Fat Embolism After Autologous Facial Fat Grafting

Abstract

Background Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. We present the case of a patient who died due to massive cerebral micro fat embolism after facial fat grafting. Objectives Raising awareness and providing more evidence on prevention and treatment of this potentially lethal complication of facial fat grafting. Methods A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurological and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures. Results Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 ml fat was injected. The main complications are visual impairment, of which 88.5 % remained blind, and neurological symptoms, who never fully recover. Seven cases were fatal. Fat embolism can occur in veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but lack evidence. Several different preventive measures are described. Conclusions Although facial fat grafting is considered a safe procedure, one should be aware of the risk for fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcome, preventive measures are of utmost importance to improve patient safety.

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal

“…Of which, 359 were excluded: 38 papers were not in English, 41 were review articles, 279 articles were not reporting recipient site complications, 1 was not on human subjects. A total of 103 [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ,…”

Complications Associated with Facial Autologous Fat Grafting for Aesthetic Purposes: A Systematic Review of the Literature

“…These include the following, amongst other things: injection into the muscle and traumatized and scar tissues should be avoided; a so-called pretunnel should be created with a short pause before the actual injection of fat; multiple subcutaneous tunnels should be formed with an injection cannula bigger than the harvesting cannula; injection of small aliquots of fat should be performed with small syringes with low pressure, while applying digital compression proximal to the injection site. 27 It has to be noted that the included case reports and case series are considered to have low LoE overall. Furthermore, as already indicated, complications are significantly under-reported in literature.…”

Using multiple wavelengths in order to improve the facial contouring procedure by the lipolysis and sculpting

“…These include extended recovery periods, postoperative discomfort, infection risk, scarring, deep vein thrombosis, fat embolism, and adverse effects related to anesthesia. 2,12 For these reasons, there is needs for nonsurgical treatments.…”

“…Despite its effectiveness in eliminating excess and unwanted fat deposits, liposuction comes with potential risks and side effects. These include extended recovery periods, postoperative discomfort, infection risk, scarring, deep vein thrombosis, fat embolism, and adverse effects related to anesthesia 2,12 …”