BackgroundThere have been several reports of patients experiencing cerebral embolisms following the injection of autologous fat into the face during cosmetic surgery. These embolisms likely resulted from unintentional introduction of fat particles into facial arteries, which then reached the cerebral arteries by retrograde motion.Case PresentationWe describe here a patient who developed an internal carotid artery (ICA) embolism after autologous fat injection for temporal augmentation. To our knowledge, this is the first report of a pathologically proven ICA embolism after fat injection into the face.ConclusionsOur results suggest that the fat particles reached the cerebral arteries via a previously unknown pathway.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.