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[Press Release] Nose Filler Injection Can Cause Vision Loss When Injected With Poor Injection Techniques & Without Understanding Of Facial Anatomy, Dr Ivan Puah Warns

SINGAPORE, November 2020 — Dermal fillers using hyaluronic acid is one of the common types of soft-tissue augmentation used in Singapore for nose enhancement. Medical Director of Amaris B. Clinic, Dr Ivan Puah warns that when inexperienced medical injectors or non-medical professionals conduct a filler injection treatment, patients are at higher risks of developing filler related side-effects and complications. Dr Puah is the appointed trainer on Botulinum Toxin and Dermal Fillers for Merz, and co-author of a research paper titled ‘Prevention and Management of Vision Loss Relating to Facial Fillers Injection’ for Singapore Medical Journal.

Accidental Intravascular Administration Of Filler Material In The Nose Or Around The Glabella Areas

Nose bridge lifting is one of the most popular filler treatments in Singapore and Southeast Asia, sought by both men and women across all demographics and psychographics. Unfortunately, the rise in demand for nose fillers has also led to an alarming increment of serious complications such as permanent and temporary vision loss in patients. 

Accidental intravascular administration of the filler injections on the nose bridge or around the glabella areas may cause embolisation in the eye. Blood supply blockage to the eye can occur a few seconds after the filler injection. When the arterial supply is blocked by a clot of the hyaluronic acid filler, vision will be impaired.

In the event of vision loss, there is no universal consensus on the best way to dissolve or dislodge the fillers to reverse the problem. The doctor can take immediate actions to dislodge the fillers by reducing intraocular pressure. The patient only has a critical window between 60 and 90 minutes to rectify this issue before the vision loss becomes permanent. This is why injectors must be trained to recognise the symptoms, implement prompt measures and quickly refer patients to ophthalmologists for immediate treatment before the condition becomes irreversible.

Dr Ivan Puah, Medical Director at Amaris B. Clinic, during an injectable treatment in early 2019

True Understanding Of Facial Anatomy And Good Injection Techniques Are Of Utmost Importance When Looking For An Aesthetics Doctor For A Filler Injection

Seeking an aesthetics doctor transcends beyond medical qualifications as a medical professional. Experience and proven track record in administering successful filler injections, understanding facial anatomy and having the knowledge of good injection techniques are some of the main things a patient should look out for before proceeding with the filler treatment. 

Understanding facial anatomy enables the doctor to select a safe injection site, avoiding all the major blood vessels that may result in accidents and complicated side effects. Experienced hands and good injection techniques allow the injectors to deliver safe and natural results catering to the different needs of each patient.

Only go to a medical professional for any injectable treatments

Unregulated online and social media advertising of salons and spas offering their services at unreasonably low prices are driving and encouraging people to seek beauty enhancements. Beauty therapists and beauticians in Singapore and Malaysia are carrying out the injectable treatments when such treatments should only be carried out by medical doctors who are trained and qualified to do so. When injectables are done incorrectly, it can lead to skin necrosis, facial paralysis and blindness. 

“It is a worrying trend as I am seeing an increasing number of patients who have come to correct the “facial defects” on their faces following dermal filler procedure – which can range from over-filling and inflammation on the face to the presence of granuloma. Beauty therapists or beauticians, no matter how skillful they are, may not understand the anatomy and physiology of the human body adequately. It is important to know how to treat vascular complications from dermal filler issues, which require the use of hyaluronidase enzymes. Only doctors can administer this prescription-based injection,” Dr. Ivan Puah, who has more than 15 years of injectable experience, shares. 

Consumers in Singapore may not be aware, but only Ministry of Health licensed medical clinics can conduct treatment that requires injections such as botulinum toxin and fillers. Unfortunately, the current beauty industry is largely unregulated in this region, hence the onus falls on consumers to be more vigilant and choose the appropriate service providers who are professionally trained, licensed and qualified to perform facial injectables for their beauty needs.

Dr Ivan Puah strongly advises, “It is best to consult with a qualified professional on the most appropriate treatment to suit your needs and address your concerns effectively. Interested people should consult a qualified practitioner to discuss their medical conditions, if any, before the treatment. This can help eliminate or reduce any potential risks. It is not worth risking the quality of your vision to save a few bucks.” 



Loh KT, Chua JJ, Lee HM, Lim JT, Chuah G, Yim B, Puah BK. Prevention and management of vision loss relating to facial filler injections. Singapore Med J. 2016 Aug;57(8):438-43. doi: 10.11622/smedj.2016134. PMID: 27549227; PMCID: PMC4993968.…