Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review.

Abstract

BACKGROUND\nWith the popularity of facial filler injections, increased severe adverse events, such as cerebral embolism, have been reported.\n\n\nOBJECTIVES\nThis article aims to summarize the clinical manifestations, and proposed mechanism of the filler-induced cerebral embolism (FICE) cases.\n\n\nMETHODS\nA literature review was performed with the search keywords including filler injection, hyaluronic acid, fat graft, cerebral infarction/embolism, stroke, cerebrovascular infarction, disorders of consciousness, and hemiplegia .\n\n\nRESULTS\nAmong the 43 cases of FICE from 35 articles enrolled, 37 patients were female, and 6 were male. Twenty-nine of these patients received fat grafting, followed by 12 who received HA injection. Most of the injection sites of FICE patients were at the glabella, followed by temporal, forehead, and nasal areas. Among 30 patients receiving injection under local anesthesia, 43.33% presented with neurological symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss, and 17 patients did not have newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy and symptomatic and nutritional treatment. Nearly half of the patients recovered or improved in neurological manifestations but not the visual loss. Five patients died.\n\n\nCONCLUSIONS\nFICE is a severe complication following facial filler injection. Careful prevention, timely identification and treatment are crucial to decrease the morbidity and mortality of FICE.