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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1080-1081

Acute Visual Loss and Stroke Following Autologous Fat Injection into the Temporal Area


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 Submission13-Jan-2020
Date of Decision04-Feb-2020
Date of Acceptance31-Oct-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Jie-Ping Lu
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
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325333

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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

How to cite this URL:
Lu JP, Song XK, Cao YQ, Zhao JM. Acute Visual Loss and Stroke Following Autologous Fat Injection into the Temporal Area. Neurol India [serial online] 2021 [cited 2021 Dec 5];69:1080-1. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1080/325333




Sir,

Autologous fat injection into the face is considered a safe and popular technique in cosmetic surgery.[1] 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.[2] 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.[3] Acute stroke and visual loss are rare but serious complications.[2] Both vascular adverse events, especially the latter, lack effective treatment options and have poor prognosis.[2] The possible mechanisms of this case are as follows:[4] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chajchir A, Benzaquen I. Fat-grafting injection for soft-tissue augmentation. Plast Reconstr Surg 1989;84:921-34.  Back to cited text no. 1
    
2.
Sito G, Manzoni V, Sommariva R. Vascular complications after facial filler injection: A literature review and meta-analysis. J Clin Aesthet Dermatol 2019;12:E65-72.  Back to cited text no. 2
    
3.
Krastev TK, Beugels J, Hommes J, Piatkowski A, Mathijssen I, van der Hulst R. Efficacy and safety of autologous fat transfer in facial reconstructive surgery: A systematic review and meta-analysis. JAMA Facial Plast Surg 2018;20:351-60.  Back to cited text no. 3
    
4.
Yoon SS, Chang DI, Chung KC. Acute fatal stroke immediately following autologous fat injection into the face. Neurology 2003;61:1151-2.  Back to cited text no. 4
    


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