The superior labial artery is a branch of the facial artery arising just above the corner of the mouth and passing medially within the upper lip between the orbicularis oris and the labial mucosa to supply the upper lip skin and mucosa. It gives a columellar branch ascending alongside the columella to the nasal tip, and anastomoses with its contralateral partner to form the labial arterial ring. The columellar branch is the primary blood supply to the nasal columella.
The superior labial artery and its columellar branch are the critical blood supply structures in rhinoplasty and cleft lip repair. In open rhinoplasty, the transcolumellar incision must spare the columellar branch of the superior labial artery to maintain nasal tip blood supply; injury causes columellar necrosis. In cleft lip repair, the superior labial artery is preserved on the lateral lip element during muscle reconstruction. Filler injection into the upper lip risks vascular occlusion of the superior labial artery, causing lip necrosis and potentially retrograde embolisation to the retinal circulation.
Intravascular injection of hyaluronic acid filler into the superior labial artery produces immediate blanching and pain of the upper lip followed by ischaemic necrosis and risk of retrograde embolisation to the ophthalmic artery via labial-facial artery connections; immediate hyaluronidase injection is the emergency treatment.
