To the Editor We read with interest the recent article by Carle et al1 describing cases of central retinal artery occlusion caused by cosmetic facial filler injection. However, we would like to point out some issues in 2 aspects regarding this article.
First, they purported that this was the first report regarding blindness caused by filler injected into the forehead. However, our group previously reported 12 cases of cosmetic facial filler injection–related retinal artery occlusion2 and, more recently, 44 cases of nationwide survey results.3 Most were young women, and the glabella was the most commonly injected site. In our articles, the injection sites were mainly classified as glabella, nasolabial fold, or nasal dorsum for rhinoplasty. Injections in the forehead region were included in the glabella category for the following reasons. Many young patients received forehead and glabellar filler injections simultaneously with the purpose of augmenting or reshaping the forehead4,5 rather than simply improving a frown line in the glabella, which occurs as an aging process. Moreover, the presumed entry site for retrograde embolism in the glabella and forehead region may be the same artery, ie, the supratrochlear or supraorbital artery,2 which suggests that the glabella and forehead should be regarded as the same etiological region regarding cosmetic facial filler–associated retinal artery occlusion. Therefore, blindness caused by filler injection in the forehead is not a new finding but one that has already been reported in the literature even though it is roughly described as the glabella region.