Filling the Gap: Facial Anatomy and Safe Lower Lip Injection Practices

Background/Objectives: Anatomical knowledge of the arterial supply to the lower face is critical to prevent unnecessary harm to patients seeking cosmetic procedures, particularly lower lip dermal filler injections. Our study sought to characterize the prominent vascular structures of the lower lip: inferior labial (ILA), labiomental (LMA) and mental (MA) arteries. Methods: Forty-eight hemiface specimens from 30 formalin-embalmed donors were utilized in this study. Dissection was performed of the LMA, ILA, and MA to determine their diameter, branching pattern for characterization, and to assess their supply to the lip distally. Results: The ILA (mean diameter, 1.5 ± 0.49 mm) was found to be prevalent in 90% of sampled donors. The LMA (1.2 ± 0.53 mm) was found in 75% of donors. All 48 hemifaces were found to have a MA (1.6 ± 0.51 mm). 88% of ILAs, 43% of LMAs, and 96% of MAs were identified as directly supplying the lower lip. Mean location of the MA as it supplied the lower lip was determined to be (-17 mm, -8.2 mm) and (20 mm, -8.1 mm) in the left and right hemifaces, respectively. F-Test for variance found no significant differences amongst the horizontal (p = 0.82) and vertical distances (p = 0.41) bilaterally. Conclusions: Our findings demonstrate the high variability in vascular supply of the lower lip, suggesting the need for high-resolution ultrasound guidance and the integration of anatomical training within injection courses for the safe injection of dermal fillers.