A Complication of Cosmetic Surgery

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     A 45-year-old woman who had received local anesthesia underwent injection of abdominal subcutaneous fat into the vertical glabellar frown lines to remove wrinkles. Within a minute after the procedure, she had a severe frontal headache and right periorbital pain, which were followed by swelling of the right eyelid and diplopia. Examination the next day showed right-eye proptosis, chemosis, and ptosis with retraction of the frontalis muscle (Panel A). Facial sensation was spared, and there was no ocular bruit. Cranial computed tomography showed a focal, linear hypodensity, consistent with the presence of fat, in the right cavernous sinus (Panel B, arrow). Magnetic resonance imaging showed an enlarged right superior ophthalmic vein and a linear, fat-density signal in the right cavernous sinus. Images obtained with fat suppression confirmed the presence of fat in the right superior ophthalmic vein (Panel C, arrowheads) and right cavernous sinus. A pocket of retained fat in the left glabellar area was also seen (Panel C, arrow). It appears that the fat was injected into the frontal vein and that it then reached the cavernous sinus by way of the superior ophthalmic vein. The patient's condition improved rapidly over the next several days.

    So Young Moon, M.D.

    Gregory Youngnam Chang, M.D.

    121st U.S. Army General Hospital

    Seoul, Korea

    http://www.100md.com/html/DirDu/2006/11/29/30/79/34.htm