so there are two vessels in the forehead that you need to be aware of the super trar and super orbital the super trar artery is going to be approximately 1.4 CM from the midline and then the super orbital artery is going to be another centimeter lateral so it's 2.4 from the midline and the way I like to look at it is come first you can palpate where that super orbital Notch is and I come from inferior to Superior and I'm going to turn on the power doppler and we already see it so what we're seeing here is the super orbital artery and off it actually has two branches coming out and we can see that there's two branches in this case it's usually in the mid pupillary line so what happens the artery actually runs along the per oium as it goes into the forhead initially and then at around 15 millim it pierces through the muscle and goes more superficially so therefore it's much more dangerous to inject below the 15 15 mm from the orbital Rim in a deep fashion because you're in the same plane as the artery so generally it's recommended that you don't inject below that 15 mm line because you are at high risk of disrupting that artery or injecting in that artery same thing for the super trolear again that's going to be a little more medial and that's going to be in this particular area right here so there we go that's the super trolear artery coming out of super trar Notch so why are these arteries so important well in general obviously if you're injecting the forehead I told you you don't want to inject within 15 mm of the or but more importantly is if the patient has a filler Associated blindness I would recommend trying to cannulate this super trocar artery injecting hyaluronidase to try to reverse the ha that is in the retina okay so let me do one last thing here so let's see if we can can trace these arteries in the forehead and see what levels they are so I was about 15 mm from the orbital Rim when I was doing this exam and you see the artery is actually within the muscle so the muscle's right here and the arteries here so as I told you the artery comes out along the bone but at about 15 mm it starts to rise so this is the supraorbital artery about the 15 mm Mark let's go even higher and you're going to see it even more superficial I want to find it more superficial than that so what we're seeing here is an evaluation of the forehead pretty close to the hairline and I want to show you how the artery here is just beneath the skin surface which is here you see the lowest part of the dermis and you see it's very very close to the lowest part of the dermis with the muscle being down here so as I told you it becomes almost subcutaneous as you go up into the forehead so this is a supraorbital artery subcutaneous in the upper forehead so that concludes the evaluation of the forehead
