Variations of the Angular Artery in the Midface

“Various arterial pathways have been identified providing evidence that, in the midface, there is no guaranteed safe location for minimally invasive procedures.”

The high variability of the angular artery in the midface necessitates caution when injecting in this area.
The high variability of the angular artery in the midface necessitates caution when injecting in this area.

High variability in the course of the angular segment of the facial artery means that there is no guaranteed safe location in the midface for minimally invasive procedures. This was the conclusion of an anatomic study by Sebastian Cotofana, MD, PhD, et al, published in the Aesthetic Surgery Journal (July 2021). 

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For “The Course of the Angular Artery in the Midface: Implications for Surgical and Minimally Invasive Procedures,” the investigators measured the bilateral location and the depth of the midfacial segment of the facial artery in 156 Caucasian subjects (aged 45.19 ± 18.7 years with a mean body mass index of 25.05 ± 4.9 kg/m2) using multi-planar computed tomographic image analyses obtained from contrast agent-enhanced cranial computed tomographic scans.

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They found that at the nasal ala, the mean depth of the main arterial trunk was 13.7 ± 3.7 mm (range, 2.7-25.0 mm). At the medial canthus, it was 1.02 ± 0.62 mm (range, 1.0-3.0 mm). The location also varied in its relationship to the midfacial muscles: at the nasal ala superficial to levator anguli oris in 62.0% but deep to the levator labii superioris alaeque nasi in 53.6%; at the medial canthus superficial to the levator labii superioris alaeque nasi in 83.1% and superficial to the orbicularis oculi in 82.7%.

With the results confirming high variability in the course of the angular segment of the facial artery, the authors caution that, “Various arterial pathways have been identified providing evidence that, in the midface, there is no guaranteed safe location for minimally invasive procedures.”

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