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Nerve Damage from Cheek Fillers

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Understanding Risks and Safeguards

Facial aesthetics procedures have grown exponentially in popularity over the past decade, with patients seeking treatments like Botox, fillers, and thread lifts to achieve a more youthful and rejuvenated appearance. Among the most popular options are dermal filler injections, which add volume and fullness to targeted areas of the face. However, like any procedure, fillers carry potential risks and complications. One of the most concerning is damage to the delicate facial nerves.

In this article, we’ll explore the basics of cheek fillers, causes and types of nerve damage, and preventive measures patients and providers can take to avoid nerve injury from filler injections.

The Basics of Cheek Fillers and Facial Aesthetics

cheek filler treatment

Dermal fillers are injectable implants used for facial rejuvenation and enhancement. They are classified as temporary, semi-permanent or permanent based on longevity.

  • Temporary fillers composed of hyaluronic acid (Restylane, Juvederm) last 6-18 months.
  • Semi-permanent options like hydroxapatite (Radiesse) fillers last about 2 years.
  • Permanent fillers are rarely used due to potential long-term side effects.

Cheek fillers are a type of dermal filler procedure that gives your cheeks a fuller, more defined look by injecting safe substances called dermal fillers around and above your cheekbones. Cheek fillers can be used to define and enhance your cheekbones, increase the volume of your cheeks, look more youthful, plump up wrinkles, and smooth lines.

Different types of dermal fillers can enhance the appearance of your cheekbones, and how they work depends on the type of filler your provider uses:

Filler TypeDescriptionDuration
Hyaluronic acid fillersMade of a substance naturally found in the body. Most common type used for cheek fillers.Up to 1 year or more
Polylactic acid fillersStimulate collagen production. Also used for cheek fillers.Up to 2 years
Calcium hydroxylapatite fillersMade of a mineral-like compound found in human bones.Up to 1 year or more
Polymethyl-methacrylate microspheres fillersTiny beads suspended in a gel. Used for deep wrinkles.Up to 5 years
Polyalkylimide fillersSynthetic fillersUp to 5 years

Understanding Nerve Damage in Facial Aesthetics

Facial Anatomy

When it comes to cheek fillers, understanding facial anatomy is crucial to ensure safe and effective administration. The facial anatomy includes various layers of the skin, muscles, blood vessels, and nerves. Injecting fillers requires a thorough knowledge of the facial anatomy to avoid nerve damage. 

There are seven facial nerves danger zones that should be avoided while injecting fillers to the face:

  1. Glabella (between your eyebrows or just above the nose)
  2. Nasolabial grooves (smile lines - lines between the corner of your nose and your mouth)
  3. Periorbital area (around the eyes)
  4. Temples
  5. Nose
  6. Lips/Oral commissure
  7. Nasolabial fold and the Nasal Alar Groove

Inappropriate injection technique and too-high volumes can cause side effects like visible implants, palpable nodules, over-, or under-correction. Lumps and bumps at the site of injection are some of the most prevalent side effects seen with filler injections.

Facial Nerves

The intricate network of facial nerves enables emotional expression and movement. But these nerves also put patients at risk of injury during filler injections and other facial procedures. The facial nerves that are most commonly affected by facial fillers are the temporal branch of the facial nerve, the zygomatic branch of the facial nerve, and the infraorbital branch of the trigeminal nerve.

These nerves are located in the areas where fillers are commonly injected, such as the temples, cheeks, and under-eye area. Thinner skin types and delicate under-eye areas require advanced expertise to avoid nerve damage

Neurapraxia, or temporary nerve trauma, is the most common type of nerve damage from fillers. It involves compressed nerves and disrupted blood flow, resulting in numbness that typically resolves within weeks or months. More dangerous risks include nerve transection and permanent vision or muscle impairment.

Nerve injury can occur through:

  • Direct needle trauma injecting into or too close to a nerve. The infraorbital nerve below the eye is particularly vulnerable.
  • Compression injury from excessive filler material around the nerve.
  • Vascular occlusion reduces blood supply to the nerve.
  • Unintended trauma like bruising during injections.

In rare cases, filler procedures can also cause nerve damage far from the injection site. For example, injections near blood vessels on the face can inadvertently release filler into an artery that travels to the eye, leading to vision issues like diplopia or complete blindness.

Diagnosing and Monitoring Nerve Damage

Careful patient consultation and assessment helps identify candidates at elevated risk for nerve damage. Patients should share complete medical histories, nerve conditions, and disclose previous facial procedures or injections.

Prior to treatment, physicians like Dr. Lanna perform a thorough examination evaluating nerve function. Facial animations and movements are observed and recorded to compare post-procedure. For some patients, ultrasound or advanced imaging may help visualize injection sites and proximity to nerves.

Following injections, patients must be monitored closely for signs of nerve injury, which may indicate compression or intravascular injection. Early symptoms include pain, numbness, tingling, difficulty moving muscles, blurred vision, and appearance changes like drooping eyelids. Close follow-up and prompt intervention maximizes outcomes.

Potential Risks and Complications

Like any cosmetic procedure, cheek filler injections carry inherent risks ranging in severity. The most common complications include:

InfectionBacterial or viral infections at the injection site. Signs are redness, pain and swelling.
Allergic reactionSome filler ingredients may trigger hypersensitivity and anaphylaxis in rare cases.
Vascular occlusionDisrupted blood flow and tissue ischemia from intravascular injection.
Skin discolorationBruising, redness and swelling that resolves slowly.

Rarer but serious risks include:

  • Arterial occlusion causing vision changes, skin necrosis and blindness.
  • Permanent nerve injury and paralysis of facial muscles causing an asymmetrical appearance.
  • Retinal artery occlusion leading to permanent partial or complete vision loss.

Those with vascular conditions, bleeding disorders, active skin infections, and certain autoimmune diseases have heightened risks for complications. Thinner skin types and delicate under eye areas also require advanced expertise to avoid nerve damage.

Preventive Measures and Treatment Options

Expert knowledge of facial anatomy and proper injection technique significantly reduces complications like nerve damage. Steps providers can take include:

  • Careful aspiration prior to injection
  • Palpation of landmarks like mid-pupillary line to avoid vessels
  • Small volume injections slowly over time
  • Avoiding bolus injections near vulnerable nerves

If nerve injury is suspected, prompt intervention aims to reduce permanent damage:

  • Cold packs constrict blood vessels and reduce swelling compressing nerves.
  • Hyaluronidase breaks down HA filler to reduce pressure on the nerve.
  • Steroid injections minimize inflammation.
  • Neurotoxins like Botox provide temporary paralysis allowing nerves time to heal.

With serious vision or muscle impairment, surgical nerve decompression or excision of filler material may be required.

Recovery time varies significantly based on injury severity. Mild cases may resolve fully within a few weeks. More extensive injuries can involve months of nerve regeneration and rehabilitation to regain optimal movement and facial expressions. Collagen stimulation injections and microneedling may aid the healing process.


a man getting cheek filler treatment

While rare in experienced hands, nerve damage remains an inherent risk with advanced facial filler injections. Patients can protect themselves by thoroughly researching providers’ expertise and educational background.

Board-certified facial plastic surgeons like Dr. Lanna offer the most advanced anatomy training and injection techniques to provide natural-looking results and avoid complications. Staying informed on all risks and carefully following post-procedure instructions are also vital steps patients can take to maximize their safety and aesthetic outcome from cheek fillers. Get in touch with us today to schedule your consultations.

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