TITLE:
Ocular & Otolaryngology Complications Following Botulinum Toxin and Dermal Filler Injections
AUTHORS:
Hannah Cobb, Natasha Doshi, Komalpreet Kaur, Alejandra Sataray-Rodriguez, Jessica Lee, Samreen Shah
KEYWORDS:
Botulism Injections, Adverse Events, Cutaneous Fillers, Thrombosis, Ptosis
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.15 No.4,
September
15,
2025
ABSTRACT: Cutaneous fillers and botulinum toxin are widely used in dermatology and cosmetic surgery to enhance facial features, treat functional disorders, and combat signs of aging. While generally considered safe, it’s crucial to understand potential complications. This review aims to provide a comprehensive understanding of cutaneous fillers and botulinum toxin, focusing on facial complications, particularly those related to ocular and ear areas. The review discusses various types of cutaneous fillers, including hyaluronic acid (HA), calcium hydroxylapatite (CaHA), poly-L-lactic acid (PLLA), and polymethylmethacrylate (PMMA), highlighting their distinct properties and applications. Different types of botulinum toxin A, such as onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, are also examined. Potential complications, ranging from transient issues like swelling and bruising to more severe events like vascular occlusion, ptosis, diplopia, and optic neuropathy, are discussed. Preventative measures, including thorough anatomical knowledge, proper injection techniques, patient education, and the use of ultrasound imaging, are emphasized to minimize risks. The importance of recognizing early signs of complications and implementing timely interventions, such as hyaluronidase administration or hyperbaric oxygen therapy, is highlighted. A collaborative approach involving ophthalmologists, otolaryngologists, vascular surgeons, and dermatologists is crucial for optimizing patient safety and outcomes. The review underscores the need for ongoing training and adherence to evidence-based guidelines to ensure safe and effective cosmetic procedures. Methods: A systematic literature review was conducted to investigate ocular and otolaryngological complications following injectable botulinum toxin and cutaneous filler procedures. A comprehensive search of relevant databases was performed, utilizing keywords such as “botulinum injections”, “ptosis”, “thrombosis”, “cutaneous fillers”, and “adverse events”. Studies were selected based on their analysis of complication types, etiological factors, and proposed prevention methods within the specified anatomical regions. Results: The literature review revealed that ocular and otolaryngological complications following injectable botulinum toxin and cutaneous filler procedures are influenced by a complex interplay of factors. Iatrogenic causes, such as improper injection technique and inadequate anatomical knowledge, were frequently reported. Patient-related factors, including anatomical variations and pre-existing conditions, also contributed to adverse outcomes. Furthermore, the literature highlighted the role of product-related factors, such as filler type and injection volume, in the development of complications. Conclusion: In conclusion, the analysis emphasizes the imperative of a comprehensive research agenda to expand upon the diverse challenges increasing ocular and otolaryngological complications during injectable botulinum and cutaneous filler injections. The identified iatrogenic factors, including technique and anatomical knowledge, necessitate tailored interventions and techniques to enhance precision and reduce complications. This research agenda aims to inform health-care practices and policies, ultimately improving the safety profile for patients undergoing facial cosmetic procedures.