Brain and Beauty. Facial Filler Injection Brain Complications: A Case Report

Introduction: Hyaluronic acid is a facial filler.Its application is considered safe but has some adverse complications that may be serious and irreversible.Complications may occur when this material gains access into the blood vessels with their occlusion, causing sudden deficits.The administration of hyaluronidase could be useful in reducing some of these adverse effects.Case Presentation: This is a case report of a woman who was infiltrated with hyaluronic acid at the dorsum of the nose, suddenly developed pain, right eye visual loss, ptosis and total ophthalmoplegia.A few minutes later, hyaluronidase was applied at the dorsum of the nose and retrobulbar.Later, dermal lesions appeared, and cerebral ischemic changes were documented on magnetic resonance imaging.The dermal lesions improved in a couple of weeks.The visual loss persisted to shadow perception.Conclusion: Fillers injected at the dorsum of the nose may gain access to the nasal blood vessels to the retinal artery, and by reverse flow to the carotid artery to the brain blood vessels.This may cause ischemic brain lesions.As in this case, it causes retinal, dermal, and cerebral ischemic lesions.In our case, hyaluronidase was administered within the accepted dose and time.The patient remained with some irreversible sequelae.We believe the material was fragmented, instead of dissolved and this may have caused multiple small brain lesions.The patient did not have a detectable neurological deficit because they did not affect eloquent areas.To our knowledge, this type of brain complication has not been reported.