We report a case of a 23-year-old man with cerebral infarction and permanent visual loss after injection of a hyaluronic acid gel filler for augmentation rhinoplasty. The patient was admitted to the hospital with complaints of loss of vision in the right eye, facial paralysis on the right side, and paralysis of the left limbs with severe pain during augmentation rhinoplasty with filler injection. Brain magnetic resonance imaging and computed tomography showed ophthalmic artery obstruction and right middle cerebral artery infarction. Acute thrombolysis was performed to treat the infarction; however, the patient's condition did not improve. Intracerebral hemorrhage in the right temporal/frontal/occipital/parietal lobe, subarachnoid hemorrhage, and midline shifting were observed on brain computed tomography after 24 hours after thrombolysis. Emergency decompressive craniectomy was performed. After the surgery, the patient continued to experience drowsiness, with no improvement in visual loss and motor weakness. Three months later, he could walk with cane. This case indicates that surgeons who administer filler injections should be familiar with the possibility of accidental intravascular injection and should explain the adverse effects of fillers to patients before surgery.

Performing rhinoplasty using filler injections, which improve facial wrinkles or soft tissues, is relatively inexpensive. However, intravascular filler injections can cause severe complications, such as skin necrosis and visual loss. We describe a case of blepharoptosis and skin necrosis caused by augmentation rhinoplasty and we discuss the patient’s clinical progress. We describe the case of a 25-year-old female patient who experienced severe pain, blepharoptosis, and decreased visual acuity immediately after receiving a filler injection. Our case suggests that surgeons should be aware of nasal vascularity before performing an operation, and that they should avoid injecting fillers at a high pressure and/or in excessive amounts. Additionally, filler injections should be stopped if the patient complains of severe pain, and appropriate measures should be taken to prevent complications caused by intravascular filler injections.

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Study Design. Analytical biomechanical study using a finiteelement (FE) model. Objective. We investigated the effects of paraspinal muscle volume to the physiological loading on the lower lumbar vertebral column using a FE model. Summary of Background Data. The FE model analysis can measure the physiological load on the lumbar vertebral column. Which changes as the surrounding environment changes. In this study, our FE model consisted of the sacrum, lumbar spine (L3-L5), intervertebral discs, facet joints, and paraspinal muscles. Methods. Three-dimensional FE models of healthy lumbar spinal units were reconstructed. The physiological loads exerted on the lumbar vertebra column were evaluated by applying different paraspinal muscle volumes (without muscles, 50%, 80%, and 100% of healthy muscle volume).Results. As the paraspinal muscle volume increased, the loads exerted on the vertebral column decreased. The mean load on the intervertebral disc was 1.42 AE 0.75 MPa in the model without muscle, 1.393 AE 0.73 MPa in the 50% muscle volume model, 1.367 AE 0.71 MPa in the 80% muscle volume model, and 1.362 AE 0.71 MPa in the 100% muscle volume model. The mean loads exerted on the posterior column of lumbar spine were 1 1 . 7 9 AE 4 . 7 0 M P a i n t h e m o d e l w i t h o u t m u s c l e s , 11.57 AE 4.57 MPa in the model with 50% muscle volume, and 11.13 AE 4.51 MPa in the model with 80% muscle volume, and 10.92 AE 4.33 MPa in the model with 100% muscle volume. The mean pressure on the vertebral body in the model without paraspinal muscle, and with 50%, 80%, and 100% paraspinal muscle volume were 14.02 AE 2.82, 13.82 AE 2.62, 13.65 AE 2.61, and 13.59 AE 2.51 MPa, respectively. Conclusion.Using FEM, we observed that the paraspinal muscle volume decreases pressure exerted on the lumbar vertebral column. Based on these results, we believe that exercising to increase paraspinal muscle volume would be helpful for spinal pain management and preventing lumbar spine degeneration.

Squamoid eccrine ductal carcinoma (SEDC) is an exceedingly rare tumor that shows both squamous differentiation and adnexal ductal differentiation. As our review of the literature revealed, only a total of 7 cases were reported to date. We report an additional case of SEDC occurring on the scalp of a 53-year-old man. Despite complete excision by conventional technique with clear margin, the lesion recurred within a 3-month period, with regional lymph node metastasis. The tumor was completely removed, and the large scalp defect was reconstructed by using scalp rotation flap. We present a case of recurrent SEDC on the scalp, and we surgically resected this tumor. In addition, the large scalp defect was reconstructed successfully with scalp flap, and no recurrence has been observed in the patient's postoperative follow-ups.