Disastrous Cerebral and Ocular Vascular Complications after Cosmetic Facial Filler Injections: A Retrospective Case Series Study

Background: Cosmetic facial filler injections have become increasingly popular for facial rejuvenation. However, vascular complications, although rare, can lead to devastating outcomes including cerebral infarctions and permanent vision loss. Objective: This study aimed to evaluate the incidence, clinical presentation, imaging findings, treatment, and outcomes of patients experiencing cerebral and ocular vascular events following facial filler injections. Methods: A retrospective analysis was performed on cases referred to tertiary hospitals between 2016 and 2023 with documented cerebral or ocular vascular complications after dermal filler injections. Data regarding filler type, injection sites, time of symptom onset, neurological/ophthalmic evaluations, imaging results, treatments, and patient outcomes were collected. Results: Among 24 identified patients (mean age 36.2±9.8 years, 22 females), 18 (75%) suffered ophthalmic artery occlusion (OAO), 9 (37.5%) had ischemic cerebral infarctions, and 5 had combined manifestations. Most complications followed glabellar or nasal root injections using hyaluronic acid-based fillers. Permanent blindness occurred in 15 patients; neurological sequelae persisted in 7. Early intervention with hyaluronidase, corticosteroids, and hyperbaric oxygen therapy showed partial benefits. Conclusion: Facial filler injections carry a small but catastrophic risk of cerebrovascular and ocular vascular occlusion. Increased awareness, anatomical knowledge, and adherence to safety protocols are essential to minimize risks.