Venous visualization by real-time near-infrared light imaging in facial esthetic procedures: An observational study

Abstract Background: Facial esthetic procedures using dermal fillers are becoming popular but often cause complications, including venipuncture. Knowledge of facial anatomy can reduce the risk of vascular events. Despite quite a few cadaveric studies, the distribution of facial vessels varies between individuals, making identification of the vascular patterns before procedures important. Objectives: We aim to provide real-time visualization of facial superficial veins as a referral template for esthetic practitioners. Methods: We chose 28 healthy participants seeking hyaluronic acid and/or botulinum toxin injections to perform near-infrared light transillumination before injection to visualize superficial veins in different facial subunits. Venous visualization was categorized as good or poor quality based on the clarity and reproducibility of vein depiction. Results: Important vascular structures, such as the emerging points of the ophthalmic artery, supraorbital vein, supratrochlear vein, superior/inferior palpebral veins, sentinel vein, angular vein, facial vein, superior/inferior labial veins, submental vein, anterior jugular vein, communicating vein, and external jugular vein, were identified. The facial areas with good venous visualization under transillumination included the forehead, temple, periorbital region, cheeks, perioral area, lips, jowl, and neck; the areas with poor venous visualization were the glabella, nose, and chin. Conclusion: Near-infrared light transillumination imaging is an easy-to-use and cost-effective tool that provides real-time visualization of superficial veins, which are critical for preoperative assessment and during facial esthetic procedures. This technology holds promise for reducing the risk of venous complications, such as bruising and hematoma, when used appropriately. However, it is important to note that the device does not enable visualization of arterial structures, and therefore, cannot reduce the risk of arterial injuries. Further studies are required to validate its role in improving injection safety and precision.