Post-rhinoplasty complications with previous hyaluronic acid injection history: Cerebral infarction and vision loss

Exploring Superselective Intraarterial Thrombolysis for Autologous Fat Injection-Induced Vision Loss

BACKGROUND

Intravascular injection represents the most severe complication in fat transplantation procedures. Currently, the prognosis for patients who suffer from blindness due to fat transplantation-induced ocular vascular occlusion is far from optimistic.

OBJECTIVES

The aim of this study was to explore and evaluate the efficacy and safety of arterial thrombolysis in the treatment of ocular vascular occlusion caused by fat transplantation.

METHODS

We analyzed the data of 12 patients who underwent intraarterial thrombolysis and conservative treatments for facial autologous fat grafting-associated ocular vascular occlusion. Among the cases, there were 6 instances of ophthalmic artery embolism and 6 cases of central retinal artery occlusion. All patients suffered with sudden blindness, sometimes accompanied by eye pain, ptosis, strabismus, skin necrosis at the injection site, or cerebral microinfarction. They received symptomatic conservative treatments and intraarterial thrombolysis, encompassing mechanical vessel recanalization, vessel dilation, and dissolution of thrombus constituents.

RESULTS

Following intraarterial thrombolysis, a noteworthy improvement in the blood flow of both the main trunk and peripheral branches of the ophthalmic artery was observed in the majority of patients when contrasted with their pretreatment status. One patient experienced a headache intraoperatively, while no significant discomfort was reported by the remaining patients. After conservative treatments and intraarterial thrombolysis, all patients experienced improvement in ocular symptoms, skin necrosis, and cerebral infarction. Three patients demonstrated improvement in visual acuity. These patients had surpassed the recommended time window for treatment, yet the occlusion of the ophthalmic artery was not complete.

CONCLUSIONS

Intraarterial thrombolysis combined with conservative treatments achieves early perfusion and is expected to promote visual recovery. Hospitals that possess the necessary treatment capabilities are encouraged to establish this therapeutic pathway.

Delayed Diagnosis of Septal Ulcer after Hyaluronic Acid Nasal Filler Injection

The utilization of fillers, notably hyaluronic acid, has increased due to their proven effectiveness, versatility, and generally favorable safety profile. In the field of rhinoplasty, hyaluronic acid dermal fillers have been employed for the correction of nasal deformities and surface irregularities. Nevertheless, the intricate vascular network of the nasal region, involving anastomoses between the external and internal carotid arteries, predisposes it to serious vascular complications. We report a case of a severe septal ulcer secondary to local ischemia following an injection of a hyaluronic acid nasal filler. The patient presented with immediate pain and nasal discomfort; however, there was an unfortunate delay in diagnosis and treatment. This report discusses the intricacies of the case and imparts crucial insights gleaned from the incident.