New Insight into Glabellar Arteries: A Three-Dimensional Computed Tomography and Dissection Study

Background: Vascular complications from glabellar intravascular filler injections are major safety concerns. Filler injection into the glabella without precise knowledge of its vascular topography poses a risk of severe complications. Methods: Computed tomography was used to study 90 cadaveric heads after contrast agent and filler injection, and 15 cadaveric heads were dissected. Results: Central, paracentral and reverse dorsal nasal arteries (CAs, PCAs, and rDNAs) were found in 70 (38.9%), 58 (32.2%), and 16 (8.9%) of the 180 hemifaces, respectively. Based on the presence of CAs, PCAs and rDNAs between the bilateral supratrochlear arteries (STAs), glabellar arteries were categorized into two main patterns: in type 1 (without named arteries between the bilateral STAs) (22/90, 24.4%), the glabella was supplied by the bilateral STAs and their branches; in type 2 (with named arteries between the bilateral STAs) (68/90, 75.6%), the glabella was supplied by the bilateral STAs and CAs, PCAs and rDNAs. Type 2 could be further divided into three subtypes: in type 2a (45/90, 50.0%), the glabella was supplied by the bilateral STAs and one of the named arteries; in type 2b (21/90, 23.3%), the glabella was supplied by the bilateral STAs and two of the named arteries; and in type 2c (2/90, 2.3%), the glabella was supplied by the bilateral STAs and unilateral CA, PCA and rDNA. Conclusion: This study elucidated novel arterial systems and proposed considerations for glabellar filler injection.