Alexander Rivkin, MD
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Alexander Rivkin, MD
Plastic surgeon | Views: 243959

Friendname: AlexanderRivkinM.D.
Business Name: Westside Aesthetics
Website: www.westsideaesthetics.com
Location: 1033 Gayley Ave #104
los angeles, CA 90024
United States
Telephone: 310 443 5273
Languages Spoken: English

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Ask An Expert > Alexander Rivkin Message Board > Fillers Under the Eye - Scared of Complications
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West Hartford, CT
Fillers Under the Eye - Scared of Complications
I'm considering having filler injected in my under eye circles. I've had this done twice before. The first time I loved it (That was a little over a year ago). About a month ago I went to get a touch up from a new Dr. (I moved recently) and I hated the results. It looked like the whole area was just pushed up and not filled in. I also got a blueish hue. I had it dissolved with vitrase. The first doctor used a fine needle to do the injection, while the second used a blunt cannula. I wasn't aware that there is a risk for blindness until I went to the second dr who said using a needle can increase risk for injecting into a blood vessel. This has me scared and uncertain as to what to do. My hollows really really bother me. The second dr. seemed to convey the chance of injecting into a vessel with a blunt were near impossible and that it was very safe through this technique. Yet I hated her results. I'm not sure if it had anything to do with the needle vs blunt or if her technique was just off.

Now in doing research, I'm overwhelmed with information. I'm seeing different safety precautions that can be used. (Withdraw the needle to ensure not in a vessel, use blunt tip, use epinephrine) I'm also reading about different aesthetic techniques (under the muscle, above the muslce, multi-planar, Thread behind the needle, push the needle forward while injecting). I really don't know what I should be looking for in a surgeon.

And I absolutely do not want to have surgery.

First and foremost i'm concerned about safety. Clearly I don't want to trade my under eye circles for blindness. Yet I'm sick and tired of having people asking whats wrong- you like tired or sick. I'm looking for a dr. to tell me if there are techniques that eliminate the risk for blindness (if not eliminate, minimize)?

Finally, I live in the Tri-sate area. Can a physician refer me to someone in NY, NJ,CT, or MA who is very reputable with this and uses a safe technique? I would be EXTREMELY grateful.


Plastic surgeon
los angeles, CA
United States
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Experience and results are everything  September 22, 2009 11:31 AM

You need to find a doctor who is very experienced in this technique. experience matters more than philosophizing about theoretical dangers of blindness. i have injected filler (always hyaluronic acid and always using a regular, sharp needle) under the eyes of about 1200 patients and have never had a serious complication. i have not seen a single case of blindness from filler injection under the eye reported in the literature. the artery is so small and the risk so remote that sacrificing good results to prevent this unheard of complication seems silly. insist on seeing the doctor's before and after pictures to evaluate their aesthetic sense and to make sure that they have done enough cases to show some good ones.
if you'd like me to take a look at your pictures, i would be happy to. just email them to arivkin@westsideaesthetics.com

Fillers  September 22, 2009 4:44 PM

Fillers under the eye, in the tear trough, is technique dependant.
Most of us use sharp needle when injecting fillers. most of us use blunt canula to inject fat.
The closer the needle to the side of the nose there is very small risk, which has been reported, of blindness caused by the filler gaining access to the angular plexus of vessels then to the opthalmic artery.



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