Risk of Blindness From Temple Filler Injections: Investigating Vascular Anastomoses Between the Deep Temporal and Ophthalmic Arteries.

Summary

Retrospective angiographic analysis identified four anastomotic routes linking deep temporal arteries to the ophthalmic artery, explaining how temple filler can cause vision loss via retrograde and anterograde flow. The work challenges assumptions about the safety of the supraperiosteal plane and highlights a mechanistic basis for rare but catastrophic complications.

Key Findings

• Identified four DTA-to-OA anastomotic routes enabling filler migration via combined retrograde and anterograde flow.
• Direct DTA–lacrimal artery anastomosis demonstrated; other routes involve IMAX with subsequent connections (superficial temporal, infraorbital, middle meningeal arteries).
• Findings challenge the presumed safety of the supraperiosteal plane in the temple region.

Clinical Implications

Even with supraperiosteal injections, embolization to the ophthalmic artery is anatomically plausible. Practitioners should minimize bolus volume/pressure, consider cannula orientation and aspiration limits, and prioritize risk communication and emergency protocols.

Limitations

• Small, retrospective, selected angiogram cases limit generalizability and do not quantify risk.
• No interventional validation; anatomical routes inferred without direct filler injection experiments.

Future Directions

Prospective imaging with standardized injection simulations, flow modeling, and cadaveric perfusion to quantify risk by plane, volume, and pressure; translation into practical injection safety protocols.