Retinal and Choroidal Vascular Occlusion After Fat Injection Into the Temple Area

Liu, Lu; Xu, Xinglian; Wang, Zhiliang; Ye, Fuxiang; Fan, Xianqun

doi:10.1161/circulationaha.112.000397

Cited by 16 publications

(12 citation statements)

References 3 publications

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“…Data obtained were analyzed, including clinical symptoms and signs, injection sites and injected filler material, the associated examinations. A total of 75 patients were included, 7 – 13 which is the largest case series reported to date (Table 1 ). Thirty-seven patients, who suffered blindness received autologous fat injections, which were described to have a worse visual prognosis and higher cerebral infarction incidence.…”

Section: Reviewmentioning

confidence: 99%

A Novel Hypothesis of Visual Loss Secondary to Cosmetic Facial Filler Injection

Dû²,

Lu³

2015

Annals of Plastic Surgery

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With the current tendency of increasing minimally invasive cosmetic surgeries, some rare but disastrous complications of facial filler injections come into sight, such as visual loss. The study aims to investigate the possible route that the injected droplet accesses the ophthalmic artery to explain and prevent such devastating complications. We searched the National Library of Medicine’s PubMed database for cases of visual loss secondary to cosmetic facial filler injection, and reviewed relevant case reports/surveys, as well as accompanying references. Data obtained were analyzed, with special interest in injected sites and filler material, and clinical features of visual loss. Based on the anatomy of facial vessels, we inferred the possible route of injected droplet migrating from injection sites to ophthalmic artery. Most physicians propose a retrograde embolic mechanism, but the culprit artery when injecting different sites is not determined. We consider accidentally breaking into supraorbital artery or supratrochlear artery may cause occlusion of ophthalmic artery when injecting into glabella or forehead region. Speaking of the nasolabial fold and nasal dorsum region, any injections in the anastomosis of the dorsal nasal artery, angular artery, and lateral nasal artery can lead to retrograde embolism. Similarly, in the temporal region, we believe there is abnormal anastomosis between frontal branch of superficial temporal artery from external carotid artery and supraorbital artery from ophthalmic artery. In our hypothesis, we can explain the accompanying brain infarction after iatrogenic visual loss. If the injecting pressure is forceful enough, it may push the embolic materials into middle cerebral artery. Although iatrogenic ophthalmic artery occlusion is a rare complication after the facial filler injection surgery, it is usually devastating. Both the patient and the surgeon should be aware of the risk of irreversible blindness. Ideally, the injection sites should avoid the small vessels nearby, the injecting force and velocity should be as gentle and slow as possible.

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Section: Reviewmentioning

confidence: 99%

A Novel Hypothesis of Visual Loss Secondary to Cosmetic Facial Filler Injection

Dû²,

Lu³

2015

Annals of Plastic Surgery

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“…It should be noted that complete demographic data were not available in three patients ( 21 , 30 ). The most frequently injected sites were the glabella ( 10 , 11 , 15 – 17 , 22 , 31 , 32 ), forehead ( 2 , 10 , 21 , 24 , 26 , 30 , 31 ), temple area ( 2 , 6 , 29 , 31 , 33 , 34 ), and nasolabial groove ( 11 , 18 – 21 , 23 ). Two patients (4.9%) showed skin necrosis ( 25 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

“…Associated initial ocular problems included ocular pain (39%) ( 1 , 10 , 11 , 15 , 17 , 19 , 20 , 26 , 31 ), ptosis (31.7%) ( 11 , 16 , 23 , 24 , 31 ), ophthalmoplegia (26.8%) ( 1 , 11 , 31 ), exotropia (14.6%) ( 1 , 11 ), esotropia (2.4%) ( 11 ), and iris depigmentation (2.4%) ( 4 ). Nine cases (22.0%) involved retinal artery occlusion ( 11 , 15 , 18 , 19 , 21 , 26 , 29 ), and 19 cases (46.3%) involved ophthalmic artery occlusion ( 11 , 16 , 17 , 20 , 25 , 28 , 31 , 32 ). Six (14.6%) cases involved brain infarction ( 17 , 19 , 20 , 25 , 32 , 34 ), all of which were associated with middle artery infarction.…”

Section: Discussionmentioning

confidence: 99%

“…Six (14.6%) cases involved brain infarction ( 17 , 19 , 20 , 25 , 32 , 34 ), all of which were associated with middle artery infarction. Twenty-two (53.7%) cases involved therapies ( 1 , 2 , 6 , 11 , 15 , 18 , 22 – 25 , 27 – 29 , 32 – 34 ), mainly ocular massage ( 18 , 25 , 32 ), oxygen and carbon dioxide therapy ( 18 , 25 ), anterior chamber paracentesis ( 11 , 32 ), intravenous mannitol ( 2 , 25 ), systemic steroids ( 22 – 24 , 27 ), intraarterial thrombolysis ( 1 , 11 ), and decompressive craniectomy ( 2 , 6 , 33 , 34 ). However, none showed improvement in visual acuity.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 26 articles were identified, and they were summarized in Supplementary Table 1 (1,2,4,6,10,11,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Forty-one patients (35 women and 4 men; mean age 33.39 years old; range 18-66 years old) were included.…”

Section: ((((Facial Filler Injections) and (Autologous Fat)) Or (Autologous Fat Facial Injection))) And ((((((((Artery Embolism) Or (Compmentioning

confidence: 99%

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Case Report and Literature Review: Catastrophic Embolism Following Cosmetic Injection of Autologous Fat in the Face

et al. 2021

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Injection of autologous fat on the face is a commonly performed procedure in plastic surgery. However, it can lead to rare but devastating complications due to fat embolism. In this study, we presented two cases of cerebral infarction and/or sudden vision loss after cosmetic injections of autologous fat on the face. Two women underwent injections into the temporal and frontal areas, respectively. In case 1, the patient underwent decompressive craniectomy as her condition deteriorated continuously and died. In case 2, the patient's vision had not improved at the 3-month follow-up visit. Imaging examinations showed occlusion of the right external carotid artery in case 1, and multiple retinal arterioles were segmentally occluded in case 2. We also screened relevant studies via a systematic search of PubMed (last updated on May 9, 2020) and performed a narrative review due to the significant heterogeneity between the studies. To prevent this catastrophic event, the autologous fat injection should be performed carefully. If embolization does occur, early diagnosis and timely treatment may help improve functional outcomes.

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Long-term Outcomes of Temporal Hollowing Augmentation by Targeted Volume Restoration of Fat Compartments in Chinese Adults

Huang

Xie

Wang

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Previous anatomical and clinical studies have suggested that targeted restoration of the volume and distribution of fat compartments using appropriate cannula entry sites and injection planes is an excellent fat-grafting technique for facial contouring and hand rejuvenation. OBJECTIVE To perform subjective and objective evaluations of the safe and effective profile of the targeted fat-grafting technique for temporal hollowing augmentation. DESIGN, SETTING, AND PARTICIPANTS In a retrospective cohort study, a total of 96 consecutive patients with temporal hollowing were treated at the

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Retinal and Choroidal Vascular Occlusion After Fat Injection Into the Temple Area

Cited by 16 publications

References 3 publications

A Novel Hypothesis of Visual Loss Secondary to Cosmetic Facial Filler Injection

A Novel Hypothesis of Visual Loss Secondary to Cosmetic Facial Filler Injection

Case Report and Literature Review: Catastrophic Embolism Following Cosmetic Injection of Autologous Fat in the Face

Long-term Outcomes of Temporal Hollowing Augmentation by Targeted Volume Restoration of Fat Compartments in Chinese Adults

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