Middle temporal vein: a fatal hazard in injection cosmetic surgery for temple augmentation.

Middle Temporal Vein: A Fatal Hazard in Injection Cosmetic Surgery for Temple Augmentation Because facial aesthetics procedures are trending away from open surgery toward injection surgery, the use of autologous fat has been developed and approved for the correction of facial contour as the newest and most popular dermal filler. Common complications (eg, infections, absorption, asymmetry) are either avoidable or reversible. However, the safety of this procedure is still under consideration owing to some rare but severe complications, such as blindness and cerebral fat embolism,1,2 which result from accidental injection into the artery, especially after temple augmentation. Fortunately, the incidence has decreased owing to raised awareness and care in following protocol. However, we have recently encountered another potentially fatal complication—nonthrombotic pulmonary embolism—in 3 cases, which manifested as acute respiratory failure after a cosmetic temple injection procedure using autologous fat by different medical practitioners. Of the 3 patients, 2 underwent local anesthesia and complained of sudden sweating, dyspnea, and tachypnea. The third patient, who had received general anesthesia, was found to have experienced cardiac respiratory arrest and died despite the best efforts of the physicians. The cause of death was confirmed by autopsy to have been pulmonary embolism. To sound an alarm and to avoid more tragedy, we emphasize the culprit vessel: the middle temporal vein (MTV), a vein in the temporal region with nearly the same position in different patients, predisposes itself to injection owing to some anatomical characteristics detailed herein.