Purchase this article with an account.
Yong-Kyu Kim, Cheolkyu Jung, Se Joon Woo, Kyu Hyung Park; Different angiographic findings of cosmetic facial filler-associated ophthalmic and retinal artery occlusion: Autologous fat vs. hyaluronic acid. Invest. Ophthalmol. Vis. Sci. 2014;55(13):251.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the angiographic features of cosmetic facial filler associated ophthalmic artery and its branches occlusion, thereby elucidate its pathophysiology.
We retrospectively reviewed 6 female patients who sustained ophthalmic artery and its branches occlusion after cosmetic filler injection (3 cases of hyaluronic acid and 3 cases of autologous fat) and underwent immediate cerebral angiography and intra-arterial thrombolysis. We compared fundus fluorescein angiographic and cerebral angiographic findings as well as clinical characteristics between two groups of patients with different filler substances.
Those underwent fat injection showed visible emboli at main ophthalmic artery trunk on cerebral angiography, while hyaluronic acid injected group showed obstruction at posterior ciliary branch. Fundus fluorescein angiography showed that fat particles could reach the arterioles as well as large vessels. However in hyaluronic acid cases, perfusion delay was observed without definitely visible emboli. All three hyaluronic acid cases showed skin necrosis, while none in the fat cases. The cerebral angiographic findings also suggest that the angiographic runoff is diminished in the distal branches of internal maxillary arteries only in hyaluronic acid injected group.
The mechanism of arterial obstruction after cosmetic facial filler injection seems to be different according to the materials used. Autologous fat, due to its various sizes, induces multiple embolisms in both large and small vessels. However, hyaluronic acid, due to its small and uniform size, might obstruct distal branches of ophthalmic artery and induces perfusion delay. Furthermore, water absorption-volume expansion property of hyaluronic acid seems to cause elevation of distal intra-tissue pressure, which might impede normal blood flow from ophthalmic artery to its distal ends, resulting in higher rate of skin lesions.
This PDF is available to Subscribers Only