Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization

Cotofana, Sebastian MD, PhD
Alfertshofer, Michael
Schenck, Thilo L MD, PhD
Bertucci, Vince MD
Beleznay, Katie MD
Ascher, Benjamin MD
Lachmann, Nirusha MD, PhD
Green, Jeremy B MD
Swift, Arthur MD
Frank, Konstantin MD

¹Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
²Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Germany
³University of Toronto, Toronto, Ontario, Canada
⁴Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada

Corresponding Author: Dr Sebastian Cotofana, Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA. Email: [email protected]; Instagram: @professorsebastiancotofana

^†Dr Ascher is a physician in private practice in Paris, France.

^‡Dr Green is a physician in private practice in Coral Gables, FL.

^§Dr Swift is a physician in private practice in Montreal, Quebec, Canada.

Editorial Decision date: May 18, 2020; online publish-ahead-of-print November 09, 2020

Aesthetic Surgery Journal (ASJ) 40(12):p 1327-1335, December 2020. | DOI: 10.1093/asj/sjaa137

Abstract

Background:

Lips are considered a key element of facial attractiveness due to their central position in the face and their elemental role in verbal and nonverbal communication.

Objectives:

The authors sought to provide clinically relevant information on the 3-dimensional pathway of the superior and inferior labial arteries within the lips to increase safety during labial soft tissue filler injections.

Methods:

The study enrolled 41 healthy volunteers with a mean age of 26.17 ± 9.6 years and a mean body mass index of 23.09 ± 2.3 kg/m². Ultrasound imaging was performed at 6 different locations. The position of the labial arteries within the lips, depth of the arteries, cranio-caudal location of each artery in relation to the vermilion border, and diameter of the superior/inferior labial arteries were recorded.

Results:

The most frequent location of both the superior and inferior labial arteries was the submucosal plane (58.5%) followed by intramuscular (36.2%) and subcutaneous (5.3%) planes. The depth of the superior labial artery in the upper lip was 5.6 ± 0.13 mm, whereas the depth of the inferior labial artery in the lower lip was 5.2 ± 0.14 mm. Both arteries were more frequently located within the red lip: upper lip (83% vs 18.7%) and lower lip (86.2% vs 13.8%). In the midline, the artery coursed within the red lip in all investigated volunteers.

Conclusions:

Clinically, results of this study favor a superficial injection plane for lip volumization procedures. A perpendicular approach to the lip (coming from the cutaneous lip) might increase safety because the artery is located most frequently within the red lip.