Background: Prominent blood vessels on the face, while common, are not usually a source of cosmetic concern. By far the most common location of blood vessel visibility is in the forehead. Prominent arteries in the temporal region and side of the forehead as well as more central forehead veins can be seen in both men and women. Ligation of these vessel prominences is the preferred treatment.
Almost all of the prominent blood vessels that I have seen in my practice have been in the temporal region. But in rare cases I have seen it occur in the perioral region either on the side of the mouth or in the lips. These are branches of the facial artery whose symptoms are visible pulsations in one discrete spot and feeling of enlargement/prominence.
The facial artery comes off of the external carotid artery below the jaw. It crosses the jaw over the midportion of its body and extends upward towards the corner of the mouth. Form this point it ends up to the side of the nose and the inner eye area where it is known as the angular artery. It sends off branches at the corners of the mouth to the lip known as the labial arteries. The facial artery is rather tortuous to accommodate a wide range of facial movements. It’s tortuous nature and the branch pattern at the corner of the mouth can create a loop of the facial artery which can develop a pulsatile pattern due to its looped shape.
Case Study: This 33 year-old male had a prominent and bothersome vessel located just to the left side of his mouth. It could be seen to be in one spot about 2 cms lateral to the corner of the mouth with a very visible pulsation pattern. The pulsations could be seen but not the actual vessel.
Under local anesthesia, an 8mm skin incision was made in a skin crease that was determined when he smiled. Careful dissection revealed several very superficial branches as well as a deeper loop. All were double ligated with permanent 5-0 sutures, for a total of four specific ligation sites.
With the tying down of the ligatures, there was an immediate reduction in the size and visibility of the arterial pulsations. While there has to be an immediate effect with arterial ligation, the real test is what it is like three to six months after the surgery. Presumably in facial artery ligation of a prominent loop, secondary vessel ligation or inflow recruitment does not occur.
Highlights:
1) Certain arteries on the face can be aesthetically disturbing due to their visibility with the most common being the temporal arteries in men.
2) A very uncommon aesthetic artery disturbance is that of the facial artery where it crosses onto the face at the level of the mouth.
3) Ligation of the pulsatile region of the facial artery can be done through a small overlying incision.
Dr. Barry Eppley
Indianapolis, Indiana