Transverse Facial Artery Perforators: Anatomical, Two- and Three-Dimensional Radiographic Study

Background: Increased anatomical knowledge of skin vascularization, such as the recent description of angiosome and perforasome concepts, has led to important innovations in flap surgery. In this sense, few studies have been performed on face vascularization especially for facial artery perforasomes. The aim of this study was to analyze the number, size, and localization of transverse facial artery perforators and their perfusion area. Methods: Fourteen hemifaces of fresh adult cadavers from the Department of Anatomy of Lyon University were harvested. Transverse facial artery perforators were identified, dissected, cannulated, and selectively injected with 1 ml of patent blue or contrast solution. Photography, microangiography, and computed tomography were performed. Perforator diameter and localization from the lateral canthus were measured. Exact topography and size of the perforasome were analyzed. Results: Twenty-three transverse facial artery perforators were identified. Mean perforator diameter was 1.01 +/- 0.3 mm. Mean perforating site was 31.0 +/- 8.0 mm lateral to and 38.7 +/- 8.8 mm below the lateral canthus. Mean single perforasome surface area was 25.3 +/- 18.34 cm(2) and mean transverse facial artery skin territory was 40.5 +/- 9.78 cm(2). Conclusions: The transverse facial artery provides at least one perforator that can be accurately localized using a Doppler probe. Clinical applications related to the improved knowledge of transverse facial artery perforators could be as follows: (1) performing a lateral facial skin flap; (2) facial composite allotransplants; (3) face-lift procedures to improve skin perfusion; and (4) prevention of vessel injury in aesthetic procedures such as dermal filler injection or thread-lift techniques.