Clinical Implication of the Arterial Supplies and Their Anastomotic Territories of the Nasolabial Region for Avoiding Arterial Devastation and Complications during Soft Tissue Filler injection

Abstract

BackgroundThe nasolabial fold is one of the most concerning aging property in the middle face region. This fold initially appears when people are coming age‐wise to their 20s. To correct this fold, the aesthetic nonsurgical procedure, known as filler injection, has been popularly and increasingly performed. However, the arterial complications occurring as a consequence of nasolabial fold filler injection have been continually reported in a recent year. Therefore, the objective of this study was to investigate the arterial location related to nasolabial fold filler injection sites and their anastomotic pathways.MethodsThirty hemi‐faces of 15 Thai embalmed cadavers were performed by dissection method. The nasolabial folds (NLF) were used as the anatomical landmarks: at the inferior margin of NLF (NLF1), at the level of the mid philtral horizontal line of NLF (NLF2), and at the inferior alar level of NLF (NLF3). Additionally, the 5 cadavers were underwent the modified Sihler's staining procedure to investigate the arterial anastomoses.ResultsThe main artery nearby of NLF1 and NLF2 was the facial artery. The facial artery located inferior and medial to NLF1 (Type I, 7 of 25 cases); moreover, the mean distance was 3.53 ± 2.11 mm along the X‐axis and 3.53 ± 1.75 mm along the Y‐axis. The facial artery located medial (Type V, 12 of 22 cases) to NLF2 and the distance was 4.93 ± 1.53 mm along the X‐axis. For the NLF3, there were several accurate arteries including the facial artery (10 of 30 cases), the infraorbital artery (9 of 30 cases) and the lateral nasal artery (10 of 30 cases). The anastomosis of the nasolabial arteries was served both as the connection of external‐external carotid system and the connection of internal‐external carotid system. The communication between the facial artery and the transverse facial artery was found in all specimen. Similarly, the communication between the facial artery and the infraorbital artery was seen in all cases. Finally, the anastomosis between the dorsal nasal artery and the lateral nasal artery was found in 5 of 10 (50%) cases.ConclusionAt the lower part of NLF, the facial artery must be concerned. The filler injection should not over approximately 1.5 mm medial to NLF1 and 1 mm inferior to NLF1. For the NLF2, the safe injection point should less than 2.5 mm in the medial direction. In order to prevent injury of the facial artery and the infraorbital artery, the injection tools must not be exceeded 2 mm lateral to NLF3, while the injection less than 2 mm medial to NLF3 is the harmless point for the lateral nasal artery. The possibility of blindness might be caused by the anastomosis between the lateral nasal artery and the dorsal nasal artery.Support or Funding Information The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship from the Graduate School, Chulalongkorn University Overseas Academic Presentation Scholarship for Graduate Students from the Graduate School, Chulalongkorn University This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.