Abstract
Background
Filler injections are frequently associated with vascular complications.
Objectives
To investigate the course and location of the middle-midface perforators to establish safe cannula entry sites for filler injections.
Methods
The middle-midface was studied using 28 hemiface specimens from soft embalmed Thai cadavers at the Faculty of Medicine, Chulalongkorn University. Investigations were performed following injection of red latex.
Results
Middle-midface perforators were classified into 3 groups according to their origin. These perforators originated from the buccal branch of the facial artery (57%); the parotid artery (25%); or directly from the facial artery (18%). The distance between the buccal artery perforator (level with the upper alar crease) and the lateral canthal (Y axis) line was 2.6 (SD 6.0) mm and Frankfort’s horizontal (X axis) lines was –16.4 (5.4) mm. The distance between the parotid artery perforator and the lateral canthal vertical line was 4.2 (10.8) mm and Frankfort’s horizontal line was –13.9 (3.4) mm. The distance between the facial artery perforator and the lateral canthal vertical line was 11.2 (10.8) and Frankfort’s horizontal line was–16.0 (5.3) mm.
Conclusions
A single long perforator was identified along the lateral canthal vertical line. This most commonly originated from the buccal branch emerging from the facial artery. Therefore, we recommend a cannula be inserted at the Beut site 2 cm inferolateral to the lateral canthus. This injection site is recommended as a safe to avoid injury to the middle-midface perforator.