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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 1080-1081
Acute Visual Loss and Stroke Following Autologous Fat Injection into the Temporal Area
Jie-Ping Lu1, Xiao-Kai Song2, Yu-Qin Cao2, Jiang-Ming Zhao2
1 Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine; Hefei National Laboratory for Physical Sciences at the Microscale, Neurodegenerative Disorder Research Center, School of Life Sciences, University of Science and Technology of China, Hefei, Anhui, China
2 Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
|Date of Submission||13-Jan-2020|
|Date of Decision||04-Feb-2020|
|Date of Acceptance||31-Oct-2020|
|Date of Web Publication||2-Sep-2021|
Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, NO.17, Lujiang Road, Luyang District, Hefei, Anhui - 230001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lu JP, Song XK, Cao YQ, Zhao JM. Acute Visual Loss and Stroke Following Autologous Fat Injection into the Temporal Area. Neurol India 2021;69:1080-1
Autologous fat injection into the face is considered a safe and popular technique in cosmetic surgery. However, the adverse events are increasingly being reported with the widespread application of this procedure, among which the acute visual loss and stroke are serious but rarely observed. Here, we report a patient with acute visual loss and stroke after autologous fat injection into the temporal area to correct temporal depression.
A 35-year-old woman suddenly developed visual loss in her left eye, soon followed by confusion, aphasia and right hemiplegia when she was undergoing autologous fat injection into the temporal area to correct temporal depression. She quickly received intravenous recombinant tissue plasminogen activator, but the symptoms did not improve. The patient arrived at our hospital eight hours after symptom onset. Physical examination revealed agitation, global aphasia and complete right hemiplegia. Visual acuity couldn't be examined due to aphasia. The left pupil was dilated and unresponsive to light. There was eyeball protrusion, eyelid swelling, conjunctiva hyperemia and corneal opacity in the left eye. She had no prior medical history. Routine laboratory tests and cardiac assessments were normal. The fundus photography and fluorescein angiography couldn't be performed due to the patient's agitation. Diffusion-weighted imaging revealed an acute infarction in the left frontal and parietal cortices [Figure 1]a. T2-weighted imaging (T2WI) showed dilatation of the left superior ophthalmic vein (SOV) [Figure 1]b. The computed tomography angiography (CTA) showed no arterial dissection or stenosis.
|Figure 1: (a) Diffusion-weighted imaging showed high signal intensities in the left frontal and parietal cortices. (b) T2-weighted imaging showed dilatation of the left superior ophthalmic vein (red arrow)|
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One month later, the patient was able to raise her right upper limb and walk with the help of others. The right hand could perform simple grasping tasks. However, there is little visual acuity improvement to her left eye with only slight light perception.
With the continuous progress of techniques and people's constant pursuit of beauty, the rate of facial fat grafting has dramatically increased for facial rejuvenation. The incidence of related adverse events is about 4.8%, majority of which are moderate and transient, such as scarring, fibrosis, edema, etc. Acute stroke and visual loss are rare but serious complications. Both vascular adverse events, especially the latter, lack effective treatment options and have poor prognosis. The possible mechanisms of this case are as follows: a sharp needle perforated the vessel wall. The operator applied excessive force and velocity of injection causing the increase in local pressure, the fat embolus reached the left ophthalmic artery and the branches of the left middle cerebral artery by reversed flow through anastomoses between the left superficial temporal artery and the left ophthalmic artery. In addition, the patient's physical signs indicated venous reflux obstruction of the left eye. T2WI showed dilatation of the left SOV. No arteriovenous fistula was found in CTA. The mechanism is presumed that the fat embolus reached the left SOV by reversed flow through the left superficial temporal vein.
Therefore, the cosmetic surgeons should be well familiar with the anatomy of the injection sites and perform carefully with blunt needles and appropriate pressure to avoid any serious vascular complications.
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Conflicts of interest
There are no conflicts of interest.
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