• Tanya T Khan, Betsy Colon-Acevedo, Pradeep Mettu, Claudio DeLorenzi, and Julie A Woodward.
• Drs Khan and Colon-Acevedo are Fellows in Oculoplastic and Reconstructive Surgery, Dr Mettu is a Fellow in Neuro-ophthalmology, and Dr Woodward is Chief of Oculoplastic and Reconstructive Surgery, Duke University Eye Center, Durham, NC. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada.
• Aesthet Surg J. 2017 Feb 1; 37 (2): 203-208.

BackgroundEmbolia cutis medicamentosa (ECM) is a rare phenomenon attributed to intra-arterial drug injection. Glabellar filler injections can result in potentially devastating visual loss from inadvertent retrograde arteriolar embolization due to the extensive vasculature within the upper face. The minimum amount of filler necessary to potentiate this complication has not yet been reported.ObjectivesWe aim to determine the volume of filler necessary to occupy the supratrochlear artery from the glabella to the bifurcation of the ophthalmic and central retinal arteries. We specifically examine the volume of the supratrochlear artery from the glabella to orbital apex.MethodsThe study was approved by Duke University Institutional Review Board and involved surgical dissection of six fresh tissue cadaver heads (12 hemifaces). The arterial system in each cadaver head was injected with latex for visualization. The supratrochlear arteries were isolated anteriorly from the glabella to the orbital apex posteriorly. Intra-orbital vessel radius and length were measured. The vessel volume was calculated by water displacement of the intra-arterial latex.ResultsThe vessel volumes ranged from 0.04 to 0.12 mL. The average vessel volume was calculated as 0.085 mL, the average length as 51.75 mm, and the average radius as 0.72 mm.ConclusionsVascular occlusion from filler injections can lead to devastating visual consequences due to inadvertent retrograde intra-arterial embolization. Our findings indicate that the average entire volume of the supratrochlear artery from the glabella to the orbital apex is 0.085 mL. Injectors should be aware that a bolus of this critical volume may lead to a significant adverse outcome.© 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

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