Dangerous and Under-Recognized Arteries of the Glabella—An Ultrasound Study of Central and Paracentral Arteries and Risk During Filler Injection

BACKGROUND Injecting fillers in the glabella is dangerous due to the presence of the central and paracentral arteries. These superficial arteries can connect to the ophthalmic artery putting patients at risk for blindness and stroke. OBJECTIVE Determine the prevalence of the central and paracentral arteries (PCA) utilizing a portable ultrasound device. MATERIALS AND METHODS A retrospective review of ultrasound data to determine the incidence and location of glabellar arteries at the level of the medial eyebrow in 29 Iranian subjects. RESULTS The central and PCA were found on ultrasound in 26 and 36 of the 58 sides, respectively. The average distance from midline to the central and PCA was 4.1 mm (range 1.8–6.7 mm) and 8.2 mm (6.8–10.1 mm), respectively. The average depth from the skin to the central and PCA was 2.7 mm (2.2–3.2) and 3.0 mm (2.6–3.4 mm), respectively. Almost all patients (26/29) had at least 1 artery in the subcutaneous plane underlying the glabella. Increased body mass index resulted in increased arterial depth. CONCLUSION Portable ultrasound was able to detect the central and paracentral arteries in most patients. Knowledge of the existence of these arteries and their subdermal location may be important to develop strategies to increase the safety of glabellar filler injections.