Safe Glabellar Wrinkle Correction With Soft Tissue Filler Using Doppler Ultrasound

Abstract Background Glabellar wrinkle corrections are usually performed by injecting botulinum toxin and hyaluronic acid fillers. The glabella is one of the most dangerous locations for filler injection because of possible visual complications. Objectives The aim of this study was to use Doppler ultrasound to determine the anatomic relation between glabellar wrinkles and the supratrochlear artery pathway, perform safe hyaluronic acid filler injection to correct glabellar wrinkles, and determine the efficacy of the procedure. Methods From January 2019 to July 2019, 42 patients (74 glabellar wrinkle lines; 32 bilateral and 10 unilateral wrinkles) were evaluated. Glabellar wrinkle lines were corrected with hyaluronic acid filler. Doppler ultrasound was used to avoid the supratrochlear artery. Results Among the 74 wrinkle lines, the supratrochlear arteries were located either at the glabellar wrinkle lines (30/74, 41%) or lateral to the glabellar wrinkle lines (44/74, 59%). In the latter 44 wrinkles, fillers were injected into the subdermal layer of the glabellar wrinkle lines. In the 30 wrinkles where supratrochlear artery was located at the glabellar wrinkle lines, the artery was located at the deep subcutaneous layer in 24 and at the subdermal layer in 6; thus, filler injection was not performed. Conclusions The supratrochlear artery may be located either at or lateral to the glabellar wrinkle lines. When performing glabellar wrinkle correction, Doppler ultrasound can be used to confirm the location of the supratrochlear artery before filler injection, which helps in avoiding vascular complications. Level of Evidence: 4