Supratrochlear artery: anatomy and risk in the glabella
- Artery
Quick facts
- Origin
- One of the two terminal branches of the ophthalmic artery (the other is the dorsal nasal artery).
- Exit from the orbit
- At the upper inner angle of the orbit, medial to the exit of the supraorbital artery, together with the supratrochlear nerve.
- Course
- Rises in the paramedian forehead, almost vertically, becoming superficial just above the eyebrow.
- Anastomoses
- With the artery of the opposite side, with the supraorbital, with the dorsal nasal and with the angular artery.
- Relevance in facial harmonization
- Main artery of the glabella; the region is among the most cited for necrosis and vision loss after filler.
The supratrochlear artery is one of the two terminal branches of the ophthalmic artery. It leaves the orbit at the upper inner angle, near the root of the nose, and rises through the central part of the forehead, on each side of the midline. It is the main artery of the glabella and one of the reasons this region is treated as a high vascular risk zone for filler.
What is the course of the supratrochlear artery?
The artery accompanies the supratrochlear nerve. On leaving the orbit, it passes medial to the exit of the supraorbital artery, crosses or wraps around the corrugator muscle and the orbicularis oculi, and rises through the paramedian forehead in an almost vertical course. Just above the eyebrow, it becomes more superficial, running in the subcutaneous tissue as it rises.
| Segment | What to look for |
|---|---|
| Exit from the orbit | Upper inner angle, usually near the vertical line through the inner corner of the eye |
| Glabellar region | Between the corrugator, the procerus and the orbicularis; branches cross toward the midline |
| Forehead | Vertical and increasingly superficial course, about two fingerbreadths from the midline, with variation |
Distance from the midline and depth vary between people and between sides. The published figures serve for anatomical review, not as an injection map.
In plastic surgery, this artery is the basis of the paramedian forehead flap, used in nasal reconstruction, which shows how constant and large in caliber it is in the forehead.
Why is the glabella a high risk zone?
Three factors explain it:
- Link to the eye: the supratrochlear artery belongs to the ophthalmic artery system. Product injected into it under pressure can travel against the flow and block the central retinal artery.
- Little alternative circulation in the skin: the glabella is frequently cited in reports of necrosis after filler.
- Thick, adherent skin: the product has little room, and excess volume can compress vessels.
Because of this risk, many glabellar lines are treated first with botulinum toxin, which acts on the muscle and leaves no volume at the site. Indication, product and technique are decisions for the qualified professional, according to the rules of their professional council in Brazil.
How does it show up in the assessment?
- Glabellar lines at rest versus in motion: show whether the concern is muscular or also a static line.
- Visible veins and vessels: in thin skin, they may be visible in the paramedian region.
- Previous fillers and surgeries: change the anatomy and the response of the tissue.
The most common procedure in the region is covered in toxin in the glabella.
Also called: arteria supratrochlearis, frontal artery (old name).
Frequently asked questions
Why is the glabella considered a risk zone for filler?
Because the supratrochlear and supraorbital arteries, branches of the ophthalmic artery, pass through the region. Occlusion can cause skin necrosis and, through retrograde flow, vision loss. In addition, the vascular network of the glabella has few alternative routes.
Does botulinum toxin in the glabella carry the same vascular risk?
No. Toxin does not form an embolus the way filler does. The undesired effects most cited in the glabella with toxin are bruising and eyelid drooping from diffusion, not vascular occlusion.