title: Facing the Worst Risk: Confronting the Dorsal Nasal Artery, Implication for Non-surgical Procedures of Nasal Augmentation.
abstract: BACKGROUND
  The nose is a dangerous site for filler injection. This study investigated the anatomy of the dorsal nasal artery at the upper part of the nose to clarify how ocular complications occur.
  
  
  METHODS
  Dissections were performed in 50 noses of the embalmed cadavers. Either the soft embalming or formaldehyde embalming processes were used.
  
  
  RESULTS
  The dorsal nasal artery is not a constant artery. The artery traveled in the subcutaneous tissue layer of the nasal dorsum on the transverse nasalis muscle and its midline nasal aponeurosis which connected the muscles on both sides. Bilateral dorsal nasal arteries existed only in 34%. In 28% of the specimens, a single and large dorsal nasal artery was presented. The diameter was 0.4 ± 0.2 mm when bilateral dorsal nasal arteries were present and 0.7 ± 0.3 mm in a single artery. The largest artery was 1.2 mm. The artery usually crossed the midline at the middle third part of the nose over the upper lateral cartilages to form an anastomosis with the contralateral lateral nasal artery as the oblique nasal artery in 14%. The artery might descend and communicate with the ipsilateral lateral nasal artery in 6% or descended as a midline artery and form the nasal tip plexus in 8%. In 38% of the specimens, the arteries became small, formed a subcutaneous plexus and randomly distributed on the superficial layer of the subcutaneous tissue in the upper two-thirds of the nose.
  
  
  CONCLUSIONS
  During the injections at the upper (bony) and middle (cartilaginous) part of the nose for nasal dorsal augmentation, the injector has to make sure the cannula tip is in the preperiosteal plane by reinsertion of the cannula if needed, due to the chance of encountering the large single dorsal nasal artery at the midline.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand. tansatitapinuntrum@gmail.com.
authors.forename: Tanvaa
authors.initials: T
authors.lastname: Tansatit
authors.affiliation: The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
authors.forename: Prawit
authors.initials: P
authors.lastname: Apinuntrum
authors.affiliation: The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
authors.forename: Thavorn
authors.initials: T
authors.lastname: Phetudom
mesh_terms: D000328:Adult; D001158:Arteries / Q000033:anatomy & histology* / Q000187:drug effects; D002102:Cadaver; D003357:Cosmetic Techniques; D000067548:Dermal Fillers / Q000008:administration & dosage* / Q000009:adverse effects; D004210:Dissection; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000098:blood supply*; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D000067548:Dermal Fillers
keywords: Cadaver; Dorsal nasal artery; Filler injections; Nasal augmentation