Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections

Touré, Gaoussou; Nguyen, Tan Mai; Vlavonou, Sandrine; Ndiaye, M.

doi:10.1016/j.bjps.2020.12.042

Cited by 12 publications

(10 citation statements)

References 30 publications

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“…Due to the fact that the transverse facial artery runs through this area, it is important to determine the precise location (including its depth and passage) in order to avoid complications associated with injections 26 . As a result of the anastomose between the transverse facial artery and the facial artery, there is a potential risk of blindness if filler is injected into the transverse facial artery 1,27 . Also, it is important to pay attention to transverse facial artery during midface flaps and facelift surgeries 28 .…”

Section: Discussionmentioning

confidence: 99%

“…26 As a result of the anastomose between the transverse facial artery and the facial artery, there is a potential risk of blindness if filler is injected into the transverse facial artery. 1,27 Also, it is important to pay attention to transverse facial artery during midface flaps and facelift surgeries. 28 Based on anatomical studies, the transverse facial artery has two branches, including a superior emerging branch and a deep emerging branch that supplies the parotid gland, the parotid duct, and the masseter muscle.…”

Section: Discussionmentioning

confidence: 99%

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Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures

Khorasanizadeh

Delazar

Gheidari

et al. 2023

J of Cosmetic Dermatology

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Background: Knowledge of normal facial vascular variations could prevent catastrophic complications of cosmetic procedures as well as providing a guide for surgical planning. Color Doppler ultrasound is a safe and noninvasive method for real time vascular evaluation. Objective:The aim of this study was to evaluate the normal variations of the facial, angular, transverse facial, supratrochlear and supraorbital arteries in a sample of normal individuals.Methods: Normal individuals referred for dermal filler injection to the tertiary dermatologic center, were selected. Patients who were smoker or had a history of facial filler injection, facial surgery, or trauma were excluded from the study. Facial artery at three levels as well as angular, supratrochlear, supraorbital, and transverse facial arteries were evaluated by an 18 MHz ultrasound linear probe regarding their distance from facial reference lines and landmarks, and also their depths in various regions of face.Results: A total number of 43 individuals were evaluated in this study. Thirty-one (72.1%) were women. The number of absent facial artery was zero in level one, three (3.48%) in level two, and nine (10.46%) in level three. The angular artery was absent in 10 (11.62%) participants. The transverse facial artery was absent in 27 (31.39%) assessed individuals. Distance from reference lines at level 2 and 3 of facial artery and its depth at level 2 were significantly different between left and right side (p-values: <0.001, 0.01, and 0.03, respectively). No significant difference was seen between depth and distance of two sides for angular and transverse facial arteries. The comparison of the depths and distances from the reference lines of the assessed arteries between two sexes revealed only a significantly greater value of facial artery distance in level 1 in males (p-value: 0.001). BMI was also significantly correlated with the depth of facial artery in level 2 (Pearson correlation coefficient = 0.471, p-value = 0.002) and

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures

Khorasanizadeh

Delazar

Gheidari

et al. 2023

J of Cosmetic Dermatology

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“…A recent report by Chun et al 16 described a 43‐year‐old woman who was diagnosed with acute vision loss following botulinum toxin A injection to the masseter muscle. Attempting to clarify the pathogenesis of vision loss following lateral facial injections of botulinum toxin, Toure et al 17 conducted an anatomical exploration of cadavers. The authors assumed an association between an outcome of blindness and the variable course of the transverse facial artery.…”

Section: Discussionmentioning

confidence: 99%

Ophthalmic adverse events following facial injections of botulinum toxin A: A systemic literature review

Skorochod

Нешер

Nesher

et al. 2021

J of Cosmetic Dermatology

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Background Over the years, botulinum toxin has found its place as a neuromuscular blocking agent in numerous medical fields. Since the approval of botulinum toxin by the FDA for cosmetic indications in 2002, it had become the most commonly performed esthetic procedure worldwide, with ever‐growing demand. The characteristics of the toxin, along with the facial areas it is injected to, could possibly account for a wide array of complication. Methods The authors conducted a literature search for reported cases of ophthalmic adverse events following Botulinum toxin facial injections in the electronic databases of PubMed and Cochrane Library databases. Results The authors found 25 publications, reporting 49 cases of ophthalmic adverse events following botulinum toxin injections. Injections for cosmetic indications accounted for 51% of all injections, treatment of blepharospasms for 22% of cases, protective ptosis for 11% of cases, and treatment of hemifacial spams for 8% of cases. The average quantity of botulinum toxin injected to a single patient ranged between 1.25 and 75 units, with a median of 13.75 units.Majority of injections for cosmetic indications were performed to the lateral canthal area (56%), followed by the glabella (28%) and the forehead (20%).Adverse events following injections included diplopia (64%), ptosis (14%), and decrease in visual acuity or vision loss (8%). Conclusions Botulinum toxin is gaining extreme popularity in the management of a wide area of diseases and for cosmetic indications. Proper knowledge of potential adverse events is crucial for the clinician in attempt to decrease complications.

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“…The superior labial artery (SLA) and inferior labial artery (ILA) also have variability in their course and depth [31] . While the SLA is not very likely to be found subcutaneously at the vermillion border, the vasculature is superficial in the midline and Cupid's area, which can carry a high risk [31] . Additionally, the lips become thinner with aging, which may predispose the arteries to intravascular injection [31] .…”

Section: Anatomymentioning

confidence: 99%

“…While the SLA is not very likely to be found subcutaneously at the vermillion border, the vasculature is superficial in the midline and Cupid's area, which can carry a high risk [31] . Additionally, the lips become thinner with aging, which may predispose the arteries to intravascular injection [31] . Therefore, for lip injections, injections should be limited to approximately 3 mm depth in order to avoid the SLA and ILA that course deeper within the lip [12] .…”

Section: Anatomymentioning

confidence: 99%

Ischemic complications of dermal fillers

Mehta¹,

Kaplan²,

Zhang-Nunes³

2022

Plast Aesthet Res

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Dermal fillers have become increasingly popular as a cosmetic treatment for facial rejuvenation. Although these injections are generally considered to be safe, as the number of injections has increased, so has the rate of complications. Ischemic complications of fillers is critical and include vision loss, ophthalmoplegia, skin necrosis, and cerebral infarction. Knowing the anatomy well to optimally prevent and manage these serious complications. Prevention includes knowledge of the vascular anatomy of the facial area, as well as certain injection techniques such as aspiration, use of a smaller needle, and adoption of a larger cannula. The use of ultrasound has been a recent innovation in preventing and treating filler complications as well. The reversibility of fillers should also be considered when choosing a filler. Some hyaluronic acid (HA) fillers, including the newer ones on the market, are difficult to reverse and non-HA fillers and fat are irreversible. This review aims to discuss facial anatomy, the various ischemic filler complications, the prevention and management of these complications, and the relatively recent use of imaging as an adjunct.

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Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections

Cited by 12 publications

References 30 publications

Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures

Anatomic evaluation of the normal variants of the arteries of face using color Doppler ultrasonography: Implications for facial aesthetic procedures

Ophthalmic adverse events following facial injections of botulinum toxin A: A systemic literature review

Ischemic complications of dermal fillers

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