Fat Embolism After Autologous Facial Fat Grafting

Nicolas S Dhooghe; Sebastiaan Maes; Bernard Depypere; Karel E Y Claes; Renaat Coopman; Bela Kubat; Michel H Piette; Stan Monstrey

doi:10.1093/asj/sjab252

Fat Embolism After Autologous Facial Fat Grafting

Nicolas S Dhooghe^*, Sebastiaan Maes, Bernard Depypere, Karel E Y Claes, Renaat Coopman, Bela Kubat, Michel H Piette, Stan Monstrey

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting.

OBJECTIVES: The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting.

METHODS: A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures.

RESULTS: Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurologic symptoms, some of which never fully recovered. Including the present patient, 7 cases were fatal. Fat embolism can occur in the veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs, and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but evidence for their efficacy is lacking. Several different preventive measures are described.

CONCLUSIONS: Although facial fat grafting is considered a safe procedure, one should be aware of the risk of fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcomes, preventive measures are of utmost importance to improve patient safety.

LEVEL OF EVIDENCE: 4:

Original language	English
Pages (from-to)	231-238
Number of pages	8
Journal	Aesthetic Surgery Journal
Volume	42
Issue number	3
DOIs	https://doi.org/10.1093/asj/sjab252
Publication status	Published - 15 Feb 2022

Keywords

UNILATERAL VISUAL-LOSS
CEREBRAL-ARTERY OCCLUSION
OPHTHALMIC ARTERY
INJECTION
FACE
INFARCTION
BLINDNESS
BRANCHES
PATIENT

Access to Document

10.1093/asj/sjab252

Cite this

@article{2e366f0b6b93408dad4df8217e078d1b,

title = "Fat Embolism After Autologous Facial Fat Grafting",

abstract = "BACKGROUND: Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting.OBJECTIVES: The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting.METHODS: A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures.RESULTS: Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurologic symptoms, some of which never fully recovered. Including the present patient, 7 cases were fatal. Fat embolism can occur in the veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs, and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but evidence for their efficacy is lacking. Several different preventive measures are described.CONCLUSIONS: Although facial fat grafting is considered a safe procedure, one should be aware of the risk of fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcomes, preventive measures are of utmost importance to improve patient safety.LEVEL OF EVIDENCE: 4: ",

keywords = "UNILATERAL VISUAL-LOSS, CEREBRAL-ARTERY OCCLUSION, OPHTHALMIC ARTERY, INJECTION, FACE, INFARCTION, BLINDNESS, BRANCHES, PATIENT",

author = "Dhooghe, {Nicolas S} and Sebastiaan Maes and Bernard Depypere and Claes, {Karel E Y} and Renaat Coopman and Bela Kubat and Piette, {Michel H} and Stan Monstrey",

note = "{\textcopyright} 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.",

year = "2022",

month = feb,

day = "15",

doi = "10.1093/asj/sjab252",

language = "English",

volume = "42",

pages = "231--238",

journal = "Aesthetic Surgery Journal",

issn = "1090-820X",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Fat Embolism After Autologous Facial Fat Grafting

AU - Dhooghe, Nicolas S

AU - Maes, Sebastiaan

AU - Depypere, Bernard

AU - Claes, Karel E Y

AU - Coopman, Renaat

AU - Kubat, Bela

AU - Piette, Michel H

AU - Monstrey, Stan

PY - 2022/2/15

Y1 - 2022/2/15

N2 - BACKGROUND: Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting.OBJECTIVES: The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting.METHODS: A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures.RESULTS: Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurologic symptoms, some of which never fully recovered. Including the present patient, 7 cases were fatal. Fat embolism can occur in the veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs, and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but evidence for their efficacy is lacking. Several different preventive measures are described.CONCLUSIONS: Although facial fat grafting is considered a safe procedure, one should be aware of the risk of fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcomes, preventive measures are of utmost importance to improve patient safety.LEVEL OF EVIDENCE: 4:

AB - BACKGROUND: Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. This paper presents the case of a patient who died due to massive cerebral microfat embolism after facial fat grafting.OBJECTIVES: The aim of this study was to raise awareness and provide more evidence on the prevention and treatment of this potentially lethal complication of facial fat grafting.METHODS: A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurologic and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures.RESULTS: Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 mL fat was injected. The main complications were visual impairment, with 88.5% of cases resulting in permanent monocular blindness, and neurologic symptoms, some of which never fully recovered. Including the present patient, 7 cases were fatal. Fat embolism can occur in the veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs, and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but evidence for their efficacy is lacking. Several different preventive measures are described.CONCLUSIONS: Although facial fat grafting is considered a safe procedure, one should be aware of the risk of fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcomes, preventive measures are of utmost importance to improve patient safety.LEVEL OF EVIDENCE: 4:

KW - UNILATERAL VISUAL-LOSS

KW - CEREBRAL-ARTERY OCCLUSION

KW - OPHTHALMIC ARTERY

KW - INJECTION

KW - FACE

KW - INFARCTION

KW - BLINDNESS

KW - BRANCHES

KW - PATIENT

U2 - 10.1093/asj/sjab252

DO - 10.1093/asj/sjab252

M3 - Article

C2 - 34133713

SN - 1090-820X

VL - 42

SP - 231

EP - 238

JO - Aesthetic Surgery Journal

JF - Aesthetic Surgery Journal

IS - 3

ER -