Anatomical Characterization of Transverse Facial Artery Perforators: A Micro-computed Tomography and Cadaveric Study.

Abstract

Perforators of the transverse facial artery (TFA) contribute to the formation of the subdermal vascular plexus of the lateral face. However, detailed three-dimensional information regarding the layer-specific course, depth, and relationship with landmarks remains limited. To elucidate the three-dimensional topography of TFA perforators and the associated subdermal vascular plexus using contrast-enhanced micro-computed tomography (micro-CT), conventional CT, and cadaveric dissection. Forty-eight hemifaces from 24 non-frozen adult cadavers were analyzed. Forty hemifaces underwent CT imaging and anatomical dissection, whereas eight hemifaces were subjected to phosphotungstic acid (PTA) staining and micro-CT imaging. The locations of the perforators were quantified using surface landmarks (the lateral canthus, ala of the nose, and otobasion inferius), and the depth of the subdermal vascular plexus were measured along predefined reference lines. TFA perforators were identified in 96% of hemifaces, typically as a single dominant perforator (91.3%). The emergence point was located 31.7 ± 6.9 mm lateral and 40.3 ± 4.2 mm inferior to the lateral canthus at a depth of 11.3 ± 3.7 mm. After traversing the SMAS, the perforators branched into a subdermal vascular plexus (depth: 3-5 mm) distributed in the inferolateral orbital and malar regions. These three-dimensional anatomical data provide a practical reference for both surgical and minimally invasive interventions. By defining the precise location and depth of the TFA perforator system, these findings can help optimize flap design in facelifts and reconstructive surgeries, while also improving the safety of interventions such as filler injections and thread-lifting.