Reply: Investigation of the Orbital Arterial Distribution Using Image Superimposition to Determine Safe Zones for Retrobulbar Injection and to Prevent Filler Complications

Abstract

In our article, we suggested the safe direction for injection of fillers or other materials escaping arteries. 1 We have already reported on the depth of injection in the orbit with regard to eyeball protrusion and eyeball size. 6 In summary, we think that the safe guideline for retrobulbar injection was confirmed.Lastly, we agree with authors that real-time ultrasound is useful in facial injections for guidance because of individual differences in craniofacial morphology. Unfortunately, there are limitations related to the poor tissue penetrance of ultrasound. 7 Use of ultrasound on deep tissue such as orbital arteries might not be as helpful as ultrasound use on facial arteries.For more safe techniques, we believe that future studies should investigate differences in the threedimensional distribution of the orbital arteries according to age and race. Also, safety parameters, such as injection speed and volume range for retrobulbar filler injections, should be established.

Infraorbital Rejuvenation Combined with Thread-Lifting and Non-cross-linked Hyaluronic Acid Injection: A Retrospective, Case-Series Study

“…Additionally, addressing the nasojugal area with a soft tissue filler can be challenging due to the limited overlying soft tissue. Furthermore, the angular artery and angular vein, branching from the facial artery and facial vein, respectively, are superficially located, posing a risk of vascular complications [ 22 ]. The angular artery is occasionally connected to the dorsal nasal artery, a terminal branch of the ophthalmic artery, and injury to this vessel could result in severe visual impairment.…”