Blood Vessels to Avoid When Injecting CK1 of the MD Codes
When injecting the CK1 point of the MD Codes (located in the cheek region), the facial artery and its branches are the primary vascular structures requiring careful avoidance, as they pose the highest risk for vascular occlusion leading to tissue necrosis or blindness.
Critical Vascular Anatomy at CK1
The CK1 injection point lies in a high-risk vascular zone where the facial artery and its branches traverse unpredictably:
- The facial artery exhibits high variability in its course and depth, making it impossible to guarantee absolute safety based on surface anatomy alone 1
- The facial artery typically deviates at least twice as it courses through the face: at the lateral mental points and at the post-modiolar or supra-commissural points 2
- In 83.7% of individuals, the facial artery evolves into the angular artery as it ascends toward the medial canthus, passing through the midface region where CK1 is located 3
Specific Danger Zones
The buccal and nasolabial segments of the facial artery are particularly relevant to CK1 injections:
- The facial artery in the buccal region shows unpredictable two-dimensional course and three-dimensional depth, with only three constant anatomical landmarks: the mandible, modiolus, and medial canthus 1
- The horizontal distance between the facial artery and surrounding structures varies significantly (ranging from -1.90 to -6.92 mm in different facial regions), making blind injection techniques hazardous 3
- Autologous fat and hyaluronic acid are the fillers most frequently involved in vascular occlusions, with injury to ophthalmic and retinal arteries resulting in irreversible blindness in 61% of reported cases 4
Safe Injection Strategy
To minimize vascular injury risk at CK1:
- Inject in the supraperiosteal plane when possible, as this layer provides greater distance from the superficial arterial branches 3
- Use slow injection technique with frequent aspiration, though aspiration does not guarantee avoidance of intravascular injection 1
- Inject small volumes with low pressure, as high-pressure injection can force material retrograde into ophthalmic circulation even without direct arterial puncture 4
- Maintain awareness that the facial artery may deviate laterally from the oral commissure toward the post-modiolar point, placing it directly in potential injection paths 2
Critical Pitfalls
- The ophthalmic and retinal arteries are at risk through retrograde flow if the facial or angular arteries are inadvertently cannulated, with these injuries showing the strongest association with permanent vision loss 4
- Vascular anatomy cannot be reliably predicted from external landmarks alone in the midface region, requiring injectors to understand that complications can occur despite proper technique 1
- Partial or total recovery occurred in only 28% of vascular complication cases, with 72% showing no improvement, emphasizing the critical importance of prevention over treatment 4