Should a doctor know where the arteries in the face are to avoid causing blindness or skin necrosis from filler?

There is no way to know 100% where the arteries, veins and nerves are exactly on every patient, because there are many variations in the anatomy, so they can be a little higher, lower, deeper, in a different direction, etc. But what a physician who does inject fillers on the face should know is general guidelines, where those structures (arteries, veins, nerves, muscles) are deep, where they are closer to the skin, if there is a particular area that involves more risk, if there is a particular mark in the bone that can tell the injector where is variation. Knowing all these, helps the injector, if a cannula or needle is safer, if it has to be injected deep or superficially, if it has to be injected with a bolus technique, or fanning technique, if it needs to injected with mini deposits, also if aspiration on the syringe is needed, etc. Finally it is also important to know how to detect an intravascular injection and the treatment.

Hello, while it may not be possible to know exactly where the vessels are during facial injections, it is safe technique to withdraw before injecting to know whether the needle is within a vessel or not. Additionally, there are some instruments to help visualize the vessels prior to injection that some injectors use. Always make sure to visit an experienced injector who is familiar with their facial anatomy. 

Yes, but keep in mind, this side effect is extremely rare. I recommend injections with cannulas to limit complications. Best, Dr. Emer

Yes a facial plastic surgeon should know generally where the vessels are on the face, but individual face anatomy can vary.  Certain areas on the face are known to be more varied.  There have been cadaver studies showing how variable the infraorbital foramen can be anatomically person to person.  Although the chances of an intravascular event are low with an experienced injector, there is always some risk.  

The arteries in the body follow a general plan which is similar in everyone, but there is variation from person to person. Veins are more variable but also follow a general plan. It is important that your injector understand the anatomy of the face, not just the veins and arteries, but also the nerves, muscles, bones and fat pads to help you achieve the optimum aesthetic result in the safest fashion. There are certainly “danger zones” where filler should not be injected, as this can result in blindness. Thankfully such devastating side effects are extremely rare. In my practice I use a blunt tipped cannula to inject dermal fillers, as there is a much reduced risk of injections into arteries and veins. It’s important to make a fully informed decision regarding injections with fillers, and to find an injector who is adequately trained in anatomy and safe injecting technique: you safety should be the number one priority.

While the risk of skin necrosis and blindness are both extremely rare, you are smart to think about them.  As a physician who lectures on avoiding complications, I can tell you that any physician doing these procedures must be aware of the anatomy in order to do filler injections anywhere on the face.  However, we all also have to recognize that every face is different and patients may have unusual anatomy.  Thus even the best trained physician must also be aware of how to manage complications in the rare instance that they occur.There are techniques to reduce these complications -- choosing which filler to use and at what depth to inject are two of them.  Doctors may also choose to use a blunt tipped cannula instead of a needle to inject certain areas to reduce the risk.  However that also is not 100% effective.The key is to see a physician who understands the big multifactorial picture and is willing and able to explain your risks and how she or he works to avoid them.I hope this answer is helpful.  Best wishes.

Thank you for your great question.  While the risk of arterial injection is low, the risk of complications from arterial injection are exceedingly rare in experienced hands.  In other words, inadvertent arterial injections can occur, but when recognized and treated immediately and appropriately, long-term side effects can be avoided.  Ways to minimize risks include microcannula approach and choosing an expert injector who injects slowly and carefully and aspirates prior to injection.  Hope that helps, best of luck to you!