What is the anatomy of the vessels over the face?

Anatomy of Vessels Over the Face

The facial vascular system consists of a complex network of arteries and veins that follow predictable patterns with notable anatomical variations that are crucial to understand for surgical procedures and clinical interventions. 1, 2

Arterial Supply of the Face

Major Arterial Sources

• External Carotid Artery System

  • Facial artery (main supply to anterior face)
  • Superficial temporal artery
  • Maxillary artery

• Internal Carotid Artery System

  • Ophthalmic artery branches
  • Supraorbital and supratrochlear arteries

Facial Artery

• Origin: Branches from external carotid artery in the neck

• Course:

  • Crosses the lower border of mandible, always anterior to facial vein (mean distance 6.2mm) 3
  • Forms an angle of approximately 49.8° with the inferior border of the mandible 4
  • Follows a tortuous path upward toward the medial canthus
  • Located medial to nasolabial fold in 65.5% of cases 4

• Major Branches:

  1. Submental artery (present in 44.8% of cases) 4
  2. Inferior labial artery (present in 60% of cases) 4
     • Originates most commonly at the angle of the mouth (60% of cases) 5
     • External diameter: 0.5-1.5mm 5
  3. Superior labial artery (present in 82.2% of cases) 4
     • Average diameter: 1.6mm (range 0.6-2.8mm) 5
     • Originates superior to angle of mouth in 72.3% of cases 5
     • Supplies columellar branches to the nose
  4. Lateral nasal artery (present in 25.1% of cases) 4
  5. Angular artery (present in 42.5% of cases) 4

• Termination Patterns:

  • Most commonly terminates as lateral nasal or angular artery (69.81%) 6
  • Other termination patterns include:
    • Angular facial vessel (22%)
    • Nasal facial vessel (60%)
    • Alar vessel (12%)
    • Superior labial vessel (4%) 5

Other Important Arteries

• Superficial temporal artery:

  • Terminal branch of external carotid artery
  • Supplies temporal region and lateral forehead
  • Divides into frontal and parietal branches

• Maxillary artery:

  • Terminal branch of external carotid artery
  • Supplies deep facial structures through multiple branches
  • Infraorbital artery emerges through infraorbital foramen to supply midface

Venous Drainage of the Face

Facial Vein

• Course: Runs posterior to facial artery 3
• Formation: Begins as angular vein at medial canthus of eye
• Drainage: Empties into internal jugular vein
• Relationship to facial artery: Independent course with facial artery always located anterior to the vein 3

Other Important Veins

• Angular vein: Present in all cases, even when angular artery is absent (angular artery present in only 34.4% of cases) 3
• Superior and inferior labial veins: Follow corresponding arteries
• Deep facial vein: Connects facial vein to pterygoid plexus
• Ophthalmic veins: Connect facial venous system to cavernous sinus

Clinical Significance

Danger Zones

• Periorbital region: Rich anastomoses between facial and ophthalmic arterial systems
• Nasolabial fold: High concentration of vessels with facial artery typically medial to the fold 4
• Oral commissure: Facial artery located approximately 8.5mm from oral commissure 4
• Glabellar region: Terminal branches of facial and ophthalmic arteries converge

Vascular Complications

• Facial artery's unpredictable course and depth makes it impossible to guarantee absolute safety during minimally invasive procedures 7
• Potential for retrograde flow from facial artery into ophthalmic system during filler injections
• Risk of vascular occlusion highest in areas of terminal branches and anastomoses

Surgical Considerations

• Knowledge of labiomental arteries is crucial for flap design in perioral reconstruction 5
• Mucosal flaps from upper lip based on deep septal or alar branches can restore lower lip defects 5
• Composite flaps from lower lip supplied by labiomental branch can restore combined defects 5

Anatomical Variations

• Facial artery symmetry present in only 68% of individuals 5
• Significant variability in branching patterns, course, and depth 7
• Three consistent anatomical landmarks for facial artery: mandible, modiolus, and medial canthus 7
• Variations in termination patterns affect surgical planning and filler injection safety

Understanding the complex and variable vascular anatomy of the face is essential for safe execution of surgical and minimally invasive procedures, with particular attention needed to the predictable landmarks and high-risk zones where vessels follow more consistent patterns.