Background: Aesthetic deformities of facial arteries are uncommon of which the prominent anterior branch of the temporal artery is the most recognized of them. This is where the pathway of the artery is seen from the temples into the forehead with it appearing like the branches of a tree. It is the visibility of the pathway of the artery that patients desire to be reduced/removed.
The other type of aesthetic facial artery problem I have seen relates to that of the facial artery. In this arterial concern it is not the pathway of the artery that is the problem but the visible pulsations that it creates. The actual arterial pathway is not actually seen but the skin pulsing up and down over it is. This is very specifically located at the side of the mouth about 2cms from the oral commissure and just above it.
The anatomy of this pulsation relates to the pathway of the facial artery as it crosses up over the border of the lower jaw and superiorly into the medial facial area. As the facial artery crosses near the corner of the mouth a branch takes off where it splits into the upper and lower labial (lip) arteries. It is this area in which the pulsation occurs which implies some aberration at this branching point that brings the artery closer to the skin surface where it can be seen.
Case Study: This male had a history of a visible left facial pulsation that developed about ten years ago. There was no precedent history of trauma or other inciting event for its occurrence. Its location was consistent with the course of the facial artery by the side of the mouth.
left facial artery pulsations video Dr Barry Eppley IndianapolisIn his own video the left facial artery pulsations were very evident.
Under local anesthesia a 1cm incision was made in a skin crease at the lower end of the faint nasolabial fold line. A large branch of the pulsing facial artery was dissected out and it was discovered that it was an arterial loop rather than a more straight arterial course. Double ligation was done on both ends of the arterial loop which eliminated the pulsation.
Of the handful of facial artery ligations I have done for visible pulsations, they all have been on the left side and none have had a any history of trauma. They all developed spontaneously for no apparent reason. They were successfully resolved in a single surgery under local anesthesia with minimal scarring.
1) The prominent facial artery is seen as visible pulsations just to the side of the mouth.
2) The pulsatile facial artery is an aberrant loop of the artery as it splits into the labial and angular branches.
3) The pulsatile facial artery can be ligated through either a direct overlying or indirect small skin incision at the end of the nasolabial fold line.
Dr. Barry Eppley