A Novel Idea in the Use of Ultrasound to Guide Nasolabial Hyaluronic Acid (HA) Dermal Filler Injections to Prevent Alar Nasal Necrosis

Abstract

BackgroundNasolabial dermal filler (DF) injections are one of the most popular cosmetic procedures performed worldwide. DF injections at the nasolabial fold have been associated with nasal necrosis due to inadvertent intravascular injection of the adjacent facial artery (FA). Current DF injection protocols are devoid of imaging the anatomical site, and the use of ultrasound (US) for imaging the FA is very limited in literature. The purpose of this study is to determine the feasibility of utilizing US to identify and measure the FA at different bony landmarks near and within the nasolabial region.MethodsPart ICadaveric dissections (n=18; 10 female, 8 male) will be completed to explore the course of the FA from the external carotid artery to the terminal branches supplying facial structures.Part IIA bilateral US of the FA using 13–6 MHz, 38 mm linear array US transducer was performed on consenting adults (n=16; 9 female, 7 male) from the Department of Anatomy and Cell Biology at Western University. The following bony landmarks were identified and used for US measurements, taken in real time: anterior‐inferior angle of the mandible, mandibular teeth, maxillary teeth, maxillary ridge. Measurements of FA diameter, artery distance to skin, and artery distance to bone were obtained at each landmark using digital image distance measurements on the Sonosite M‐Turbo P08189‐88R US machine.ResultsPart IPreliminary results (n=8; 4 female, 4 male) show FA variability between cadaveric specimens, as well as left/right FA variability within cadaveric specimens themselves.Part IIPreliminary results of the average FA distance to the skin measured at 0.438 cm ± 0.126 for the left FA and 0.459 cm ± 0.205 for the right FA. A significant difference (P< 0.05) was noted for FA distance to the skin between the left mandibular teeth (0.481 cm ± 0.107) and left maxillary ridge (0.343 cm ± 0.097).ConclusionsThese findings highlight the importance of understanding the anatomy of the FA within the nasolabial fold, and the need to carefully personalize the placement of DF injections, due to the anatomical variability identified in both the cadaveric and ultrasound portions of the study. Furthermore, since it is feasible to identify and measure the FA using the selected US transducer, the future direction of this study will be to examine the application of US to guide DF injections.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.