12 Facial Danger Zone 3 – Perioral Region

10.1055/b-0040-177254

12 Facial Danger Zone 3 – Perioral Region

Rod J. Rohrich and Dinah Wan

Abstract

The superior and inferior labial arteries course within the upper and lower lips, respectively, in the deep plane between the orbicularis oris muscle and oral mucosa. Filler injections in the lips should remain superficial to the labial arteries to avoid excessive bruising. Injections should be performed no deeper than 3 mm from the vermilion or skin, within the subcutaneous or superficial intramuscular plane. The facial artery courses approximately 15 mm lateral to the oral commissure and is at risk for injury and subsequent distal embolus when injecting near the corner of the mouth. Injections in this region should be performed in the superficial subcutaneous tissue and within one thumbwidth of the commissure.

Key Points for Maximizing Filler Safety in the Perioral Region

Filler injections in the upper or lower lip should be placed no deeper than 3 mm from the skin or vermilion, within the subcutaneous or superficial intramuscular plane.
Injections in the oral commissure should stay within a thumbwidth of the corner of mouth in the superficial subcutaneous plane. ¹ ^, ²
Inject with low pressure in an anterograde/retrograde fashion.

12.1 Safety Considerations in the Perioral Region

The superior and inferior labial arteries course within the upper and lower lips, respectively. Avoidance of these vessels when injecting filler for lip augmentation is critical to prevent tissue ischemia and/or excessive bruising (▶ Fig. 12.1).
The facial artery courses just lateral to the oral commissure and is at risk for injury when injecting near the corner of the mouth.

**Fig. 12.1** The superior and inferior labial arteries’ courses, respectively, within the upper and lower lips. These are at risk for injury during filler injections in the lips. The facial artery courses near the oral commissure as it gives off the labial artery branches and may be disrupted if injections are performed too laterally in the perioral region. Inadvertent injection of filler material into these vessels may lead to distal embolus and tissue necrosis in the angular artery region.

12.2 Pertinent Anatomy of the Perioral Region

12.2.1 Upper Lip Superior Labial Artery

Originates from the facial artery 10 to 12 mm lateral to and 5 to 9 mm above commissure (▶ Fig. 12.2 ). ³ ^, ⁴ ^, ⁵ ^, ⁶
There is greater variability in the trajectory of the superior labial artery along the upper lip as compared to the path of the inferior labial artery in the lower lip.
Initially runs superior to vermilion border along the lateral third of upper lip, then dips below border as it approaches the middle third or Cupid’s bow. ⁶
Courses 3 to 7.6 mm deep to the skin. ⁴ ^, ⁶
Most commonly found in the plane between the orbicularis oris and the oral mucosa, and less often within the orbicularis (▶ Fig. 12.3). ⁴ ^, ⁶ ^, ⁷