Fatal Cerebral Infarction and Ophthalmic Artery Occlusion After Nasal Augmentation with Hyaluronic Acid—A Case Report and Review of Literature

  • Qing Yang
  • Binglun Lu
  • Ning Guo
  • Liang Li
  • Yanjun Wang
  • Xianjie MaEmail author
  • Yingjun SuEmail author
Case Report Non-Surgical Aesthetic



Cerebral infarction is a rare complication of hyaluronic acid (HA) filler injection, usually presenting with sudden increase in intracranial pressure and loss of vision.


A 40-year-old Asian woman in a coma was transferred to the emergency intensive care unit of Xijing Hospital, China, 48 h after nasal augmentation with HA. Magnetic resonance imaging indicated cerebral infarction and left optic nerve edema and ischemia. Magnetic resonance angiography did not reveal vessel embolism.


The patient developed gastric ulceration, pulmonary infection, respiratory failure, and cerebral herniation, and died 6 days after the HA filler injection.


Facial cosmetic HA filler injection can cause devastating and even fatal complications.

Level of Evidence V

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


Cerebral infarction Hyaluronic acid Embolism 


Compliance with Ethical Standards

Conflict of interest

The authors claim no conflict of interest in this study.

Ethical Approval

This retrospective study was approved by the Institutional Research Ethics Committee of Xijing Hospital (Approval No. KY20192122-C-1).

Informed Consent

Signed informed consent was obtained from the patient’s family representative.


  1. 1.
    Qin J, Qi X, Zhou J, Wu PS et al (2017) Analysis of artery occlusion caused by facial autologous fat injections. Zhonghua Yan Ke Za Zhi 53(8):594–598Google Scholar
  2. 2.
    Szantyr A, Orski M, Marchewka I, Szuta M et al (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. Aesthet Plast Surg 41(3):580–584CrossRefGoogle Scholar
  3. 3.
    Sito G, Manzoni V, Sommariva R (2019) Vascular complications after facial filler injection: a literature review and meta-analysis. J Clin Aesthet Dermatol 12(6):E65–E72PubMedPubMedCentralGoogle Scholar
  4. 4.
    He MS, Sheu MM, Huang ZL, Tsai CH et al (2013) Sudden bilateral vision loss and brain infarction following cosmetic hyaluronic acid injection. JAMA Ophthalmol 131(9):1234CrossRefGoogle Scholar
  5. 5.
    Hong JH, Ahn SJ, Woo SJ, Jung C et al (2014) Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections. J Neurol Sci 346(1–2):310–314CrossRefGoogle Scholar
  6. 6.
    Kim EG, Eom TK, Kang SJ (2014) Severe visual loss and cerebral infarction after injection of hyaluronic acid gel. J Craniofac Surg 25(2):684–686CrossRefGoogle Scholar
  7. 7.
    Lin YC, Chen WC, Liao WC, Hsia TC et al (2015) Central retinal artery occlusion and brain infarctions after nasal filler injection. QJM 108(9):731–732CrossRefGoogle Scholar
  8. 8.
    Li KT, Huang YH, Chen CH, Chou LW (2016) Delayed-onset cerebral infarction after cosmetic facial injection using hyaluronic acid. J Formos Med Assoc 115(7):587–588CrossRefGoogle Scholar
  9. 9.
    Ansari ZA, Choi CJ, Rong AJ, Erickson BP et al (2019) Ocular and cerebral infarction from periocular filler injection. Orbit 38(4):322–324CrossRefGoogle Scholar
  10. 10.
    Zhuang Y, Yang M, Liu C (2016) An islanded rabbit auricular skin flap model of hyaluronic acid injection-induced embolism. Aesthet Plast Surg 40(3):421–427CrossRefGoogle Scholar
  11. 11.
    Yao B, Shen F, Zhao X, Liu G et al (2019) Ophthalmic artery occlusion combined with superior sagittal sinus thrombosis caused by hyaluronic acid injection for facial soft tissue augmentation: a case report. Medicine (Baltimore) 98(36):e17048CrossRefGoogle Scholar
  12. 12.
    Park KH, Kim YK, Woo SJ, Kang SW et al (2014) Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol 132(6):714–723CrossRefGoogle Scholar
  13. 13.
    Wang M, Li W, Zhang Y, Tian W et al (2017) Comparison of intra-arterial and subcutaneous testicular hyaluronidase injection treatments and the vascular complications of hyaluronic acid filler. Dermatol Surg 43(2):246–254CrossRefGoogle Scholar
  14. 14.
    Mohan RK, Crocker M, Moynihan B (2017) Decompressive craniectomy for the treatment of malignant middle cerebral artery infarction. Br J Neurosurg 31(4):401–409CrossRefGoogle Scholar
  15. 15.
    Lu X, Huang B, Zheng J, Tao Y et al (2014) Decompressive craniectomy for the treatment of malignant infarction of the middle cerebral artery. Sci Rep 17(4):7070Google Scholar
  16. 16.
    Loh KT, Chua JJ, Lee HM, Lim JT et al (2016) Prevention and management of vision loss relating to facial filler injections. Singapore Med J 57(8):438–443CrossRefGoogle Scholar
  17. 17.
    Signorini M, Liew S, Sundaram H, De Boulle KL et al (2016) Global aesthetics consensus: avoidance and management of complications from hyaluronic acid fillers-evidence- and opinion-based review and consensus recommendations. Plast Reconstr Surg 137(6):961e–971eCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi’anChina
  2. 2.Department of Plastic and Reconstructive SurgeryChangan HospitalXi’anChina
  3. 3.Department of Radiology, Xijing HospitalFourth Military Medical UniversityXi’anChina
  4. 4.Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing HospitalFourth Military Medical UniversityXi’anChina
  5. 5.Department of Emergency Medicine, Xijing HospitalFourth Military Medical UniversityXi’anChina

Personalised recommendations