Maintaining a youthful appearance despite advancing years has become quite popular and even acceptable in society. It has long been the case among women, but men are equally opting for this trend in appearing ageless. While elite athletes maintain their vigour through physical conditioning, millions of others are turning to readily accessible cosmetic procedures.India has emerged as a global hub for aesthetic procedures. The International Society for Aesthetic Plastic Surgery (ISAPS) reported nearly 1.3 million aesthetic procedures in India in 2024, predominantly on the face and eyelids, with at least half of these procedures through non-surgical injectables. These included hyaluronic acid filler injections, Botulinum toxin, and calcium hydroxyapatite, among others. More than 20 million non-surgical aesthetic procedures are performed globally, with 40 per cent growth over the past five years. The report suggests that in India, only two-third of procedures are performed in big hospitals, while the remainder are done in private clinics or small hospitals (ISAPS report, 2025).That a benign-sounding cosmetic procedure could be sight-threatening was brought home to me some 25 years ago, when a terrified dermatologist rushed a young university student to me. The young girl had fainted within seconds of receiving an intralesional (directly into a specific skin lesion or tissue mass) steroid injection into a strawberry birthmark (haemangioma) at the tip of her nose. She regained consciousness within 30 minutes, only to report that she was completely blinded in both eyes. She had been brought to me without delay. A quick examination revealed that steroid particles had embolised (obstructing a blood vessel or organ), blocking the retinal arteries in both eyes. I could see the drug emboli moving briskly through the retina. Emergency measures within minutes of the episode restored her near-normal vision (Retina, 2002). Most patients blinded by aesthetic injectables are not so fortunate.What Studies sayStudies in recent years have reported a 509 per cent rise in blindness from forehead fillers. Stroke-like features were observed in 19 per cent cases. Consumers must be aware of the risks of receiving non-surgical filler injections from uncertified salon operators, who are abundant in India.Beleznay and colleagues (the Aesthetic Surgery Journal, 2019) identified 98 cases of irreversible blindness up to 2015 and a further 48 in the subsequent four years. A more recent report by the American Academy of Ophthalmology documented 198 cases of blindness, 83 per cent due to hyaluronic fillers and 15 per cent due to autologous fat (Ophthalmology, 2025). There was a dramatic rise in cases of partial or complete blindness between 2018 and 2023, with 365 new cases reported (Doyon et al., the Aesthetic Surgery Journal, 2024). They reported a 509 per cent rise in blindness from forehead fillers. Many of these cases also involved eyelid drooping and complete paralysis of the eye muscles. Stroke-like features were observed in 19 per cent.Half of the cases occurred after injection in the nasal area, followed by the glabella (between the brows), the forehead and the nasolabial folds (nose-to-mouth lines). These areas are the “danger zones” on the face, where the arteries have an intimate connection with the blood supply to the eye, and the risk of retrograde embolisation of the fillers is high.Injecting fat to treat sunken dark circles under the eyes carries the highest risk of blindness and requires utmost care and familiarity with the technique and anatomical landmarks. These procedures ought to be performed only by trained plastic surgeons.Prospective consumers of cosmetic facial enhancement must be aware of the risks of receiving non-surgical filler injections from uncertified salon operators, who are abundant in India.The Central Drugs Standard Control Organisation (CDSCO) has banned the marketing of injectables as cosmetics, as they are classified as medical devices. Soft tissue fillers are Class C devices, carrying moderate to high risk, and must be used by certified aesthetic surgeons and dermatologists. Under the CDSCO guidelines, official distributors of aesthetic fillers in India may sell these products only to certified clinics.While there is no official data on the number of salons and wellness clinics in India that illegally offer injectable fillers procured through grey markets, the volume of procedures performed by these clinics could be equal to or greater than those performed by certified clinics.Although blindness is rare, there is currently no systematic reporting of such cases in India. Before committing to such procedures, ensure that the clinic is certified, has a pre-existing arrangement for quick access to an ophthalmologist, and, if the need arises, is equipped with the necessary protocols and crash kits for blindness.Factcheck: India ranks high globally for aesthetic procedures like lip and cheek contouring. Hyaluronic acid fillers are the most widely used soft-tissue fillers due to high biocompatibility. The dermal fillers market in India is estimated to be worth $52.4 million, with over 1.3 million aesthetic procedures being done in India in 2024. Injections near facial arteries can block blood flow, leading to tissue necrosis, stroke, or vision loss. Recent news stories have reported that advanced scans frequently uncover blocked perforator vessels from misplaced fillers. Industry studies also warn that fake aesthetic and beauty products are another major issue.— The writer is Emeritus Professor, PGI, Chandigarh