Ischaemic stroke
Also written: ischemic stroke
Cerebral infarction reported as a rare complication of facial filler injection, when embolised material reaches the intracranial circulation through carotid anastomoses.
Ischaemic stroke after cosmetic filler injection is rare and well documented enough that it cannot be dismissed as anecdote.
The route is the same anastomotic network that causes blindness. Material entering a facial artery branch under pressure can travel retrograde into the ophthalmic artery, and from there into the internal carotid circulation and its intracranial branches. Case reports describe sudden vision loss accompanied by neurological deficit — hemiparesis, dysarthria, altered consciousness — with infarction confirmed on imaging.
Reported cases cluster around the same high-risk injection sites as ocular events: glabella, forehead, nose and periorbital region. Autologous fat features disproportionately, plausibly because of the volumes and pressures involved.
The practical implications are narrow but firm. Neurological symptoms after facial injection are a medical emergency requiring immediate transfer, not a complication to be managed in the clinic. Hyaluronidase does not address intracranial embolus. And the possibility is part of what informed consent for high-risk regions should actually cover, however uncomfortable that conversation is.
