Ischaemic strokes from facial injections of dermal fillers: Clinico-radiological features and outcomes.

[INTRODUCTION] Ischaemic stroke is a severe complication of dermal filler injections that remains poorly described and understood. This study aims to characterise the clinical features and outcomes of patients who experience strokes following facial dermal filler injections.

[METHOD] A systematic review and retrospective analysis of ischaemic strokes caused by dermal filler injections and reported over the past 3 decades, were conducted. Cases involving autologous fat were also compared against those that did not.

[RESULTS] Fifty-five cases from 45 studies were analysed. Their median age was 32 years (18-61), and most were women (49/55, 89%). Injections frequently occurred at the glabella (17/53, 32%) and temples (12/53, 23%), and autologous fat was most often used (33/55, 60%). Half (29/55, 53%) had ocular symptoms at presentation. Hemiparesis/hemiplegia (30/55, 55%) and confusion/ reduced consciousness/alertness (26/55, 47%) were the predominant stroke symptoms. Most infarcts were unilateral (45/54, 83%) and large (32/48, 67%). Treatment primarily involved corticosteroids (12/41, 29%) and antiplatelet agents (11/41, 27%), while hyaluronidase injections (3/41, 7%) and hyperbaric oxygen therapy (2/41, 5%) were rarely used. Less than half (22/55, 40%) experienced good functional recovery. Those injected with autologous fat were likelier to be symptomatic from their strokes (100% versus [vs] 68%, P=0.0012), develop larger strokes (93% vs 24%, P<0.0001) and experience non-ambulatory outcomes (44% vs 73%, =0.0381).

[CONCLUSION] Strokes are rare complications of dermal fillers. Injections using autologous fat risk larger strokes and worse ambulatory outcomes. An hour of post-procedural observation appears reasonable, and those with ocular complications should undergo brain imaging even in the absence of stroke symptoms.