As hyaluronic acid filler commonly applied in many cosmetic fields, tissue necrosis due to filler embolism
is reported infrequently. Herein we report the first case of nasal hyaluronic acid filler injection resulting in
nasal necrosis, multifocal brain infarction and ocular ischemia with hypotonia. A 25-year-old female, who
had received an injection of hyaluronic acid filler along the nasal dorsum a month before, visited our hospital
to manage the skin ulcer of nasal ala. Immediately after the injection, the patient had complained of nausea,
vomiting, headache and nose pain without neurologic symptom. The skin had bluish change at her nose
and forehead. And the right eyelid ptosis was observed with decreased eyeball movement and visual loss.
Multifocal punctuated infarctions were found on both frontal lobes on brain MRI. The necrotic skin of right
nasal ala was healed in 3 months. But, the width of the right nasal ala was smaller than the left side, and the
right eye remained blind with extropia at 8 months after injection. Although hyaluronic acid filler is safe in
most cases, patients should be informed of the possibility of this rare complication.
(Archives of Aesthetic Plastic Surgery 18: 138, 2012)