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The Feasibility Determination of Risky Severe Complications of Arterial Vasculature Regarding the Filler Injection Sites at the Tear Trough

Jitaree, Benrita, M.Sc.; Phumyoo, Thirawass, M.Sc.; Uruwan, Sukanya, M.Sc.; Sawatwong, Worapat, B.Sc.; McCormick, Liam, M.Biol.Sci.; Tansatit, Tanvaa, M.D., M.Sc.

Plastic and Reconstructive Surgery: November 2018 - Volume 142 - Issue 5 - p 1153–1163
doi: 10.1097/PRS.0000000000004893
Cosmetic: Original Articles
Journal Club

Background: The tear trough is a significant sign of periorbital aging and has usually been corrected with filler injection. However, the arterial supply surrounding the tear trough could be inadvertently injured during injection; therefore, this study aimed to evaluate the nearest arterial locations related to the tear trough and investigate the possibility of severe complications following filler injection.

Methods: Thirty hemifaces of 15 Thai embalmed cadavers were used in this study.

Results: The artery located closest to both the inferior margin (TT1) and mid-pupil level (TT2) of the tear trough was found to be the palpebral branch of the infraorbital artery. Furthermore, at 0.5 mm along the tear trough from the medial canthus (TT3), the angular artery was identified, which was found to be a branch of the ophthalmic artery. The artery at TT1 and TT2 was located beneath both the zygomaticus major and the orbicularis oculi muscles. The distances from TT1 to the artery were measured as follows: laterally, 2.79 ± 1.08 mm along the x axis; and inferiorly, 2.88 ± 1.57 mm along the y axis. For the TT2, the artery was located inferomedially from the landmark of 4.65 ± 1.83 mm along the x axis and 7.13 ± 3.99 mm along the y axis. However, the distance along the x axis at TT3 was located medially as 4.00 ± 2.37 mm.

Conclusion: The high risk of injury to the artery at the tear trough should be considered because of the numerous arteries to this area.

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Bangkok and Nakhon Pathom, Thailand; and Liverpool, United Kingdom

From the Department of Anatomy, Faculty of Medicine, and the Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital; the Department of Basic Medical Science, Faculty of Medicine Vajira Hospital, Navamindradhiraj University; the College of Health Sciences, Christian University; and the School of Life Sciences, Faculty of Health and Life Sciences, University of Liverpool.

Received for publication December 19, 2017; accepted May 3, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Tanvaa Tansatit, M.D., M.Sc., Department of Anatomy, Faculty of Medicine and, Chula Soft Cadaver Surgical Training Center, Chulalongkorn University and, King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand,

©2018American Society of Plastic Surgeons