Avoiding facial artery occlusions

Article by:

Dr Abs

August 20, 2021

Understandably, causing vessel occlusion is a worry for many, if not, all injectors. The facial artery is a key vessel in supplying blood to the face. It arises from the external carotid which gives rise to the other following branches: superior thyroid, lingual, ascending pharyngeal, occipital, posterior auricular, maxillary and superficial temporal.

When volumising the jaw, it is not generally a potential target when injecting on the angle of the mandible. It crosses this bone more anteriorly. However, its exact depth and location has not been easily predictable, up till now. A study by Suwanchinda et al. (2018) used MRI scans to show complete consistency in locating this major vessel and its corresponding vein. The findings of this study allow us to significantly minimise facial artery occlusions during jaw procedures.

*Above: image taken from Suwanchinda et al. (2018) showing the crossing of the facial vein at the mandible (blue arrows).*

In order to understand the findings, we must first be aware of the layers of the face (some areas have a different number of layers to the usual five): (1) skin, (2) superficial fat, (3) connective tissue, (4) deep fat and (5) periosteum. Vessels are usually found in a particular one of these layers depending on the part of the face we are studying.

At the mandible crossing, we have (in order of superficial to deep) skin, superficial fat, platysma, deep fat, periosteum.
In the study, the facial artery was deep to the platysma when crossing the mandible in 100% of cases. It crossed the mandible also in 100% of the observed cases anterior to the facial vein and posterior to the mandibular ligament.

This has implications in jaw augmentation treatments. Knowing that the vessels lie deep to the platysma, minimally invasive procedures aiming to treat this area can avoid deep fillers if desired as the neuro‐vasculature can be identified deep to the platysma (and posterior to the mandibular ligament). Instead, superficial applications, ie superficial to the platysma, are lower risk and can be used instead, eg, cannula threads superficial to the platysma.