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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
The external nose consists of the nasal bone, the upper lateral cartilages – separated by the dorsal septum – and the lower lateral cartilages, which can further be divided into a left and right medial and lateral crus. The mid-nasal dorsum shows a classic five-layered arrangement, including skin (layer 1), superficial fat (layer 2), nasalis muscle (layer 3), loose areolar tissue (layer 4), and perichondrium (layer 5) (Figure 6.56) (Alfertshofer et al., 2022). This layered arrangement cannot be found at the nasal radix or tip. At the nasal radix, the layered arrangement is lost due to the procerus muscle that courses obliquely from the nasal bone to its dermal insertion in the glabella region. The nasal tip is composed of homogenous fibrofatty tissue spanning from below the skin to the alar cartilage perichondrium, which corresponds to the fusion of the subcutaneous fatty layer and the loose areolar tissue more cranially. Although the majority of the nasal arterial vasculature is located within the superficial plane, it is notable that in a significant amount of cases, it can travel within deeper layers at the nasal radix and at the mid-nasal dorsum. The vascular supply originates from the supratrochlear and dorsal nasal artery cranially (both terminal branches of the ophthalmic artery) (Cotofana et al., 2019a). Branches of the angular artery provide blood supply to the nose caudally (Figures 6.57 and 6.58).
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The angular artery is the termination of the facial artery as it heads superiorly and medially towards the medial commissure of the eye. It supplies arterial blood to the orbicularis oculi muscles as well as the lacrimal sac. See Figure 3.10.
Volumetric Approach to the Lips
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
The perioral area is quite vascular. The facial artery enters the face by going over the mandibular rim just anterior to the masseter (3). It traverses over to the oral commissure where it splits into the superior and inferior labial arteries. These two arteries course in the mucosal part of the lip, inferior to the orbicularis oris and superior to the mucosa. The facial artery continues to course superiorly after giving off the superior labial artery and is now named the angular artery. The angular artery extends from the inferior alar groove/canine fossa along the side of the nose. It starts out deep at the canine fossa and becomes more superficial as it courses superior to the medial canthus. It is in this area where the angular artery anastomoses with the dorsal nasal artery, a branch of the ophthalmic artery. This creates an anastomosis between the external carotid and the internal carotid.
Complications associated with infraorbital filler injection
Published in Journal of Cosmetic and Laser Therapy, 2020
Shivani Reddy, Tuyet A. Nguyen, Nima Gharavi
Notable vasculature in this region include the infraorbital artery, angular artery, dorsal nasal artery, and zygomaticofacial artery (Figure 1). The infraorbital foramen, from which the infraorbital artery and nerve exit, is typically located medially 1/3 of the distance between the medial and lateral canthi, and on average between 6.3–10.9 mm below the infraorbital rim and is not reported to change significantly with age (6,7). The angular artery, a branch of the facial artery, courses along the medial periorbital area and anastomoses with the dorsal nasal artery here (6). This artery can have variations in location, and in some may be located more superficially in the subcutaneous tissue. The zygomaticofacial artery and nerve arise from a foramen at the lateral orbital rim about 0.5–1.0 cm below the horizontal line at the lateral canthus (8).
Angular artery island flap for eyelid defect reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Yavuz Keçeci, Zulfukar Ulas Bali, Anvar Ahmedov, Levent Yoleri
Fabrizio et al. defined retroangular flap and used for nasal reconstruction [5]. Ascari-Raccagni and Baldari reported the use of retroangular flap for nasal tip defects repair [14]. Tan et al. use retroangular flap for different facial area defects. Anatomically, the angular artery is defined as the terminal branch of the facial artery [15]. In these mentioned studies, the angular artery was accepted as the continuation of the facial artery and the flap was assumed to be nourished by reverse flow. Therefore, the term ‘retroangular’ was logical for this consideration. Based on this flow dynamic, Vayvada et al. stated that superiorly based nasolabial flap can be planned more superiorly than the classic one and used it for lower eyelid reconstruction in 10 patients [16]. Tatar et al. also used the same flap in 11 eyelid defect repair [17].