Multiple arterial embolism after illicit intranasal injection of collagenous material.

Local injections of various materials to the face have become increasingly popular for cosmetic purposes. These procedures can cause serious adverse effects if they are not done properly or if they are performed with improper materials. Embolic arterial occlusion is rare but can be a devastating complication after injection in the facial area. Here we report multiple embolic occlusions involving branches of the internal carotid artery (ICA) and the external carotid artery (ECA) with anatomical considerations. In this case, a reticular pattern of skin necrosis, retinal branch artery occlusion (RAO), acute cerebral infarction, and secondary subarachnoid hemorrhage (SAH) occurred immediately after illegal intranasal injection of a collagenous substance. This is the most extensive and devastating case of embolic complications involving branches of the ICA and ECA after illicit facial injection for cosmetic purposes ever reported.