Crest Injection Technique in Glabella May Reduce Risks of Occlusion

Elevating or cresting the skin prior to injecting fillers in the glabella may reduce the risk of vascular occlusion.
Elevating or cresting the skin prior to injecting fillers in the glabella may reduce the risk of vascular occlusion.

Dermal fillers can reduce the appearance of static wrinkles in the glabella, but these injections do carry a high risk of vascular occlusion. One way to reduce the risks of occlusion may be to use a crest injection technique, where the injector elevates the skin in the glabella to temporarily occlude the paracentral artery prior to injection.

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This recommendation, published in the December 2021 issue of Plastic and Reconstructive Surgery – Global Open, comes from Tanvaa Tansatit, MD, MSc, Sukanya Uruwan, MSc, and Chalermquan Rungsawang, PhD, who performed a cadaver study to identify the anatomy of the arteries in the glabella region.

The researchers dissected 30 embalmed cadavers with red latex injected into the common carotid arteries to investigate the location of the arteries beneath the glabellar lines.

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They found that the supratrochlear artery, a direct branch of the ophthalmic artery, ascended from the muscular layer of the medial eyebrow along the medial canthal vertical line of the intercanthal vertical zone in 53 of 60 hemifaces (88%).

The dominant single paracentral artery from the radix artery was found within the radix vertical zone in eight out of 30 glabellae (27%) and, among these cadavers, the dominant paracentral artery was near the midline in two cadavers and arose along the radix vertical line in six cadavers.

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Therefore, they posited that the dominant paracentral artery may be the cause of ocular complications during injections of glabellar lines between the medial eyebrows, especially at the radix vertical lines. Temporarily occluding the paracentral artery by pinching the skin to create a skin crest and evert the glabellar line for a precise injection was recommended.

“Using this technique, the glabellar frown line can be safely eliminated with the correct placement of filler into the subreticular dermis plane between the skin and subcutaneous tissue,” the authors wrote. “A precise injection can effectively eliminate a deep line using a small amount of less than 0.1 ml filler, and the thinner skin requires less filler... This technique may significantly reduce the incidence of skin necrosis and ocular complications relating to glabellar injections.”

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