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

Chunyu Liu,Zhaolun Cai,Muke Zhou,Lingli Zhang,Li He

doi:10.3389/fmed.2021.646657

Abstract

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.

Highlights

Injection of autologous fat on the face is a commonly performed procedure in plastic surgery [1]. It is generally considered safe because the material obtained from the patient’s fatty tissue is abundant and non-immunogenic [2, 3], there have been several reports on the literature of patients who suffered devastating complications such as sudden vision loss and cerebral infarction due to fat embolism following autologous fat injection on the face [2, 4,5,6]
We present two patients who suffered from sudden vision loss and cerebral infarction secondary to facial autologous fat injection
No specific findings were seen in electrocardiography, echocardiography, cranial magnetic resonance angiography, or cervical computed tomography angiography (CTA)

Summary

INTRODUCTION

Injection of autologous fat on the face is a commonly performed procedure in plastic surgery [1]. Twenty-four hours before the onset of these symptoms, she had undergone an injection of autologous fat into the temporal area under local anesthesia, and the volume of the fat graft was unclear On arrival, her vital signs were normal. Neurological examination revealed lethargy, dysarthria, disorientation, and left-sided hemiplegia involving her lower face Both pupils were fixed to the right side. Cervical computed tomography angiography (CTA) showed occlusion of the right external carotid artery (Figure 1B). A 19-year-old woman with no past medical history was referred to our hospital complaining of sudden vision loss in the left eye and right hemiplegia. No specific findings were seen in electrocardiography, echocardiography, cranial magnetic resonance angiography, or cervical CTA Laboratory examinations, such as screening for vasculitis and coagulopathies, were normal. At the 3-month follow-up visit, the patient’s vision had not improved

DISCUSSION

CONCLUSIONS

Findings

ETHICS STATEMENT