Generation of Filler Emboli as a Mechanism for Filler-Related Blindness

Treatment of Facial Artery Embolization Caused by Polycaprolactone-based Dermal Filler with a Regimen Including 5-Fluorouracil

Polycaprolactone-based fillers are commonly used in plastic surgery to improve facial aging. However, adverse vascular events following these injections have been reported. An arterial embolism is a rare but serious complication associated with injectable filler procedures. We report a case of arterial embolism in a 35-year-old woman who received a polycaprolactone-based dermal filler at the nasal base and was treated with a regimen containing 5-fluorouracil. We discuss the potential causes of the patient's condition and assess the superiority of our method over conventional approaches. Before treatment, ultrasound detected a decreased flow velocity in the patient's right medial canthus artery with distal hypoperfusion, which improved significantly posttreatment. Long-term follow-up revealed near-disappearance of facial scarring. Our treatment effectively addressed facial artery embolism without any reported adverse reactions.

External carotid artery to ophthalmic artery flow associated with internal carotid artery stenosis

PURPOSE

One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease.

METHODS

In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved.

RESULTS

The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) (p < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow (p < .001).

CONCLUSIONS

ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.