Abstract

Objectives: This presentation aims to reveal the anatomy of the subdermal vascular plexus, including its different patterns, location, diameter, and territories in each facial region, as well as the correlation between the dermal vascular plexus and the particle size of biostimulators. Therefore, understanding dermal vascular anatomy is extremely significant for injectors to grasp the mechanism of intravascular injury and the various techniques to resolve vascular complications depending on the type of biostimulator used. Introduction: Intrinsic and extrinsic skin aging can lead to dermis deterioration through increased collagen breakdown and decreased collagen synthesis. Several collagen biostimulators, including calcium hydroxylapatite (CaHA), PLLA, and PDLLA, are used to improve skin aging. Depending on the type of biostimulator, injection technique, and dilution, they can be injected into various layers. However, vascular occlusion due to accidental intravascular injection, compression, or vessel wall injury following subdermal injection has been consistently reported. Materials / method: Ten complete, soft-preserved cadavers were included in this study. The principal trunks and subcutaneous perforators of the arteries supplying the face, specifically the facial artery, transverse facial artery, and superficial temporal artery, were meticulously dissected using a surgical microscope. The pattern, location, depth, diameter, and vascular territory of the subdermal vascular plexus were thoroughly investigated. Subsequently, the anatomical data were correlated with the characteristics of various biostimulator products. Results: The subdermal plexus varies in pattern, diameter, and territory across facial regions. The lateral cheek, forehead, and mandible feature a wide territory and large diameter plexus, while the medial cheek has a small territory. Correlationally, large biostimulator particles tend to occlude subcutaneous perforators, and small particles may obstruct the subdermal plexus. Consequently, varying degrees of obstruction will impact different tissue structures Conclusion: In summary, comprehending the correlation between the dimensions of the vascular plexus and the characteristics of the material microsphere serves as a crucial guideline for addressing biostimulator-related vascular complications. This information is significant for predicting the potential severity of skin necrosis following intravascular injection. Furthermore, such data will enable practitioners to perform injections with greater confidence and a reduced risk of vascular compromise.