A Systematic Literature Review of the Middle Temporal Vein Anatomy: ‘Venous Danger Zone’ in Temporal Fossa for Filler Injections

Pinch anatomy: An injection guide for temple filler injections

“…While performing the filler injections, one should be cautious not to inject in the blood vessels to avoid significant complications in the form of skin necrosis, 6 vision loss, 7,8 and nonthrombotic pulmonary embolism 9 …”

“…Photograph showing the "gentle pinch" maneuver in the temple, with thumb and index finger F I G U R E 2 Diagram showing the bunching up of skin and subcutaneous fat with "gentle pinch" without including the superficial temporal fascia in the pinch, creating a space for injection in the layers of subcutaneous fat layer F I G U R E 3 Photograph showing the "deep pinch" or "pinch and pull" maneuver in the temple, with thumb and index finger F I G U R E 4 Diagram showing the bunching up of skin, subcutaneous fat, and superficial temporal fascia with "deep pinch" or "pinch and pull" maneuver, creating a significant space for injection in the avascular, loose areolar tissue layer While performing the filler injections, one should be cautious not to inject in the blood vessels to avoid significant complications in the form of skin necrosis, 6 vision loss, 7,8 and nonthrombotic pulmonary embolism. 9 Knowing the precise location and correct depth of major blood vessels, based on facial surface anatomy, is necessary for safe and effective filler injections. However, pinching with the nondominant hand during filler injection leads to some distortion in the anatomy of the tissue.…”

Facial vascular danger zones for filler injections

“…A "venous danger zone" is located in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries ( Figure 3). 7 During a blinded insertion of cannula injections to reach the target area, the injector cannot discriminate the sensation at the cannula tip between the resistance of a fibrous septum in the way of the insertion and the resistance of encountering an artery. Severe complications in the form of nonthrombotic pulmonary embolism can occur as a result of an inadvertent injection in the MTV while performing temporal fossa filler procedures.…”

“…Severe complications in the form of nonthrombotic pulmonary embolism can occur as a result of an inadvertent injection in the MTV while performing temporal fossa filler procedures. 7…”

“…A “venous danger zone” is located in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries (Figure 3). 7 …”