How to reduce the risk of occlusion in the philtrum (columella artery)

In 2018, a medical colleague of Dr Tim’s got in touch when they experienced their first vascular occlusion of the columella artery – they dealt with it extremely well, resolving it over the course of the weekend. The full outcome of that event is highlight in Dr Tim’s blog, reducing the risk of occluding the columella artery.

However, afterwards the aesthetic clinician had a terrible sense of fear that it would happen again and emailed him for advice. In this blog, Dr Tim Pearce shares his thoughts on how you can be safer, particularly when injecting the philtrum, which is where this vascular occlusion of the columella artery occurred.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

The anatomy of the philtrum

The columella artery, from a frontal view, often runs parallel, and even within the philtral columns. It is a branch of the superior labial artery, which is most often located underneath the orbicularis oris muscle, sometimes within it, and rarely superficial to it.

The columella artery, according to cadaveric studies, has two branches – a deep and a superficial branch. The deep branch contributes blood supply to the nasal septum, which is important to know because a vascular occlusion within the lip could affect this important area. The superficial branch naturally must become superior to the orbicularis oris muscle and is likely to be more vulnerable to the needle. Therefore, we must consider the curve of the philtrum and the nasolabial angle when injecting because this means the artery must make its way into the path of a straight needle that is pointed straight at the nose.

If you are going to inject the philtrum, it is vital that you remember that the deeper your needle gets, the closer it is going to get to the columella artery.

How to inject more safely into the philtrum?

The first option for safer injecting into the philtrum is to limit to treating the lower two thirds of the philtrum. This is an easy solution for injecting more safely because the more superior you get, the closer that artery will become.

You must be very conscious of the depth of your needle and the tendency for it to go deeper into the muscle in the curved philtrum. To help you control depth, it can help to pinch the philtrum between your fingers, into a straighter shape that will fit with the shape of your needle. Dr Tim notes that we get positive aspirations at the top quite often in aesthetics, but there is no need to go quite so deep in most patients.

The needle is running parallel to the artery so you could also increase the number of aspiration tests that you carry out. When you are performing a linear thread technique, you can aspirate as many times as possible, perhaps two or three times. Dr Tim believes this would significantly increase the sensitivity of the aspiration tests, in terms of picking up being intraarterially. Mathematically, each negative aspirate is decreasing the probability somewhat of being within an artery, prior to injecting. It takes no time at all to carry out an aspiration check, once you have got used to the technique, and it causes no harm. The benefits, therefore, in his view, outweigh the risks quite clearly.

If you suspect a vascular occlusion, remember the anatomy; check the philtrum, columella, and the nose tip, and look inside the nostrils towards the septum. Get a cotton bud and test the capillary refill in each area, carefully to help you diagnose.

Check out more on the importance of lip anatomy knowledge.

If you have any further questions about dermal filler treatments to the lips and philtrum, or your own top tips, Dr Tim would love to hear them. You can find Dr Tim Pearce on Instagram.

8D Lip Design

With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.

If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.

→ 8D LIP DESIGN COURSE 

Aesthetics Mastery Show

How To Reduce The Risk Of Occlusion In The Philtrum (Columella Artery)

In this episode, Dr Tim explores further how to reduce your risk when injecting the philtrum and avoid an occlusion in the columella artery? The superficial arteries of the face, where they go to and where they come from always need to be avoided to keep your patient as safe as possible This injection helps to balance out the lips with top lip dermal filler and beautify the cupids bow.

Mohsen Parvaresh commented on YouTube to say:

“Two years ago, while injecting the philtrum full-length and retrogradely, a white blot appeared mid-way on the patient’s right philtral column’s skin. Though it was only a limited blanching, most probably a philtral artery branch had been compressed, I discontinued the injection and started vigorous massaging of the area and applying warmth. It took about 5 mins before the normal colour of the skin was restored.”

Dr Tim replied to say

“good response- that’s often all you need and not a reversal.”

Lip Filler eLearning Courses

If you want to increase your skills in lip treatment design or boost your confidence by learning how to handle complications, Dr Tim Pearce offers a range of comprehensive courses that are highly rated by our delegates:

• 8D Lip Design
• Elective Lip Filler Reversal
• Dermal Filler Complications Mastery

In addition, browse our FREE downloadable resources on complications.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.