Key vasculature

The facial artery and vein play critical roles in facial aesthetics, significantly influencing outcomes in procedures such as dermal fillers and neural modulators.

Facial Artery:

Originates from the external carotid artery.

Enters the face at the level of the mandibular body, anterior to the masseter muscle, and follows a tortuous course towards the nasolabial folds.

Courses above the buccinator, orbicularis oris, and levator anguli oris (LAO) muscles.

Courses below the zygomaticus major and risorius muscles.

The artery’s tortuosity aids in accommodating facial movements such as jaw opening and closing.

Transforms into the angular artery at the ala of the nose. Prior to this, it gives off branches of the inferior and superior labial arteries supplying the lips.

Facial Vein:

Typically follows a similar but more lateral and deeper course compared to the facial artery.
Known for its variable and tortuous path, which can significantly impact aesthetic procedures.
Clinical Significance:

Identifying and mapping these vessels is one of the most crucial skills to acquire when performing facial ultrasound to guide injectable treatments, as it can minimize risks during aesthetic procedures.

Question:

Which of the following muscles does the facial artery NOT directly course above?

Superior Labial Artery

Origin: Branches from the facial artery typically at the level of the angle of the mouth.

Course: Runs horizontally beneath the orbicularis oris muscle, then follows a slightly tortuous course along the upper lip, giving off septal and alar branches to the nose.

Inferior Labial Artery

Origin: Similar to the superior labial artery, originating from the facial artery near the angle of the mouth.

Course: Also courses beneath the orbicularis oris, but within the substance of the lower lip, providing vital blood supply.

Question:

Which of the following statements accurately describes the course of the Superior Labial Artery?

Angular Artery:

Originates as the terminal branch of the facial artery, after the facial artery gives off the branch of the superior labial artery.

Courses superiorly along the side of the nose to anastomose with the dorsal nasal artery of the ophthalmic artery.

Anatomical Course and Depth:

Located just superficial and medial to the maxillia region, and lateral to the nasal alar cartilage.

Travels superficial to the lateral part of the nasalis muscle.

Gives off nasal branches of the lateral nasal artery that supply the ala and dorsum of the nose.

Close relationship with the levator labii superioris alaeque nasi (LLSAN) muscle, running superficial to the muscle in most cases.

Question:

Which muscle is most closely positioned with the course of the angular artery?

The Dorsal Nasal Artery, a significant branch of the ophthalmic artery, plays a crucial role in the vascular supply to the nose and adjacent facial areas. Understanding its course and anatomical relations is essential for safe and effective medical aesthetic procedures.

Anatomy Overview:

Origin: The Dorsal Nasal Artery originates from the ophthalmic artery, branching out as it crosses the medial orbital rim.

Course: It typically runs inferolaterally along the upper part of the dorsum of the nose, supplying blood to the skin and underlying structures.

Branches: Provides several small branches to the skin of the lower forehead, upper eyelids, and dorsum of the nose.

Depth: The artery generally lies superficial to the nasal muscles, bones and cartilages

Question:

Which artery is the primary source of the Dorsal Nasal Artery?

The superficial, middle, and deep temporal arteries supply the temporal region.

Understanding their course, depth, and relation to surrounding structures is crucial for safe and effective medical aesthetic procedures involving the temple region.

Superficial Temporal Artery (STA):

Originates from the external carotid artery.
Courses anteriorly to the ear and ascends within the superficial temporal fascia.
Divides into frontal and parietal branches near the superior temporal line.
Depth: Runs superficially, making it palpable and visible in thin individuals.

Middle Temporal Artery (MTA):

Pierces the temporal fascia and runs within the superficial temporal fat compartment

Depth: Deeper compared to STA, lying superficial to the temporalis muscle, usually deep in the superficial temporal fat pad.

Deep Temporal Arteries (DTAs):

Arise from the maxillary artery.

Ascends below the temporalis muscle along the temporal bone
.
Divide into anterior and posterior branches to supply the deep part of the temporalis muscle.

Deepest among the temporal arteries, not palpable due to their location deep to the temporalis muscle.

Question:

Match the given temporal artery with its correct description.

Infraorbital Artery

Origin: The IOA is a branch of the maxillary artery, part of the external carotid artery system.

Course: It runs along the floor of the orbit in the infraorbital groove and canal, emerging into the face at the infraorbital foramen. After this point, the IOA and its branches run within the deep medial cheek fat below the Levator Labii Superiorsis (LLS) muscle.

Branches: Gives off several branches the course towards the lower eyelid, upper cheek, and lateral nose

The infraorbital foramen is located approximately 1 cm below the infraorbital rim along the mid-limbic line (not the mid-pupillary line as classically taught).

In close relation to the infraorbital nerve within the infraorbital canal.

Knowledge of the IOA’s anatomy is critical for procedures like filler injections as accidental injection into the IOA can lead to blindness due to retrograde arterial flow to the ophthalmic artery.

Question:

What is the primary benefit of using ultrasonography in aesthetic medicine?

Supraorbital Artery

Originates from the ophthalmic artery, branching from the internal carotid artery. Because of its association with the ophthalmic artery, it carries a risk of blindness if injected with filler.

Course and Branches:

Courses through the orbit and exits the skull via the supraorbital notch or foramen.

Travels along the forehead, providing blood supply to the forehead skin, muscles, and periosteum.
Gives off several branches: medial and lateral branches that supply the forehead and scalp.

Depth and Relation:

It lies deep to the frontalis muscle and deep to the orbicularis oculi at its origin from the supraorbital foramen. It then prices the frontalis muscle approximately 1-2 cm above the orbital rim, travelling superiorly up the forehead superficial to the frontalis muscle.

Question:

What is the immediate origin of the supraorbital artery?

The Supratrochlear Artery, a branch of the ophthalmic artery, plays a crucial role in supplying blood to the medial aspect of the forehead.

Anatomy and Course:

Originates from the ophthalmic artery, itself a branch of the internal carotid artery.

Emerges above the orbit, medial to the supraorbital foramen, to supply the forehead and scalp up to the vertex.

Typically, after emerging from the orbit, it travels deep to the corrugator supercilii muscle, then moves superiorly deep to the frontalis, piercing the frontalis about 1-2 cm above the orbital rim. Then, it continues to move superiorly, superficially to the frontalis muscle.

Question:

Which of the following statements correctly describes the course of the Supratrochlear Artery?