Mapping the nasal arterial topography: a dual-cohort ultrasound and cadaveric study

Soft-tissue filler injection for non-surgical rhinoplasty carries a low but well-documented risk of severe vascular complications, including skin necrosis and irreversible vision loss. This study employed high-resolution Doppler ultrasound in healthy living volunteers alongside macroscopic cadaveric dissection to characterize nasal arterial topography from distinct anatomical perspectives, aiming to identify lower-risk injection planes.

Thirty-five healthy Vietnamese adults (20 males, 15 females) underwent color Doppler ultrasound (12 MHz) at the radix, rhinion, and nasal tip to measure soft tissue thickness, arterial depth to skin, clearance to framework, distance to midline, and vessel caliber. Additionally, thirty hemifaces from 15 formalin-fixed Vietnamese cadavers were dissected to document arterial origins and morphological patterns. Data were analyzed using repeated-measures ANOVA and Generalized Estimating Equations.

Macroscopic arteries were identified in 80.0% of subjects at the radix/rhinion and 71.4% at the nasal tip. Dorsal arteries were significantly deeper in males across all three sites (p < 0.05). Both cohorts demonstrated similarly high rates of vascular asymmetry (bilateral macro-arteries in 60.0% by ultrasound and 53.3% by cadaveric dissection). A central paucivascular corridor (8.62 ± 1.07 mm at the radix and 8.04 ± 1.01 mm at the rhinion) was identified; however, terminal vessels converged progressively toward the midline at the nasal tip.

The nasal arterial network is highly variable and asymmetric. Blind injections relying solely on traditional midline landmarks are associated with a high risk of vascular compromise. These detailed topographic data support individualized ultrasound-guided techniques to enhance safety in aesthetic and reconstructive nasal procedures.