Supratrochlear and Supraorbital Artery Safety with Dermal Fillers
Avoid deep injections in the glabellar and forehead regions entirely—use only intradermal placement with 30-gauge needles to stay superficial to the supratrochlear and supraorbital arteries, which are the most dangerous vessels for causing retrograde ophthalmic artery embolism and blindness. 1, 2
Critical Vascular Anatomy
The supratrochlear and supraorbital arteries are terminal branches of the ophthalmic artery that supply the forehead and glabellar region. 2, 3 These vessels create a direct pathway to the central retinal artery through their anastomotic connections, making accidental intravascular injection in this area catastrophic—it can cause retrograde embolization leading to permanent blindness. 2, 3
The glabellar and supraorbital regions represent the highest-risk zones for vascular complications during filler injection, with visual alterations being the most severe consequence. 4
Mandatory Injection Technique
Use intradermal placement exclusively—never inject deeply near the supratrochlear or supraorbital arteries. 1
- Use 30-gauge needles with shallow insertion angles, targeting only the dermis layer. 1, 5
- Create visible wheals or papules (6-10 mm diameter) to confirm proper intradermal placement—this ensures you remain superficial to major vasculature. 1, 5
- Inject above the orbicularis oculi muscle to stay superficial to the arterial network. 1
- Deep injections on the periosteum in the glabellar region directly risk injuring the supratrochlear and supraorbital arteries. 2
Blunt Cannula Alternative
Consider using 22-25 gauge blunt-tip cannulas instead of needles when treating the periorbital and forehead areas, as this provides an additional safety margin. 1
Pre-Injection Safety Protocol
Aspirate before every single injection to detect intravascular needle placement—this is recommended by the American Academy of Dermatology to prevent introducing material directly into vessels. 6, 5
Use incremental small-volume injections (0.2-0.5 mL maximum per site) rather than large boluses to allow early complication detection and minimize vascular compression. 1, 5
Inject in retrograde fashion while withdrawing the needle to further reduce intravascular injection risk. 1
Advanced Precautions
Doppler ultrasound mapping of the supratrochlear and supraorbital arteries before filler injection is recommended for high-risk areas including the glabellar region and forehead. 7 While the American Academy of Dermatology notes that ultrasonographic guidance may not be practical for everyday use by most practitioners, it remains a valuable tool when available. 6
Safer Alternative for High-Risk Patients
Consider autologous platelet concentrates (APCs) instead of hyaluronic acid fillers for periorbital and forehead rejuvenation when volumization is not the primary goal. 1, 8
- APCs provide skin quality improvement, reduced hyperpigmentation, and wrinkle reduction with lower vascular risk since they are autologous materials. 8
- Use 30G needles at 0.25 mm depth for intradermal injection in these high-risk areas. 1, 8
- The limitation is that APCs do not provide lasting volumization (effects last only 3 months), but they offer rejuvenation with potentially lower complication rates. 1, 8
Common Pitfall to Avoid
The most dangerous error is deep periosteal injection in the glabellar region, which places the needle directly in the path of the supratrochlear and supraorbital arteries as they emerge from the orbit. 2, 9 This injection plane must be completely avoided—stay strictly intradermal or consider not treating this area with fillers at all given the catastrophic risk-benefit ratio. 4