The facial artery is the primary blood supply to the face, its tortuous course accommodating facial movement without kinking. The facial pulse is palpable at the mandible inferior border anterior to the masseter. Its terminal angular artery anastomoses with the ophthalmic artery branches at the medial canthus, creating a dangerous anastomotic connection that can allow facial filler material injected into facial artery branches to reach the ophthalmic artery and produce visual loss.
| Origin | External carotid artery above the hyoid in the carotid triangle |
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The angular artery anastomosis with the ophthalmic artery at the medial canthus is the primary vascular danger zone in facial filler injection. Intravascular hyaluronic acid injection into the facial artery or angular artery can embolise through this anastomosis into the central retinal artery, producing immediate monocular blindness. Immediate injection of hyaluronidase is required for partial reversal. Knowledge of this anastomosis is mandatory for all practitioners performing facial filler procedures.
Accidental intravascular facial filler injection embolising through the angular-ophthalmic anastomosis producing sudden monocular blindness requiring immediate hyaluronidase injection.
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