1416 - Beauty pursuit turned health crisis: A case report exploring the link between filler injections and ischemic strokes

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

BL

Bryan A. Lebron-Solis, DO/MS

Resident Physician
Burke Rehabilatation
SPRINGFIELD, Massachusetts, United States

Co-Author(s)

PK

Preetveer Kaur, DO

Resident physician
Burke Rehabilitation
Woodland, California, United States
AN

Atinder Nijjar, DO

Resident
Burke Rehabilitation
Richmond Hill, New York, United States
KM

Kenia Maldonado Vergara, MD

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States
GA

Gabrielle N. Avancena, MD

Resident Physician
Mount Sinai Morningside-West
New York, New York, United States

Corresponding Author(s)

AA

Andrew Abdou, MD

Attending Physician
Montefiore-Einstein Rehabilitation
Bronx, New York, United States

Case Diagnosis: Multiple right-sided infarcts following filler injection

Case Description: 64-year-old female developed unilateral blindness and multiple right-sided ischemic infarcts following a Hyaluronic acid (HA) filler injection to her nasal bridge area. Approximately ten minutes following the HA injection, she developed left-sided weakness with cluster-like headaches in the right orbital region. Imaging revealed multiple right-sided ischemic infarcts including the frontal, temporal parietal, and occipital region. Patient also developed right eye blindness, and a scar from the right epicranius region to the right nasal bridge. Two months following the incident, the patient presented with 0-1/5 strength in both her left upper and lower limbs which improved to 2-3/5 strength in both her left upper and lower limbs following three weeks of acute rehabilitation.

Discussions: While injectable fillers have a favorable safety profile, the rarer side effects can lead to serious complications. Research has shown that variability of certain facial arteries such as the angular artery can make it difficult to avoid vasculature in certain areas of the face. Common injection sites like the glabella, temple, and nasolabial folds contain arteries that anastomose with the ophthalmic artery. Following an injection, the filler breaks down into smaller particles supporting the theory that it is an emboli that causes the occlusion. Given the anastomosis of smaller facial arteries with the ophthalmic artery, these connections can increase the risk of vision loss. In a similar manner, arterial emboli are the suggested hypothesis for cerebral infarcts. If the injection pressure exceeds systolic arterial pressure, filler emboli can move to proximal parts of the arterial system such as the internal carotid artery, and cause cerebral infarcts.

Conclusions: While hyaluronidase can dissolve columns of filler, it cannot undo the damage caused by an occlusion. This case is one among the growing literature exploring the connection between misplaced injections and the lasting impact on function.