Doctors want dermal filler regulated after woman blinded

ELEANOR BLACK/October 6 2017. Dermal fillers are not currently regulated.

Doctors specialising in appearance medicine want the use of dermal fillers regulated, after an Auckland woman was blinded in one eye by a nose procedure gone wrong.

Dr Hans Raetz, president of the New Zealand Society of Cosmetic Medicine, says he has colleagues who have decided not to inject noses, because of the risk. 

In a rare complication, filler injected near the nose can travel through blood vessels feeding the eye, and starve them of blood and oxygen, resulting in blindness. There have been 100 such cases worldwide. 

The first New Zealand case involved a 44-year-old Auckland woman who was blinded in March, as reported by North and South. She had filler injected near her nose, to change the shape of the bridge. Within minutes the vision in her right eye became blurry.

"That case certainly brought it to our doorstep," says Dr Raetz. "It was a central pillar of the [NZ Society of Cosmetic Medicine] conference." Some of the people involved in the case were at the conference.

Dermal fillers are used to plump cheeks and lips and alter the shapes of noses. While a nose job by a top surgeon costs around $20,000, the cost of a non-surgical nose job using fillers is around $1000. 

Under the proposed Therapeutic Products Bill, expected to go before Parliament next year, there will be a regulatory framework around the use of dermal fillers.

The classification of dermal fillers changed from "medicine" to "medical device" in 2014, meaning that anyone can use them.

"In terms of the type of classification we have for medicines in legislation (ie prescription-only, pharmacy-only under the current Medicines Act 1981), there are currently no similar legal restrictions on who can use medical devices," says Medsafe group manager Chris James.

"In the new Therapeutic Products Bill we are looking at how to ensure appropriate use of these products."

"It's very heartening to see some action," says Dr Raetz. "We saw a problem looming where this is not a medical device that you would use in a theatre with lots of medical professionals around. This is something you can do in the back of a cosmetic clinic."

Since the classification change there have been five "adverse event reports" associated with the use of dermal fillers, according to the Ministry of Health. 

When the Auckland woman was taken to Auckland City Hospital in March, doctors did not understand what they were dealing with, according to North and South. It was three-and-a-half hours before a specialist treated the woman.

But even if she had been treated immediately, it may not have saved her eyesight. Of all the cases of blindness caused by dermal filler, not one has been reversed. 

Dr Raetz says he does not think people should be discouraged from getting fillers injected, but that they should be better informed of possible problems. 

"I think the better approach is to get clients to look at the risk. [If doctors won't do procedures] these patients will go somewhere else, I guarantee it," says Dr Raetz.

"You will drive these patients from experienced injectors to complete flakes. I know there are back-street injectors out there."

 - Stuff