The Usefulness of Magnetic Resonance Angiography to Analyze the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualization Through an Augmented Reality Application

Marc Mespreuve; Karl Waked; Barbara Collard; Joris De Ranter; Francis Vanneste; Benoit Hendrickx

doi:10.1093/asjof/ojab018

The Usefulness of Magnetic Resonance Angiography to Analyze the Variable Arterial Facial Anatomy in an Effort to Reduce Filler-Associated Blindness: Anatomical Study and Visualization Through an Augmented Reality Application

Aesthet Surg J Open Forum. 2021 May 11;3(3):ojab018. doi: 10.1093/asjof/ojab018. eCollection 2021 Sep.

Authors

Marc Mespreuve¹, Karl Waked², Barbara Collard³, Joris De Ranter⁴, Francis Vanneste⁵, Benoit Hendrickx²

Affiliations

¹ Department of Medical Imaging, University Hospital Ghent, Ghent, Belgium.
² Department of Plastic and Reconstructive Surgery, University Hospital Brussel, Brussel, Belgium.
³ AZ Zeno Hospital, Knokke, Belgium.
⁴ Department of Plastic and Reconstructive Surgery, Universitair Ziekenhuis Leuven Campus Gasthuisberg, Leuven, Belgium.
⁵ Department of Medical Imaging, AZ Zeno Hospital, Knokke, Belgium.

Abstract

Background: The use of soft tissue fillers for facial rejuvenation is increasing rapidly and the complications, unfortunately, follow the same path. Blindness caused by intravascular filler injections is a rare but devastating complication. Knowledge of the individual arterial anatomy may aid the injector in avoiding injecting into an artery and thus to prevent blindness.

Objectives: To evaluate if the use of magnetic resonance angiography (MRA) may visualize the arterial facial anatomy in a contrast- and radiation-free way and study the individual arterial variations using an augmented reality (AR) image.

Methods: The individual arterial anatomy of the 3 terminal branches of the ophthalmic artery (supraorbital [SO]; supratrochlear [STr]; and dorsal nasal [DN] arteries) of 20 volunteers was studied by a 3-Tesla MRI, combining infrared (IR) facial warming and 3-dimensional time-of-flight multiple overlapping thin slab acquisition MRA. The resulting visualization of the facial arteries was shown on the patient's face through AR technology.

Results: The MRA was able to visualize the SO in 90.0%, STr in 92.5%, and DN arteries in 75% of the examined patients, as well as numerous variations in both vessel localization and path. Furthermore, a proof-of-concept of the AR visualization of the individual arterial anatomy was successfully implemented.

Conclusions: Dermal filler injectors should be aware of the risk of filler-induced blindness and familiarize themselves with the visualization of the variable facial vascular anatomy. The implementation of a one-time MRA and subsequent AR visualization may be useful in the accurate planning of minimally invasive facial rejuvenation procedures.