The Retina TL;DR with Dr. Weng: Navigating the ocular risks of facial fillers with Jennifer Murdock, MD

Like what you just watched? The goal of The Retina TL;DR with Dr. Weng video series, hosted by Christina Y. Weng, MD, MBA, FASRS, is to provide fast-paced, high-level information for today's modern retina specialist. We'd love to hear your feedback. Email us at eyecarenetwork@mjhlifesciences.com.

In this episode of The Retina TL;DR with Dr. Weng, powered by Modern Retina, host Christina Y. Weng, MD, MBA, FASRS, welcomes Jennifer Murdock, MD, an oculofacial cosmetic and reconstructive surgeon practicing in Miami, Florida, with expertise in thyroid eye disease, eyelid and orbital reconstruction, and minimally invasive cosmetic injectables. Their discussion centers on the ocular safety of facial filler injections—a topic with growing relevance for retina specialists as GLP-1 agonist use rises among patients with diabetes. Weng is professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology, and fellowship program director, vitreoretinal diseases and surgery, with Baylor College of Medicine in Houston, Texas.

Murdock offered her "TL;DR" ("too long; didn't read"): "When it comes to the subject of today's conversation, which is going to be pretty much the safety around the eye when it comes to aesthetic injections, my TL;DR is anatomy is the most important, and then the second thing is always be prepared."

“Ozempic face” and the filler boom

Weng framed the conversation around a phenomenon called "Ozempic face"—the gaunt, volume-depleted appearance associated with rapid weight loss from GLP-1 agonists. Murdock, who offers dermal filler injections at her Miami practice, clarified that the effect results from aggressive weight loss with any GLP-1 agent, causing loss of facial fat, descending cheeks and jowls, and deteriorating skin quality. As demand for non-surgical volume restoration grows—the global filler market is valued at over $5 billion, Weng noted—retina specialists are increasingly likely to encounter patients considering these procedures.

Types of fillers

Hyaluronic acid (HA) fillers are the most common, functioning as a gel that absorbs water to plump tissue. Biostimulators—including poly-L-lactic acid (PLLA)-based Sculptra and calcium hydroxylapatite-based Radiesse—stimulate the body's own collagen production. Platelet-rich plasma, platelet-rich fibrin, and fat grafting round out the options.

Ocular risks and the anatomy that matters

The primary ocular risk is vascular occlusion—filler entering an artery and obstructing blood flow, potentially causing blindness if the retinal or choroidal circulation is involved. Murdock emphasized that the highest-risk sites are not the tear trough—which is largely avascular—but the nose and glabella, where the angular, supratrochlear, and supraorbital arteries anastomose with the retinal circulation. She noted she personally avoids injecting these areas.

Safer technique and emergency management

Risk-reduction strategies include ultrasound guidance to visualize vessels, injecting deep on bone, careful aspiration, and use of a blunt-tipped cannula. Should an occlusion occur, Murdock stressed having an emergency kit ready. For HA fillers, prompt liberal injection of hyaluronidase is first-line. Additional measures include aspirin, sildenafil or nitroprusside for vasodilation, ocular massage, and CO₂ rebreathing. Some academic centers—including a protocol at Methodist Hospital in Houston—offer interventional radiology-guided intra-arterial hyaluronidase. "Time is of the essence," Murdock noted.

Additional resources

For retina specialists seeking to learn more, the American Academy of Ophthalmology offers a comprehensive overview of periocular filler safety, and EyeWiki provides peer-reviewed articles on eyelid filler injection and complications of hyaluronic acid fillers. Additional clinical information is available at jennifermurdockmd.com.

Christina Y. Weng, MD, MBA, FASRS, is professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology, and fellowship program director, vitreoretinal diseases and surgery with Baylor College of Medicine in Houston, Texas. Weng has no relevant disclosures.

Jennifer Murdock, MD, is an oculofacial cosmetic and reconstructive surgeon in Miami, Florida. Murdock is a trainer, advisor, and speaker with Galderma.