Abstract
Introduction
With the recent increase in interest in using autologous fat (AF) filler injections to enhance aesthetic facial appearance, there is a noticeable increase in the complications such as vascular compromise and blindness. This systematic review and meta-analysis aimed to understand the symptomatology of ophthalmic complications related to AF facial injections for cosmetic purposes, their underlying causes, management options, and the final clinical outcomes.
Methods
This review was conducted according to the International Prospective Register of Systematic Reviews (PROSPERO) guidelines. In November 2021, we performed a systematic review of available literature using the following electronic databases: Cochrane, MEDLINE, and EMBASE. Our search was limited to the published studies between 2000 and 2021.
Results
A total of 1052 publications and 34 articles published were included. Twenty case reports, two case series, one prospective cohort study, and eleven retrospective studies were evaluated. The forehead was the most common single injection site (n = 196, 55.36%). The most common initial symptom was periorbital swelling (92.7%). The pooled prevalence of ophthalmic artery occlusion was 50.4% out of all AF injection-related complications. Regarding the management, most patients were managed conservatively (n = 278, 51.38%). Complete improvement was observed among 423 patients (80.57%).
Conclusion
Autologous facial fat injection is a minimally invasive procedure with a favorable safety profile in cosmetic applications. However, the common use of these injections in aesthetic surgery has resulted in a concomitant increase in devastating consequences, such as blindness. Therefore, a firm understanding of the potential complications of such interventions is essential.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Coleman SR, Katzel EB (2015) Fat grafting for facial filling and regeneration. Clin Plast Surg 42(3):289–300
Al Sufyani MA, Al Hargan AH, Al Shammari NA, Al Sufyani MA (2016) Autologous fat transfer for breast augmentation: a review. Dermatol Surg 42(11):1235–1242
Coleman SR, Carraway JH (2002) Hand rejuvenation with structural fat grafting. Plast Reconstr Surg 110(7):1731–1744
Klinger M, Lisa A, Klinger F, Giannasi S, Veronesi A, Banzatti B, Bandi V, Catania B, Forcellini D, Maione L, Vinci V (2015) Regenerative approach to scars, ulcers and related problems with fat grafting. Clin Plast Surg 42(3):345–352
Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, Mizuno H, Alfonso ZC, Fraser JK, Benhaim P, Hedrick MH (2002) Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 13(12):4279–4295
Coleman SR (2001) Structural fat grafts: the ideal filler? Clin Plast Surg 28(1):111–119
Bohluli B, Bagheri SC, Consky EK (2018) Fat grafting as an adjunct to facial rejuvenation procedures. Atlas Oral Maxillofac Surg Clin North Am 26(1):51–57
Groen JW, Krastev TK, Hommes J, Wilschut JA, Ritt MJ, Van Der Hulst RR (2017) Autologous fat transfer for facial rejuvenation: a systematic review on technique, efficacy, and satisfaction. Plast Reconstr Surg Glob Open 5(12):1606
Billings E Jr, May JW Jr (1989) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 83(2):368–381
Yu NZ, Huang JZ, Zhang H, Wang Y, Wang XJ, Zhao R, Bai M, Long X (2015) A systemic review of autologous fat grafting survival rate and related severe complications. Chin Med J 128(9):1245
DeLorenzi C (2014) Complications of injectable fillers, part 2: vascular complications. Aesthetic Surg J 34(4):584–600
Li X, Le Du JJ (2015) A novel hypothesis of visual loss secondary to cosmetic facial filler injection. Ann Plast Surg 75(3):258
Park KH, Kim YK, Woo SJ, Kang SW, Lee WK, Choi KS, Kwak HW, Yoon IH, Huh K, Kim JW (2014) Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA ophthalmology. 132(6):714–723
Egido JA, Arroyo R, Marcos A, Jimenez-Alfaro I (1993) Middle cerebral artery embolism and unilateral visual loss after autologous fat injection into the glabellar area. Stroke 24(4):615–616
Lee DH, Yang HN, Kim JC, Shyn KH (1996) Sudden unilateral visual loss and brain infarction after autologous fat injection into nasolabial groove. Br J Ophthalmol 80(11):1026
Park SW, Woo SJ, Park KH, Huh JW, Jung C, Kwon OK (2012) Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol 154(4):653–662
Moher D (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. ACP J Club 151(4):264
Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ evidence-based medicine 23(2):60–63. https://doi.org/10.1136/bmjebm-2017-110853
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for nonrandomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73(9):712–716
Danesh-Meyer HV, Savino PJ, Sergott RC (2001) Case reports and small case series: ocular and cerebral ischemia following facial injection of autologous fat. Archives of Ophthalmology (Chicago, Ill: 1960) 119(5):777–778
Lee YJ, Kim HJ, Choi KD, Choi HY (2010) MRI restricted diffusion in optic nerve infarction after autologous fat transplantation. J Neuro-Ophthalmol 30(3):216–218. https://doi.org/10.1097/WNO.0b013e3181c5d147
Park SJ, Woo SJ, Park KH, Hwang JM, Hwang GJ, Jung C, Kwon OK (2011) Partial recovery after intraarterial pharmacomechanical thrombolysis in ophthalmic artery occlusion following nasal autologous fat injection. J Vasc Intervent Radiol 22(2):251–254. https://doi.org/10.1016/j.jvir.2010.10.023
Park YH, Kim KS (2011) Images in clinical medicine. Blindness after fat injections. N Eng J Medicine 365(23):2220. https://doi.org/10.1056/NEJMicm1100804
Lee CM, Hong IH, Park SP (2011) Ophthalmic artery obstruction and cerebral infarction following periocular injection of autologous fat. Korean journal of ophthalmology: KJO 25(5):358–361. https://doi.org/10.3341/kjo.2011.25.5.358
Xing L, Almeida DR, Belliveau MJ, Hollands H, Devenyi RG, Berger A, Gale J (2012) Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat. Retina (Philadelphia Pa) 32(10):2175–2176. https://doi.org/10.1097/IAE.0b013e31826a6897
Duhoux A, Chennoufi M, Lantieri L, Hivelin M (2013) Complications of fat grafts growth after weight gain: report of a severe diplopia. J Plastic, Reconstruc Aesth Surg 66(7):987–990. https://doi.org/10.1016/j.bjps.2012.11.038
Kim SK, Hwang K (2013) A surgeon’s legal liability of compensation for blindness after periorbital fat grafts. J Craniofac Surg 24(3):970–971. https://doi.org/10.1097/SCS.0b013e31828f2926
Hong JH, Ahn SJ, Woo SJ, Jung C, Chang JY, Chung JH, Han MK (2014) Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections. J Neurol Sci 346(1–2):310–314. https://doi.org/10.1016/j.jns.2014.08.030
Hong DK, Seo YJ, Lee JH, Im M (2014) Sudden visual loss and multiple cerebral infarction after autologous fat injection into the glabella. Dermatol Surg 40(4):485–487. https://doi.org/10.1111/dsu.12426
Roshandel D, Soheilian M, Pakravan M, Aghayan S, Peyman GA (2015) Middle cerebral artery, ophthalmic artery, and multibranch retinal vessel occlusion after cosmetic autologous fat transfer to forehead. Ophthalmic Surg Lasers Imaging Retina 46(5):593–596.https://doi.org/10.3928/23258160-20150521-15
Lee JH, Choi HS (2015) Subconjunctival fat infiltration complicating autologous fat injection for facial augmentation. Ophthalmic Plast Reconstr Surg 31(3):252–254.https://doi.org/10.1097/IOP.0000000000000428
Kang JH, Park KH, Park JS (2016) Acute mental change and hemiplegia after autologous fat injection. J Cosmet Laser Therapy 18(7):413–416. https://doi.org/10.1080/14764172.2016.1197400
Szantyr A, Orski M, Marchewka I, Szuta M, Orska M, Zapała J (2017) Ocular complications following autologous fat injections into facial area: case report of a recovery from visual loss after ophthalmic artery occlusion and a review of the literature. Aesthetic Plast Surg 41(3):580–584. https://doi.org/10.1007/s00266-017-0805-3
Kim J, Kim SK, Kim MK (2017) Segmental ischaemic infarction of the iris after autologous fat injection into the lower eyelid tissue: a case report. BMC Ophthalmol 17(1):205. https://doi.org/10.1186/s12886-017-0599-8
Huh J, Yang S, Park J, Lee H, Baek S (2019) Granulomatous inflammation of the upper eyelid after autologous fat injection. J Craniofac Surg 30(3):808–810. https://doi.org/10.1097/SCS.0000000000005113
Liu H, Chen D, Zhang J (2020) Ophthalmic artery occlusion after forehead autologous fat injection. Retinal cases & brief reports 14(3):271–274. https://doi.org/10.1097/ICB.0000000000000694
Vatansever M, Dursun Ö, Özer Ö, Oktay Ö, Dinç E (2021) A rare ocular complication of autologous fat injection: subconjunctival fat infiltration. J Craniofac Surg 32(7):e679–e680. https://doi.org/10.1097/SCS.0000000000007924
Putthirangsiwong B, Vongsilpavattana V, Leelawongs S, Chanthanaphak E, Tunlayadechanont P, Chokthaweesak W (2022) Superior ophthalmic vein embolism following forehead augmentation with autologous fat injection. Aesthetic Plast Surg 46(1):450–455. https://doi.org/10.1007/s00266-021-02414-0
Park SH, Sun HJ, Choi KS (2008) Sudden unilateral visual loss after autologous fat injection into the nasolabial fold. Clinic Ophthalmol (Auckland, N.Z.) 2(3):679–683
Paik JS, Cho WK, Park GS, Yang SW (2013) Eyelid-associated complications after autogenous fat injection for cosmetic forehead augmentation. BMC Ophthalmol 13:32. https://doi.org/10.1186/1471-2415-13-32
Riesco B, Abascal C, Duarte A, Flores RM, Rouaux G, Sampayo R, Bernardini F, Devoto M (2018) Autologous fat transfer with SEFFI (superficial enhanced fluid fat injection) technique in periocular reconstruction. Orbit (Amsterdam, Netherlands) 37(3):191–195. https://doi.org/10.1080/01676830.2017.1383470
Elmelegy N (2021) Elmelegy’s modified technique for durable forehead rejuvenation using a novel instrument and fat transfer. Eur J Plast Surg 44:739–747. https://doi.org/10.1007/s00238-021-01826-0
Park, K. H., Kim, Y. K., Woo, S. J., Kang, S. W., Lee, W. K., Choi, K. S., Kwak, H. W., Yoon, I. H., Huh, K., Kim, J. W., & Korean Retina Society (2014) Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol 132(6):714–723. https://doi.org/10.1001/jamaophthalmol.2013.8204
Chen Y, Wang W, Li J, Yu Y, Li L, Lu N (2014) Fundus artery occlusion caused by cosmetic facial injections. Chin Med J 127(8):1434–1437
Park JY, Kim N (2016) Periorbital Lipogranuloma after facial autologous fat injection and its treatment outcomes. Korean J Ophthalmol 30(1):10–16. https://doi.org/10.3341/kjo.2016.30.1.10
Pascali M, Quarato D, Pagnoni M, Carinci F (2017) Tear trough deformity: study of filling procedures for its correction. J Craniofac Surg 28(8):2012–2015. https://doi.org/10.1097/SCS.0000000000003835
Chiu CH (2017) Objective evaluation of eyebrow position after autologous fat grafting to the temple and forehead. Aesthetic Plast Surg 41(6):1342–1350. https://doi.org/10.1007/s00266-017-0881-4
Chiu CY, Shen YC, Zhao QF, Hong FL, Xu JH (2017) Treatment of tear trough deformity: fat repositioning versus autologous fat grafting. Aesthetic Plast Surg 41(1):73–80. https://doi.org/10.1007/s00266-016-0692-z
Chen H, Zhang Q, Qiu Q, Yang Z (2018) Autologous Fat Graft for the Treatment of Sighted Posttraumatic Enophthalmos and Sunken Upper Eyelid. Ophthalmic Plast Reconstr Surg 34(4):381–386. https://doi.org/10.1097/IOP.0000000000001028
Yu X, Yan H, Xiao L, Hei Y (2021) Periorbital lipogranuloma after facial injection of autologous fat: A retrospective study of 18 cases. Eur J Ophthalmol 31(6):3399–3404. https://doi.org/10.1177/1120672120938574
Li XQ, Wang TL, Wang JQ (2015) Ptosis: an underestimated complication after autologous fat injection into the upper eyelid. Aesthetic Surg J 35(6):147–153. https://doi.org/10.1093/asj/sjv015
Huang P, Liu A, Ren H, Xue K (2019) Color doppler flow imaging of retrobulbar ocular blood flow changes in retinal artery occlusions caused by cosmetic facial filler injections. Ophthalmic Plast Reconstr Surg 35(3):227–231. https://doi.org/10.1097/IOP.0000000000001208
Funt D, Pavicic T (2013) Dermal fillers in aesthetics: An overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol 6:295–316. https://doi.org/10.2147/CCID
Kapoor K, Mohan; Kapoor, Puneet; Heydenrych, Izolda; Bertossi, Dario, (2019) Vision loss associated with hyaluronic acid fillers a systematic review of literature. Aesthetic Plastic Surg. https://doi.org/10.1007/s00266-019-01562-8
Haneke E (2015) Managing complications of fillers: rare and not-so-rare. J Cutan Aesthet Surg 8(4):198–210. https://doi.org/10.4103/0974-2077.172191
Mortada H, Seraj H, Barasain O, Bamakhrama B, Alhindi NI, Arab K (2022) Ocular complications post-cosmetic periocular hyaluronic acid injections: a systematic review. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-021-02730-5
Sito G, Manzoni V, Sommariva R (2019) Vascular complications after facial filler injection: a literature review and meta-analysis. J Clinic Aesth Dermatol 12(6):E65–E72
Glogau RG, Kane MA (2008) Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers. Dermatol Surg Offic Publ Am Soc Dermatol Surg 34(Suppl 1):S105–S109. https://doi.org/10.1111/j.1524-4725.2008.34251.x
Sahin I, Isik S (2012) Blindness following cosmetic injections of the face. Plast Reconstr Surg 130(5):738e. https://doi.org/10.1097/PRS.0b013e318267d740
Rayess HM, Svider PF, Hanba C, Patel VS, DeJoseph LM, Carron M, Zuliani GF (2018) A Cross-sectional Analysis of Adverse Events and Litigation for Injectable Fillers. JAMA facial plastic surgery 20(3):207–214. https://doi.org/10.1001/jamafacial.2017.1888
Beleznay K, Carruthers JD, Humphrey S, Jones D (2015) Avoiding and treating blindness from fillers a review of the world literature. Dermatologic Surgery official publication for American Society for Dermatologic Surgery 41(10):1097–1117. https://doi.org/10.1097/DSS.0000000000000486
Feinendegen DL, Baumgartner RW, Vuadens P, Schroth G, Mattle HP, Regli F, Tschopp H (1998) Autologous fat injection for soft tissue augmentation in the face: a safe procedure? Aesthetic Plast Surg 22(3):163–167. https://doi.org/10.1007/s002669900185
Rzany B, DeLorenzi C (2015) Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg 136(5 Suppl):196S-203S. https://doi.org/10.1097/PRS.0000000000001760
Hwang CJ (2016) Periorbital injectables: understanding and avoiding complications. J Cutan Aesthet Surg 9(2):73–79. https://doi.org/10.4103/0974-2077.184049
Chen W, Wu L, Jian XL, Zhang B, Li JY, Qin XL, Yu B (2016) Retinal branch artery embolization following hyaluronic acid injection: a case report. Aesthet Surg J 36(7):219–224
Loh KT, Chua JJ, Lee HM, Lim JT, Chuah G, Yim B, Puah BK (2016) Prevention and management of vision loss relating to facial filler injections. Singap Med J 57(8):438–443
Carruthers JD, Fagien S, Rohrich RJ, Weinkle S, Carruthers A (2014) Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 134:1197–1201
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Informed Consent
For this type of study, informed consent is not required.
Statement of Human and Animal Rights, or Ethical Approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mortada, H., Seraj, H., Alhamoud, M.A. et al. Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis. Aesth Plast Surg 46, 3013–3035 (2022). https://doi.org/10.1007/s00266-022-02924-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-022-02924-5