title: An Anatomical Analysis of the Supratrochlear Artery: Considerations in Facial Filler Injections and Preventing Vision Loss.
abstract: BACKGROUND
  Embolia cutis medicamentosa (ECM) is a rare phenomenon attributed to intra-arterial drug injection. Glabellar filler injections can result in potentially devastating visual loss from inadvertent retrograde arteriolar embolization due to the extensive vasculature within the upper face. The minimum amount of filler necessary to potentiate this complication has not yet been reported.
  
  
  OBJECTIVE
  We aim to determine the volume of filler necessary to occupy the supratrochlear artery from the glabella to the bifurcation of the ophthalmic and central retinal arteries. We specifically examine the volume of the supratrochlear artery from the glabella to orbital apex.
  
  
  METHODS
  The study was approved by Duke University Institutional Review Board and involved surgical dissection of six fresh tissue cadaver heads (12 hemifaces). The arterial system in each cadaver head was injected with latex for visualization. The supratrochlear arteries were isolated anteriorly from the glabella to the orbital apex posteriorly. Intra-orbital vessel radius and length were measured. The vessel volume was calculated by water displacement of the intra-arterial latex.
  
  
  RESULTS
  The vessel volumes ranged from 0.04 to 0.12 mL. The average vessel volume was calculated as 0.085 mL, the average length as 51.75 mm, and the average radius as 0.72 mm.
  
  
  CONCLUSIONS
  Vascular occlusion from filler injections can lead to devastating visual consequences due to inadvertent retrograde intra-arterial embolization. Our findings indicate that the average entire volume of the supratrochlear artery from the glabella to the orbital apex is 0.085 mL. Injectors should be aware that a bolus of this critical volume may lead to a significant adverse outcome.
authors.affiliation: Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
authors.forename: Tanya T
authors.initials: TT
authors.lastname: Khan
authors.affiliation: Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
authors.forename: Betsy
authors.initials: B
authors.lastname: Colon-Acevedo
authors.affiliation: Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Mettu
authors.affiliation: Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: DeLorenzi
authors.affiliation: Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Woodward
mesh_terms: D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000517:prevention & control*; D001766:Blindness / Q000209:etiology / Q000517:prevention & control*; D002102:Cadaver; D003357:Cosmetic Techniques / Q000009:adverse effects; D000067548:Dermal Fillers / Q000008:administration & dosage* / Q000009:adverse effects; D004210:Dissection; D005145:Face / Q000098:blood supply*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D065148:Nicolau Syndrome / Q000209:etiology / Q000517:prevention & control*; D009657:North Carolina; D009880:Ophthalmic Artery / Q000033:anatomy & histology*; D012161:Retinal Artery / Q000033:anatomy & histology*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000067548:Dermal Fillers