injecting. that keeps things very safe. the fourth most dangerous area is probably near the lips with rare arterial occlusion. the best way to avoid these risks is to do the following:
1. only go to a very experienced injector, especially if you are considering advanced regions of the face.
2. ask the doctor what is his emergency preparedness plan? what would he/she do with an impending vascular occlusion. what materials does he/she have in the office to manage such a problem?
for a detailed discussion of these problems, watch my videos on complications with fillers in my video lecture section. i have given this talk nationally several times already. fillers can be very safe. all i do is advanced injections practically speaking. just make safe choices.
best,
sml

Wonderful answer, as always!

cool, great!