Topographic Anatomy of the Inferior Medial Palpebral Artery and Its Relevance to the Pretarsal Roll Augmentation

Pretarsal Augmentation of the Lower Eyelids Using Fat Grafts in Asian Patients

Background

Surgical procedures are required to achieve long-term pretarsal roll fullness of the lower eyelids with a satisfactory appearance.

Objectives

To assess the efficacy of a surgical method using fat grafts for pretarsal augmentation of the lower eyelids.

Methods

We conducted a retrospective clinical study that included 12 Japanese patients (24 lower eyelids) who underwent pretarsal augmentation of the lower eyelids using fat grafts and were followed up for more than 6 months. Morphometric measurements of the projection, width, and area of the pretarsal roll fullness of the lower eyelids were performed. Additionally, surgical outcomes and complications were assessed.

Results

Pretarsal roll fullness of the lower eyelids was achieved for more than 6 months postoperatively. The surgery resulted in enlarged eyes with sufficient pretarsal roll fullness, and all patients were satisfied with the aesthetic outcomes. The mean projection (1.6 ± 1.0 vs 0.5 ± 0.6 mm), width (7.4 ± 1.5 vs 4.4 ± 3.6 mm), and area (143.5 ± 42.2 vs 32.8 ± 39.6 mm2) of the pretarsal roll fullness of the lower eyelids were significantly greater postoperatively than preoperatively (P < .05). No early postoperative complications were observed during the 6- to 12-month follow-up period. However, overcorrections were observed in 2 cases (16.7%) due to late-onset fat overgrowth, which was corrected by revision surgery.

Conclusions

Fat grafting can help achieve sufficient pretarsal roll fullness of the lower eyelids. The technique presented herein is a simple and reliable alternative surgical procedure for creating pretarsal roll fullness of the lower eyelids.

Level of Evidence 4

The Supratrochlear Artery Revisited: An Anatomic Review in Favor of Modern Cosmetic Applications in the Area

The supratrochlear artery represents a terminal branch of the ophthalmic artery. Cosmetic interventions may traumatize it, resulting in a circulation in the lesion in glabellar region and in the medial aspect of the forehead.

This review article aims to synopsise the existing knowledge of the anatomy of the supratrochlear artery in close correlation with minimally invasive cosmetic procedures in the facial area such as soft-tissue filler injections. Their possible adverse effects and their safe application based on the topographic anatomy were included.

A literature review was performed in PubMed/Medline online medical database.

The superficial course of the supratrochlear artery, as well as the rich, variable anastomotic network that it forms with the supraorbital, angular and dorsal nasal artery raise clinical questions in the case of soft-tissue filler injections in the nasoglabellar and central forehead area. Accidental cannulation of the supratrochlear artery and ultimately, the risk of embolization of the central retinal artery in a retrograde fashion might lead to injury with questionable cosmetic results.

Although the risk of complications from the use of soft tissue fillers is considered rare, once happen, the results could be devastating for the quality of life. Thus, the comprehension of the anatomy of the supratrochlear artery is paramount for the health practitioners.

Three-Dimensional Computed Tomographic Study on the Periorbital Branches of the Ophthalmic Artery: Arterial Variations and Clinical Relevance

BACKGROUND

Filler injection is a popular cosmetic procedure, but it can entail vascular complications. Periorbital injections have the highest risk within the entire injection area.

OBJECTIVES

The authors sought to systematically screen for periorbital arterial variations prior to treatment.

METHODS

The external carotid arteries of 10 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 11 cadaveric heads were injected with the contrast in sequential order. Computed tomography (CT) scanning was performed after injection of contrast, and 3-dimensional (3D) CT scans were reconstructed using validated algorithms.

RESULTS

Three types of periorbital blood vessels were found to derive from the ophthalmic artery, including 30% directly originating from the ophthalmic artery, 65% originating from its trochlear branch, and 5% originating from its supraorbital branch. In the forehead, the ophthalmic artery, originating from the internal carotid arteries, formed anastomoses between the frontal branch of the superficial temporal artery, originating from the external carotid artery, with the deep and superficial branches of the supratrochlear and supraorbital arteries, respectively. The lateral orbit and malar plexus can be classified into 4 types based on the trunk artery: the zygomatic orbital artery (27%), the transverse facial artery (23%), the premasseteric branch of the facial artery (19%), and all 3 contributing equally (31%).

CONCLUSIONS

Postmortem 3D CT can map periorbital arterial variations. The branching pattern of the ophthalmic artery, the ophthalmic angiosome in the forehead, and the distribution of the lateral orbit and malar plexus were identified at high resolution to guide clinical practice.

Three-Dimensional Topography of the Emerging Point of the Ophthalmic Artery

BACKGROUND

During periorbital noninvasive and surgical procedures, there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomical information that would help them to avoid associated complications.

METHODS

Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and seven Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system.

RESULTS

The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8 ± 1.0 mm medially, and the vertical distance was 14.0 ± 2.9 mm superiorly. The transverse distance from the midline was 16.5 ± 1.7 mm to the emerging point of the ophthalmic artery and 20.0 ± 2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8 ± 1.7 mm by means of three-dimensional scanning and 4.5 ± 1.1 mm using ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3 ± 1.4 mm.

CONCLUSION

These data inform clinicians about the anatomical three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures.