Severe Vascular Complications Caused by Facial Autologous Fat Grafting

Abstract

Background Vascular embolism is the most severe complication after autologous fat grafting. With a worldwide increase in fat grafting, there has been a rise in severe vascular complications, such as ophthalmic artery embolism, cerebral artery embolism, and even death. This article aims to review the role of fat in causing severe vascular complications and the association between fat grafting and severe vascular complications. Methods A critical review was conducted by appraising the cases of severe vascular complications associated with facial fat grafting reported globally. Repeated cases that were reported in multiple publications were further screened. Results The final search yielded 50 publications in English that met the inclusion criteria for review. A total of 113 cases of fat-induced severe vascular complications in the literature were identified. The number of cases reported yearly has increased over time, with even more significant increases since 2010. The glabella and temple are the most common sites of severe vascular complications described in the literature. In addition, only one case of ophthalmic artery embolism and one case of cerebral artery embolism have been treated successfully. Conclusions Given the increase in reported cases of severe vascular complications, both doctors and patients should pay careful attention to the risks of facial fat grafting. Because of the unclear mechanism of vascular embolism and the lack of guidelines for prevention and treatment, the effective cure rate is unsatisfactory. We propose that preventing vascular embolism is a priority in fat grafting and that timely, multidisciplinary treatment should be performed when severe vascular complications occur. It is necessary in future studies to explore the mechanisms of vascular embolism and effective treatment strategies to promote the development of fat grafting.

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal

“…Intravascular injection, requiring neurological or neurosurgical management, often leads to permanent disability or eventually death [ 4 ]. The exact rate of intravascular injection or migration remains unclear.…”

“…The recovery rate of major complication (MAFE) is really poor. Only two cases of cerebral and retinal [ 4 ] showed a full recovery after fat embolization.…”

“…Indeed, since 1998, not a single case of intravascular injection has been reported among major studies on facial lipofilling [ 8 ], with almost all reports on vascular accidents being described in case reports or small case series [ 4 ]. On the other hand, minor complications such prolonged oedema or erythema are often considered to be normal and therefore underreported or not included in the complications list (while being potentially impactful for the patients, extending the social downtime and decreasing procedure related satisfaction).…”

“…The safety and efficacy of fat grafting has been largely studied in different body areas, especially the breast, where fat grafting has been extensively used for both augmentation and reconstructive procedures [ 2 ]. However, severe complications of fat grafting have been reported, especially in gluteal and facial areas [ 3 , 4 ], following intravascular injection or migration.…”

“…If in gluteal fat grafting the mechanism of intravascular injection is well understood and avoidance of intramuscular injection dramatically improves safety [ 5 , 6 ], no clear consensus exists concerning facial fat grafting (FFG), where the mechanism leading to vascular complications is partially unknown and no prevention and treatment [ 4 ] guidelines have been produced. According to I.S.A.P.S.…”