Marked Unilateral Facial Artery Tortuosity Associated with a Prominent Ascending Branch and a Double Lower-Lip Arterial Pattern: An Anatomical Case Study

Background: The facial artery exhibits considerable anatomical variability in its course, branching pattern, caliber, and terminal distribution. Facial arterial tortuosity has also been reported to increase with age, making it important to distinguish unusual vascular configurations from morphological changes potentially associated with ageing. The present anatomical case describes a markedly tortuous unilateral facial artery associated with multiple consecutive cervical and facial loops, a prominent ascending arterial branch, an unusual double arterial pattern supplying the lower-lip region, and preservation of the lateral nasal–angular continuation. Case Presentation: Anatomical dissection was performed in an 82-year-old female body donor after injection of approximately 100 mL of red-pigmented liquid latex through the common carotid arterial system. The right facial artery exhibited two large cervical loops before crossing the inferior border of the mandible and five additional loops or marked curvatures along its facial course. After careful mechanical unfolding, the cervical segment measured approximately 58 mm and the facial–angular segment approximately 70 mm. A prominent ascending arterial branch arose from the facial artery near the level of the oral commissure and followed an independent superior course for approximately 30 mm before dividing into secondary branches. Two independently arising arterial branches coursed toward the lower-lip region. The more cranial vessel followed a course compatible with an inferior labial artery, whereas the second vessel followed a deeper, more caudal, and predominantly horizontal trajectory, raising the possibility of a horizontal labiomental artery. Distally, the facial artery continued through the lateral nasal and angular territories and established an anastomotic communication with the dorsal nasal artery. The contralateral facial artery followed a substantially more direct course without a comparable multi-loop configuration. Conclusions: This case documents a complex unilateral facial arterial configuration characterized by marked tortuosity involving both cervical and facial segments and associated with additional branching variations. The advanced age of the donor must be considered as a potential contributing factor to the observed arterial tortuosity, and the present anatomical observation does not establish a specific developmental or pathological mechanism. Likewise, the coexistence of multiple arterial features should be interpreted as a morphological association rather than evidence of a common embryological origin. Such individualized arterial configurations may have potential relevance for surgical dissection, reconstructive procedures, and image-guided facial interventions and reinforce the value of patient-specific vascular assessment whenever technically feasible.