Autologous Fat Injection for Soft Tissue Augmentation in the Face: A Safe Procedure?

Abstract

Autologous fat injection for soft tissue augmentation in the face is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction following fat injections into the face. Acute visual loss after injection of various substances into the face is a well-known complication of such interventions. We report two further patients who suffered from ocular and cerebral embolism after fat injections into the face. For the intravasation of fat particles there are three preconditions: well-vascularized tissue, fragmentation of parenchyma, and, especially, a local increase in pressure in the affected tissue. Fat injections into the face lead to an acute local increase in pressure in highly vascularized tissue. We assume that fragments of fatty tissue reach ocular and cerebral arteries by reversed flow through branches of the carotid arteries after they are introduced into facial vessels. The manifestation of fat embolism appears either immediately after the fat injection or after a latency period. Fat embolism can remain subclinical and may not be recognized, or the clinical features may be misinterpreted. To minimize the risk of such a major complication, fat injections should be performed slowly, with the lowest possible force. One should avoid fat injections into pretraumatized soft tissue, for example, after rhytidectomy, because the risk of intravasation of fat particles may be higher. Metabolic disturbances such as hyperlipidemia may also contribute to the clinical manifestation of fat embolism Routine funduscopic examinations after fat injections into the face could help to provide data for future estimation of the patient's general risk.

Periorbital Lipogranuloma Following Facial Autologous Fat Injections: Non-surgical Treatment

“…The chief harmful effect of periorbital lipogranuloma is cosmetic disfigurement and discomfort, such as frequent eyelid swelling, recurrent inflammation, and multiple lumps [5][6][7]. Although there have been a few case studies of periorbital lipogranuloma mainly treated with surgical excision [3,[5][6][7], there have been no previous studies with a sufficient number of cases describing the clinical features and treatments for this condition.…”

“…It is a safe method because it does not have the side effects of synthetic fillers [1,2]. However, it can cause unexpected complications, such as haematoma, paraesthesia, and irregular contours [3]. In addition, it can have potentially devastating complications, such as acute visual loss and cerebral infarction [3,4].…”

“…However, it can cause unexpected complications, such as haematoma, paraesthesia, and irregular contours [3]. In addition, it can have potentially devastating complications, such as acute visual loss and cerebral infarction [3,4]. Periorbital lipogranuloma following autologous fat injection into the forehead is a recently described adverse outcome [5,7].…”

Ischemic Stroke Caused by a Hyaluronic Acid Gel Embolism Treated with Tissue Plasminogen Activator

“…Last year, a neuroophthalmologist reported the occurrence of blindness, stroke, and skin necrosis from the injection of only 0.5 mL of filler into the left side of the nasal bridge. 17 Even a small amount injected into the lower face has been reported as having devastating complications: unilateral blindness and brain infarction occurred after the injection of only 0.5 mL into a nasolabial fold. 14 …”

Ensaio clínico randomizado sobre o uso de enxerto autógeno de gordura suplementado com células estromais derivadas do tecido adiposo para a reconstrução de partes moles faciais em pacientes portadores de microssomia craniofacial

“…Um evento raro é a hipertrofia do enxerto (68,69) , e entre as complicações severas existem relatos de embolia gordurosa com subsequente cegueira, afasia, restrição motora e até mesmo acidente vascular cerebral, por provável injeção intravascular (70)(71)(72) .…”