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Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures

An Anatomical Review

Cotofana, Sebastian, M.D., Ph.D.; Lachman, Nirusha, Ph.D.

Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 416–426
doi: 10.1097/PRS.0000000000005201
Cosmetic: Original Articles

Background: The purpose of this article is to provide a comprehensive review based on images and discussion of the current understanding of the arterial supply of the face to facilitate safe minimally invasive antiaging procedures.

Methods: Contrast-enhanced computed tomographic scans of 40 fresh frozen heads from 17 male and 23 female Caucasian body donors with a mean age of 76.9 ± 13.1 years and a mean body mass index of 23.6 ± 5.3 kg/m2 were retrospectively analyzed and compared to cadaveric dissections performed in more than 400 fresh cephalic specimens.

Results: This review presents the current understanding of the facial arteries based on existing literature, direct observation from cadaveric dissection, and the dissection experience of the two authors of the study. It reveals the constant three-dimensional locations of the facial and angular arteries: mandible, modiolus, and medial canthus as compared to their unpredictable course in other facial regions. In addition, the anatomy of the ophthalmic and central retinal arteries is discussed in the context of current treatment strategies in cases of blindness following facial soft-tissue filler injections.

Conclusions: The arterial supply of the face exhibits high variability in branching patterns, course (two-dimensional), and depth (three-dimensional). Because of the lack of predictability of the vascular anatomy, it is impossible to absolutely guarantee safety when performing minimally invasive injectable procedures. Injectors should understand the potential for adverse vascular events, communicate this risk appropriately to patients, and be properly trained and equipped to treat any such complication.

Albany, N.Y.; and Rochester, Minn.

From the Department of Medical Education, Albany Medical College; and the Department of Anatomy and Department of Surgery, Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic.

Received for publication April 9, 2018; accepted July 25, 2018.

Disclosure: The authors do not have any commercial associations or financial disclosures that might create a conflict of interest with the methods applied or the results presented in this article.

Sebastian Cotofana, M.D., Ph.D., Albany Medical College, 47 New Scotland Avenue, MC-135, Albany, N.Y. 12208,, Instagram: @professorsebastiancotofana, Facebook: Prof. Sebastian Cotofana

©2019American Society of Plastic Surgeons