A Rare Ocular Complication of Autologous Fat Injection: Subconjunctival Fat Infiltration

Abstract

The aim of this brief clinical study to describe and discuss the subconjunctival fat infiltration encountered in a patient with autologous fat injection. A 50-year-old female patient, who had an autologous fat injection 2 days ago, applied to our clinic with the complaint of redness and burning in the left eye. On anterior segment examination, a raised 20 × 15 mm adipose tissue was observed in the temporal region under the conjunctiva. Infiltrated fat tissue was surgically removed from the subconjunctival area. Subconjunctival fat infiltration is an extremely rare complication after autologous fat injection.

In recent years, dermal filling applications have become frequently used methods among cosmetic procedures. For this purpose, different filling materials such as autologous fat, hyaluronic acid, calcium hydroxyapatite, and collagen are used.¹ Autologous fat injection has become more popular and widely used in recent years due to the low cost of providing more volume and low allergy risk.² However, the cause of more than 50% of embolic events due to filling materials is autologous fat injection.³ This situation stands out as an important disadvantage of autologous fat injection. Apart from embolic events, knowing that local mechanical complications such as contour deformity due to fat injection, shape change after weight gain and subconjunctival infiltration may develop.^2,4Among these, subconjunctival fat infiltration is an extremely rare complication and there is a case described so far.⁴ The aim of this brief clinical study is to discuss a case with subconjunctival l fat infiltration after autologous fat injection to the facial region and its treatment.

CLINICAL REPORT

A 50-year-old female patient was admitted to our clinic with complaints of redness, burning, and stinging in her left eye. In the history of the patient, learned that autologous fat injection was applied to the forehead and cheek area two days before the admission. The patient had a visual acuity of 20/20 in both eyes, and her eye movements were free in all directions. Pupillary light reflexes were normal. Anterior segment examination, observed that there was an infiltration of 20 × 15 mm, swollen fat from the surface, located under the conjunctiva in the temporal region of the left eye (Fig. 1). Fundus examination was normal in both eyes. Infiltrated fat was reached by making a conjunctival incision under local anesthesia, and the fat tissue was removed from under the conjunctiva by sponge and washing with saline (Fig. 1). The conjunctival incision was closed with 7/0 vicryl and postoperative topical antibiotics, steroids, and artificial tears were started. During the follow-up, observed that the patient's complaints regressed and no complications were encountered (Fig. 1).

FIGURE 1.

(A) Slit-lamp examination shows intense fat infiltration under the temporal conjunctiva of the left eye. (B) Drainage of adipose tissue after conjunctival incision. (C) The patient's appearance in the early postoperative period.

DISCUSSION

All filling materials used today create the risk of embolism and reported that such complications are more common after the use of autologous fat. Embolic events may affect intraocular tissues, as well as vascular problems that may lead to cerebral ischemia.⁵ The mechanism of this type of arterial occlusion is an intravascular injection and retrograde embolization. When the pressure of the injected bolus rises above the arterial pressure, the blood flow begins to move in the opposite direction and embolism develops. Apart from the injection pressure, other factors that are thought to be effective in the development of embolism are the filling material used, the injection area, the filling volume and the injection speed.⁶ In order to prevent the development of embolism, recommended limiting the volume of filling material to 1 mL, to use blunt-tipped small cannulae instead of sharp-tipped needles, and to ensure that there is no intravascularization by aspiration before injection.⁷

Apart from embolism, different complications have been reported due to autologous fat injections, but the most interesting of these complications is that subconjunctival fat infiltration can be seen. One such case has been reported so far by Lee and Choi.⁴ In this case, spontaneous resolution was expected due to the limited infiltrated adipose tissue, but surgery was performed at the end of a period of one month. In our case, surgery was performed in the early period due to the excess amount of adipose tissue located under the conjunctiva and good results were obtained. In this way, thought that the passage of fat under the conjunctiva is not by local migration or venolymphatic route, but is related to direct injection under the conjunctiva. This situation, which also occurred in this case, is related to the effect of direct injection, and very pleasing that no embolic complication developed. Especially during the injection to the periocular area, the needle approaching at a right angle may be a factor that may cause this situation.

In conclusion, subconjunctival fat infiltration can be seen, although very rarely, after autologous fat injection. Therefore, in the augmentation of the periocular region, very important to pay attention to the needle entry angles and to remember the general injection principles. It should be kept in mind that the orbital can be entered especially during temporal injections, and if not noticed, more serious complications may occur.