Author: Site Editor Publish Time: 08-05-2025 Origin: Site
Understanding the danger zones in facial injections is essential for any aesthetic practitioner aiming to enhance patient safety and optimize treatment outcomes. One of the most harmful misconceptions a practitioner can hold is the belief that anatomical variations are too unpredictable to rely on structural landmarks. This mindset is not only misleading but dangerous. If human anatomy were truly that variable, our facial structures wouldn’t look as consistent as they do. In reality, the internal anatomy of the face follows predictable patterns, with only occasional variations.
Rather than obsessing over outliers seen in cadaver specimens, we must take a probability-based approach: where are vessels and foramina most likely to appear? This mindset allows us to rely on high-yield anatomical knowledge that consistently reduces clinical risks. This article explores exactly that—how to integrate anatomical awareness with sound injection technique to avoid high-risk zones in facial injections.
A practical way to begin understanding facial injection risks is by asking: what is the most dangerous way to inject a specific area? By identifying and avoiding these techniques altogether, complications can often be prevented. To fully understand these danger zones in facial injections, we must go beyond just vessel location—we must consider vessel origin, depth, and connection to critical structures like the eyes and brain.
Supratrochlear Artery
Originating from the ophthalmic artery, the supratrochlear artery extends from the orbit to the forehead. Injections placed deeply at the periosteum in this region can result in embolization to the brain or retina, causing catastrophic complications. This area is considered one of the highest-risk zones.
Supraorbital Artery
Arising near the supratrochlear artery and traveling through the supraorbital foramen, this vessel presents a similar risk. Deep injections near this foramen should be strictly avoided.
Infraorbital Artery
The infraorbital artery passes through the infraorbital foramen and continues as a branch of the maxillary artery. Vascular occlusion in this area could affect not only the cheek but also deeper areas like the palate or nasopharynx. Deep injections near this foramen are hazardous.
Mental Artery
Located at the mental foramen, this artery supplies the lower lip and chin. Deep injections here could disrupt both the mental artery and, more deeply, the inferior alveolar artery, risking dental ischemia.
Facial Artery at the Mandibular Notch
This is the largest artery in the face and often runs deeply near the mandibular notch. High-volume deep injections in this region carry significant risk. For safety, always use a blunt cannula and inject superficially within the fat layer.
Some of the most dangerous zones in facial injections arise not just from depth but from technique—specifically when a cannula or needle follows a vessel's path.
Nasal Dorsum: A Hidden High-Risk Zone
The dorsal nasal artery runs along the side of the nasal bridge, often paralleling cannula insertion. When the cannula enters the vessel, the filler can easily flow retrograde into the ophthalmic circulation. This is one of the most dangerous injection scenarios.
Safety Strategies:
Consider using a sharp needle for periosteal injections
Always move the cannula during injection
Aspirate before injecting
Use ultrasound guidance
Compress nearby vessels during injection to reduce risk
Nasolabial Fold and Facial Artery
Even with a blunt cannula, injections parallel to the facial artery (especially in the nasolabial area) can be risky. This is why many injectors prefer deep periosteal injections in this region—the needle sits beneath the artery, making it less likely to intrude into the lumen.
The lips are the most frequently reported site of vascular occlusion due to the labial artery, which runs just beneath the orbicularis oris muscle in a direction that aligns with most needle insertions.
Prevention Tips:
Master precise control over injection depth
New injectors should proceed cautiously, as 2–3 mm of excessive depth could lead directly into a vessel
Always perform aspiration and monitor resistance
If the needle shape becomes indistinct beneath the skin, it may already be inside a vessel
Some practitioners enhance nasal tip projection by inserting a cannula deep along the columella down to the maxillary bone, then injecting filler to elevate the tip. This method risks running parallel to the columellar artery.
Safer Techniques:
Use smaller volumes
Break injections into multiple passes
Inject slowly and deeply to avoid arterial entry
Anatomical studies show the columellar artery sits at an intermediate depth above the cartilage but below the dermis—targeting the correct layer is essential
We’ve already discussed the supratrochlear artery from a depth risk perspective, but this area also involves parallel artery pathways and high-pressure complications.
Glabellar Filler Injections
Frown lines are often treated with filler, but the supratrochlear artery lies directly underneath. If the needle and artery are aligned, the risk of intravascular injection increases.
Safety Protocols:
Apply pressure to block deeper vessels
Use very superficial subdermal injections
Choose low-viscosity fillers in small amounts
Always confirm needle depth and aspirate before injection
Not all complications come from direct intravascular injection. Another risk comes from excessive injection pressure compressing capillaries, leading to necrosis similar to pressure ulcers.
Central Face Zones with Minimal Expandable Space
Glabella
Nasal tip
Chin
These areas either have thick skin or limited space for expansion. Injecting too much filler creates internal pressure that compresses local capillaries.
Assessment Technique:
Before injecting, palpate and compress the area (e.g., nasal tip) to assess how much expandable space exists. Harder tissues with minimal movement mean less tolerance for volume.
Clinical Observations:
Overfilled chins can turn pale or cause localized alopecia (e.g., beard hair loss in men)
Severe cases may result in ulceration and prolonged healing
Rarely, permanent scarring may occur
Many filler product manuals specifically contraindicate use in the glabellar area—not solely due to risk of vascular occlusion, but also due to the risk of pressure-induced necrosis.
The glabellar region often has dense, fibrous tissue. Injecting a firm filler here can cause immediate whitening, followed by darkening and eventual necrosis. A better solution is to use soft, low-viscosity fillers in minimal doses to gently improve deep glabellar lines.
Mastering the danger zones in facial injections is not about memorizing rare complications—it’s about understanding predictable anatomy, applying careful technique, and maintaining a mindset of risk minimization. When safety protocols—such as appropriate depth, aspiration, vessel compression, ultrasound guidance, and product choice—are combined with anatomical precision, the risk of serious complications can be drastically reduced.
Facial injections can be safe and effective—but only if we respect the anatomy beneath the skin.
