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Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The arterial supply of the frontalis muscle comes from the supraorbital and supratrochlear arteries. The supraorbital artery is a branch of the ophthalmic artery, which, in turn, is the first branch from the internal carotid artery distal to the cavernous sinus. The trochlear artery is itself a branch of the ophthalmic artery, its origin is within the orbit. We shan’t dwell on intra-orbital anatomy too much, as it is not overly relevant for botulinum toxin nor dermal filler administration. You do need to be aware, however, that the supraorbital artery leaves the orbit and enters the soft tissues of the forehead via the supraorbital notch: a notch in the frontal bone just underneath the midpoint of the eyebrow, which you should be able to palpate with relative ease. It is imperative that you do not administer botulinum toxin or dermal filler in this region unless you have a very good reason for doing so, as you may accidentally inject it directly into the artery, potentially causing complications such as systemic spread of botulinum toxin, avascular necrosis, embolisation of filler or even pseudoaneurysm formation.
Ocular and cerebral infarction from periocular filler injection
Published in Orbit, 2019
Zubair A. Ansari, Catherine J. Choi, Andrew J. Rong, Benjamin P. Erickson, David T. Tse
Dermal filler and autologous fat injections to improve facial rhytids and alter soft tissue contour are common cosmetic procedures that are becoming increasingly popular worldwide.1 Providers with a variety of training and experience levels are performing the injections. While the majority of outcomes are favorable, potential complications include granuloma formation, infection, and soft tissue necrosis due to vascular occlusion. One of the most feared complications of facial filler injections remains vision loss due to occlusion of the ophthalmic or central retinal artery.2 More uncommonly, the emboli may travel further proximally to involve the cerebral circulation. We present a case of a young patient who suffered permanent vision loss, as well as cerebral infarcts, due to cannulation of the supraorbital artery with retrograde migration of filler into the internal carotid circulation.
Visual impairment by multiple vascular embolization with hydroxyapatite particles
Published in Orbit, 2018
Yayoi Marumo, Miki Hiraoka, Masato Hashimoto, Hiroshi Ohguro
Examining the specifics of each case, in the first case, due to the development of ptosis and anterior segment ischemia, it was concluded, that the occluded vessels were the supraorbital artery and long posterior ciliary artery.11 In the second case, both eyes suffered from total blindness due to the bilateral central retinal artery and short posterior ciliary artery occlusions.8 In the third case, the occluded sites were in the central retinal artery and short and long posterior ciliary arteries.12 In the fourth case, posterior ischemic optic neuropathy developed.13 Although a lack of ophthalmological data in the fifth case makes it difficult to predict the responsible pathology leading to total blindness, central retinal artery occlusion may have been the cause.14 Among the literature, there was no case with permanent central nervous system impairment unlike autologous fat injections. This might be due to the differences of particle sizes and weight of filler materials.