A Complication of Cosmetic Surgery

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). . . .