Distribution Pattern of the Superior and the Inferior Labial Arteries -Impact for Safe Upper and Lower Lip Augmentation Procedures.

Background: Understanding the precise position and course of the superior and inferior labial arteries within the upper and the lower lip is crucial for safe and complication free applications of volumizing materials. Methods: 193 anatomic head specimens (56.5% females) of Caucasian ethnicity were investigated in this large multi-centric anatomical study. In total six 3cm long vertical incisions were performed on each lip (midline and 1cm medial to the angles of the mouth) to identify the position of the superior and the inferior labial arteries in relation to the orbicularis oris muscle. Results: Three different positions of the superior and inferior labial arteries were identified: submucosal, i.e. between the oral mucosa and the orbicularis oris muscle in 78.1% of the cases, intra-muscular, i.e. between the superficial and the deep layer of the orbicularis oris muscle in 17.5% and subcutaneous, i.e. between the skin and the orbicularis oris muscle observed in 2.1% of the cases. The variability in changing the respective position along the labial course was 29% for the total upper and 32% for the total lower lip. The midline location was identified in both the upper and lower lip to be the most variable. Conclusions: Based on the results of our investigation, a safer location for the application of volumizing material is the subcutaneous plane in the paramedian location of both the upper and the lower lip. Care has to be taken when aiming to inject in the midline as the artery can be identified more frequently in superficial positions. (C)2017American Society of Plastic Surgeons

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