Clinical anatomy considerations on the muscular and vascular components of the midface by ultrasonographic imaging

Abstract

The first signs of face aging appear in the midface, so procedures such as botulinum toxin and filler injections are performed there. However, no guidelines based on clinical anatomy describing the muscular and vascular components in vivo have been published. The aim of this research was to describe the depths of the midface muscles and the locations of vessels using ultrasonographic (US) imaging. US was applied at 12 landmarks on the midface in 88 volunteers (49 males and 39 females; 19-36 years) to detect sex differences in the depths of muscles and the locations of the vessels. The depths of the orbicularis oculi (OOc), levator labii superioris alaeque nasi (LLSAN), and zygomaticus minor (Zmi) differed significantly with sex at P7 (p = 0.001) and P8 (p = 0.017), P1 (p = 0.028), and P4 (p = 0.035), respectively. The facial artery, facial vein, angular artery, angular vein, and perforator vessels were found at P9, P2 and P10, P1, P1 and P5, and P8, P11 and P12, respectively. The findings indicate that the depths of the OOc, LLSAN, and Zmi muscles differ between the sexes and that the vessels appear at specific landmarks. This information could help in developing anatomical guidelines for several procedures.

Ultrasound Imaging of the Facial Muscles and Relevance with Botulinum Toxin Injections: A Pictorial Essay and Narrative Review

“…The transducer is placed in the oblique coronal plane along the nasal cartilage; the nasalis is visualized in its short axis above the cartilage. The transducer can be redirected to the oblique horizontal plane to observe the muscle along its long axis (Figure 8) [25]. The nasalis originates from the maxilla and is inserted into the nasal bone.…”

“…The transducer can be rotated to the oblique sagittal plane to observe the muscle along its long axis (Figure 9B). The angular branch of the facial artery serves as an important anatomical landmark; the artery courses above the levator labii superioris alaeque nasi [25].…”

“…Following movement of the transducer in a more inferior direction, the levator labii superioris appears to be placed more medially (Figure 10B). The transducer can be rotated 90 • to visualize the muscle in its long axis, as it courses over the maxilla [25] (Figure 10C).…”

“…The scanning method is the same as that used for the levator labii superioris [25] which courses above the levator anguli oris (Figure 10B). The transducer can be rotated 90 • to visualize the muscle in its long axis as it courses above the maxilla (Figure 10C).…”

“…The origin of the zygomaticus minor can be visualized beneath the orbicularis oculi muscle (Figure 11A). The medial end of the transducer can be redirected toward the lateral half of the upper lip to visualize the muscle along its long axis (Figure 11B) [25]. The levator anguli oris originates from the maxilla and is inserted into the modiolus.…”