Analysis of artery occlusion caused by facial autologous fat injections

Abstract

ABSTRACT Objective: To investigate the causes for retinal artery occlusion and cerebral infarction resulting from cosmetic facial autologous fat injections. Materials and Methods: Twenty-seven retrospective, noncomparative cases with artery occlusion caused by facial autologous fat injections were included. Injection sites, basic demographic information (age, sex, and laterality of the involved eyes), best-corrected visual acuities (BVCAs), fundus fluorescein angiography, optical coherence tomography findings, brain magnetic resonance imaging, and associated ocular and systemic manifestations were collected as study information. Twenty-seven cases were classified according to artery occlusion, which led to blindness and brain infarction, as relationship between blindness and brain infarction may provide clues to help us figure out the process of arterial blockage. Results: Of the 27 cases, 13 patients had ophthalmic artery occlusion (OAO), 6 had central retinal artery occlusion (CRAO), and 3 had branch retinal artery occlusion (BRAO). Injection sites were the glabellar area (9 cases), nasolabial area (5 cases), forehead area (4 cases), periocular area (2 cases), nose area and nasal area (2 cases), multiple places (2 cases), and other areas (3 cases). Injection at different injection sites may lead to blindness, which means that emboli went into the blood by different branches of the external carotid artery, and eventually blocked the ophthalmic artery and its branches. Concomitant brain infarction developed in 13 cases with retinal artery occlusion. The high probability of occurrence of cerebral infarction indicated that internal carotid artery could be a flow path of emboli. Conclusion: Cosmetic facial autologous fat injections may cause retinal artery occlusion. Under the pressure of injection, fat emboli go through the terminal artery of face into the ophthalmic artery counter currently. In some cases, retrograde arterial embolism also causes brain infarction. Middle cerebral artery occlusion is closely associated with OAO.