Age- and Sex-Related Variability of the Facial Artery: A CTA-Based Morphometric Study Correlated with Facial Anatomical Landmarks

Age- and Sex-Related Variability of the Facial Artery: A CTA-Based Morphometric Study Correlated with Facial Anatomical Landmarks | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age- and Sex-Related Variability of the Facial Artery: A CTA-Based Morphometric Study Correlated with Facial Anatomical Landmarks Sindy Melissa Sanchez-Romo, Adrián Manuel Verdines-Pérez, Mario Campos-Coy, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9238303/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background The facial artery's variability in course and depth makes it essential to understand its morphology, particularly by age and sex, for safe non-surgical aesthetic procedures. Objective This study analyzes the three-dimensional anatomy of the facial artery in a Latin population using computed tomography angiography (CTA) to assess morphological variations according to age, sex, and anatomical landmarks. Methods A descriptive cross-sectional observational study was conducted at the Radiology and Imaging Department. CTA scans from 201 patients over 18 with clear visualization of the facial artery were analyzed. Using RadiAnt Dicom Viewer software, measurements included the artery’s diameter at the mandibular border, distance from the oral commissure and mandibular angle, and depth at specific anatomical points. Results The mean patient age was 58, with equal sex distribution. Type 3 facial artery, extending to the lateral nasal branch, was observed in 67.2% of cases. Males had larger artery diameters and greater distances from the mandibular angle, masseteric border of the zygomatic bone and oral commissure. The facial artery becomes progressively more superficial along its ascending midfacial course. With increasing age, the depth of the facial artery at the inferior border of the mandible and its distances to the nasolabial sulcus and oral commissure decrease. Conclusions Significant anatomical variations in the facial artery by sex and age highlight the need for individualized approaches in aesthetic procedures to enhance safety and effectiveness. This study adds critical data on Latin populations, which is lacking in existing literature, guiding practitioners toward safer, more tailored aesthetic practices. facial anatomy facial artery fillers cosmetic medicine Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 INTRODUCTION The facial artery (FA) is a vascular structure of significant importance in facial anatomy, particularly in the context of non-surgical aesthetic procedures such as dermal filler application. Its anatomical variability, influenced by factors such as age and sex, makes it a key focus of study to minimize risks and optimize clinical outcomes. A comprehensive understanding of its morphology and its relationship with specific anatomical landmarks is essential to ensure safety and efficacy in these procedures 1 . In recent years, the literature has demonstrated a growing interest in the detailed analysis of the FA through cadaveric dissections and various imaging techniques, including computed tomography angiography (CTA). These investigations have enabled the classification of the FA into different types based on its course and termination and have established its relationship with surrounding anatomical structures 2 . Current literature on the FA primarily addresses its morphological characteristics in the upper and middle thirds of the face; however, it lacks a comprehensive analysis that considers its entire facial trajectory, particularly in the lower third, in relation to age and sex. Since vascular anatomy undergoes significant variations according to these variables, the objective of this study was to analyze the morphology of the FA using CTA, considering age and sex, and its relationship with anatomical landmarks. MATERIALS AND METHODS A descriptive, observational, and cross-sectional study was conducted in the Diagnostic Imaging Service where 201 computed tomography angiography (CTA) studies of the head and neck, previously performed in the service from January 2019 to December 2023, were selected. CTA scans of individuals of both sexes, aged 18 years or older, with adequate visualization of the FA without trauma or tumors affecting its course, were included. Three-dimensional reconstructions of these imaging studies were performed using RadiAnt DICOM Viewer version 2023.1. The images were analyzed based on bilateral distance measurements and positional descriptions of the FA in relation to standardized anatomical landmarks, consistently evaluated by a single observer. The most prevalent FA variant was determined according to the Furukawa classification, which categorizes the FA as follows: Type I: Terminates proximal to the superior labial artery. Type II: Terminates distal to the superior labial artery, near the nasolabial sulcus (NLS). Type III: Extends up to the lateral nasal or angular artery. Type IV: Duplex termination with a dominant lateral angular branch. The distance of the FA was measured relative to specific facial anatomical landmarks using CTA 3D reconstructions (Fig. 1 ): FA diameter at the inferior border of the mandible (IBM). Distance from the mandibular angle to the FA along the IBM. Angle measurement between the FA and the IBM. Distance from the oral commissure to the point where the FA crosses the IBM. Distance from the masseteric border of the zygomatic bone to the FA vertically. Additionally, the distance of the FA relative to superficial anatomical landmarks was determined, such as the Manson point, defined as the intersection of a line drawn from the lateral canthus of the eye to the mandible and another from the earlobe to the chin, and the NLS. Finally, the depth of the FA in the lower facial third was assessed using sagittal and axial CTA slice at the level of the lateral alar base and IBM (Fig. 2 and Fig. 3 ). The present study was approved by the Ethics and Research Committee under the code AH24-00006. RESULTS A total of 201 FA were analyzed, with a mean age of 58 years, and half of the sample falling within the age range of 31 to 64 years. Females constituted 52% of the sample (table 1). Table 1. Demographic Characteristics N = 201 1 Age 58.56 (16.91) Age Groups 18-30 years 16 (8.0%) 31-64 years 102 (50.7%) ≥ 65 years 83 (41.3%) Sex Female 104 (51.7%) Male 97 (48.3%) 1 Mean (SD) or Frequency (%) The most prevalent variant of the FA was determined based on the Furukawa classification using a sagittal three-dimensional reconstruction. This classification categorizes the FA as follows: Type I: Terminates proximal to the superior labial artery. Type II: Terminates distal to the superior labial artery, near the nasolabial fold. Type III: Extends to the lateral nasal or angular artery. Type IV: Duplex termination with a dominant lateral angular branch. The most prevalent FA type identified was Type III , with a prevalence of 67.2% (table 2). Table 2. Types of facial artery according to Furukawa classification N = 201 1 I 0 (0) II 66 (32.8) III 135 (67.2) IV 0 (0) 1 Frequency (%) The distance of the FA from bony facial anatomical landmarks was determined using sagittal three-dimensional reconstruction. The measurements included: diameter of the FA at the IBM, distance from the mandibular angle to the FA, angle between the FA and the IBM, distance from the oral commissure to the FA at the IBM and the distance from the masseteric border of the zygomatic bone to the FA (figure 1). A comparison of these measurements based on sex revealed significant differences. In males, the diameter of the FA at the IBM was greater, as well as the distance from the mandibular angle to the FA. Additionally, males exhibited greater distances from the oral commissure to the FA at the inferior border of the mandible and from the masseteric border of the zygomatic bone to the FA (table 3 and figure 4). Figure 4. Comparison of sex-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions. Representative examples are shown for a 70-year-old male (a) and a 51-year-old female (b) . Significant differences between sexes were observed in: (A) diameter of the FA at the IBM, (B) distance from the mandibular angle to the FA, (C) distance from the masseteric border of the zygomatic bone to the FA and (D) distance from the oral commissure to the FA, with males presenting larger values. An analysis of measurements by age groups also revealed significant differences. A significant difference and inverse correlation (r = -0.440, p = 0.000) were observed in the distance from the oral commissure to the FA at the IBM, indicating that this distance decreases with age. Additionally, a significant difference was found in the distance from the masseteric border of the zygomatic bone to the FA among age groups with middle-aged subjects (31–64 years) presenting significantly larger measurements. However, no significant correlation was identified (r = -0.066, p = 0.350) (table 3 and figure 5). Table 3. Sex- and age-related morphometric measurements of the facial artery at the inferior border of the mandible Means (mm) Male (n=97) 1 Female (n=104) 1 p-value 2 18-30y (n=16) 1 31-64y (n=102) 1 ≥65y (n=83) 1 p-value 2 Diameter of the FA 2.19 (0.51) 2.30 (0.45) 2.09 (0.55) 0.003* 2.14 (0.35) 2.15 (0.46) 2.25 (0.60) 0.406 Distance from the mandibular angle to the FA 25.73 (4.42) 26.80 (4.50) 24.73 (4.11) 0.001* 25.66 (3.36) 26.18 (4.47) 25.19 (4.51) 0.319 Angle between the FA and the IBM (°) 61.40 (29.98) 59.48 (30.86) 63.18 (29.16) 0.384 58.25 (12.29) 62.86 (30.25) 60.20 (32.11) 0.761 Distance from the masseteric border of the zygomatic bone to the FA 46.10 (7.06) 47.88 (8.29) 44.43 (5.19) 0.001* 45.31 (7.37) 47.36 (6.27) 44.69 (7.69) 0.033* Distance from the oral commissure to the FA 49.14 (6.92) 50.41 (8.00) 47.95 (5.53) 0.012* 57.25 (4.20) 50.27 (6.25) 46.19 (6.51) 0.000* Distance from the FA to the MP 1.67 (1.94) 1.42 (1.74) 1.89 (2.09) 0.087 2.01 (2.68) 1.63 (1.83) 1.65 (1.92) 0.763 1 Mean (SD) 2 Student's t-test *Significant value, p < 0.05 FA: Facial artery MP: Manson point Figure 5. Comparison of age-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions. Representative examples are shown for a 20-year-old male (a) , a 52-year-old male (b) , and a 70-year-old male (c) . Significant age-related differences were identified: (A) the distance from the oral commissure to the FA decreased with increasing age; and (B) the distance from the masseteric border of the zygomatic bone to the FA, with middle-aged subjects (31–64 years) presenting significantly larger measurements. The mean distance of the FA to the Manson point was 1.67 mm (±1.94 mm). No significant differences were observed based on sex or age. The mean distance of the FA to the NLS at the level of the lateral alar base was 7. 37 mm (±4.75 mm). A significant inverse correlation with age was identified (r = -0.175, p = 0.013), indicating that this distance decreases with age. No significant differences were found based on sex (table 4 and figure 6). Table 4. Comparison of age-related morphometric differences of the facial artery at the level of the lateral alar base and at the inferior border of the mandible Mean (mm) (SD) 18-30 years (n=16)¹ 31-64 years (n=102)¹ ≥65 years (n=83)¹ p-value² Distance from the FA to the NLS 7.37 (4.75) 7.21 (3.53) 8.56 (4.96) 5.92 (4.30) 0.001* Depth of the FA at the NLS 5.43 (2.95) 4.63 (1.81) 6.07 (3.52) 4.80 (2.08) 0.007* Depth of the FA at the IBM 10.50 (3.99) 9.77 (3.16) 11.20 (4.01) 9.77 (3.99) 0.040* 1 Mean (SD) 2 Student's t-test FA: Facial artery NLS: Nasolabial sulcus IBM: Inferior border of the mandible Figure 6. Comparison of age-related morphometric differences of the facial artery (FA) at the level of the lateral alar base (a) and at the inferior border of the mandible (IBM) (b), using axial CTA slices . Representative examples are shown for a 20-year-old male, a 52-year-old male, and a 70-year-old male. Significant age-related differences were identified in: (A) distance from the FA to the nasolabial sulcus (NLS), (B) depth of the FA at the NLS, (C) depth of the FA at the IBM. Regarding the location of the FA relative to the NSL, it was found that in 86.1% of cases, the FA was located lateral to the sulcus, regardless of sex or age. The mean depth of the FA at the level of the lateral alar base was 5.43 mm (±2.95 mm), with significant differences observed between age groups, showing a decrease in depth in older subjects, although no significant correlation was identified. At the IBM, the FA had a mean depth of 10.50 mm (± 3.99 mm), and a significant inverse correlation with age was observed (r = −0.169, p = 0.016), indicating progressive superficialization with increasing age (table 4 and figure 6). When both levels were compared, the FA demonstrated a clear pattern of superficialization along its ascending course, transitioning from a deeper plane at the IBM to a more superficial plane at the lateral alar base (figure 7). DISCUSSION This study described the morphology of the terminal branch of the FA according to the Furukawa classification [1]. In the study by Koziej et al., which evaluated 255 facial arteries using computed tomography in patients, the most prevalent FA type was Type III (lateral nasal or angular) in 40% of cases 2 . This finding aligns with the observations of Pilsl et al., who conducted CT scans in cadavers and reported Type III FA in 41.7% of cases 3 . Similarly, Lohn et al., through cadaveric dissections, found that Type III was the most prevalent type, present in 47.8% of cases 4 . These findings are consistent with our results, where the most prevalent FA variant was Type III, found in 67.2% of patients. In contrast to these studies, the study by Furukawa et al., which employed CT scans in patients, identified Type II (inferior alar) as the most common FA type in 39.6% of cases. These findings highlight the diversity of FA anatomical variants according to ethnicity or geographic region 1 . When analyzing the FA measurements, significant sex differences were observed, with males showing a larger FA diameter at the IBM. These differences may be explained by the greater incidence of intimal-medial thickening, calcification, and atherosclerotic plaque development in males during early and middle adulthood 5 . Regarding FA measurements relative to bony anatomical landmarks, males had greater distances from the mandibular angle to the FA, from the oral commissure to the FA at the IBM, and from the masseteric border of the zygomatic bone to the FA. These findings can be attributed to morphological differences in bone structure between sexes. In males, the midface exhibits more pronounced angles, irregular surfaces, and less anterior projection. The mandible is larger, more angulated, and more squared, whereas in females, both the midface and the mandible are more subtle, rounded, and less prominent 6 . The prominence of the chin and the greater mouth opening in males create a configuration in which anatomical reference points such as the oral commissure are farther from other facial structures, such as the FA 7 . With aging, various anatomical changes contribute to a reduction in the distance between the oral commissure and the FA. Thinning and weakening of the orbicularis muscle, combined with the loss of ligamentous support 8 and decreased elasticity in facial retaining ligaments, lead to lip retraction, elongation of the philtrum, and downward displacement of soft tissues, including the oral commissure 9 . Additionally, facial fat atrophy and redistribution reduce volumetric support, accentuating sagging and bringing anatomical structures closer together 10 . The mean angle between the FA and the inferior border of the mandible in our population was 61.40° (± 29.98°). This result is higher than previously reported values. A study in a European population reported an average angle of 50° 2 , while in an Asian population, it was 45° 11 . These differences can be attributed to genetic diversity, variations in bone structure, and differences in soft tissue composition among populations. Calva et al. highlighted that the Manson point is a reliable anatomical landmark for accurately locating the FA. In their study, the FA was located within an average radius of 2.95 mm from the Manson point in cadaveric specimens and living subjects using Doppler examination 12 . This finding aligns with our results, where the mean distance from the FA to the Manson point was 1.67 mm (± 1.94 mm). Additionally, Koziej et al. corroborated this observation, reporting a mean distance of 1.1 mm from the FA to the Manson point, with a 90th percentile value of 2.5 mm, indicating that the FA can be located with high probability within a 3 mm radius of the Manson point 2 . In our study, 86.1% of the facial arteries were located lateral to the NLS at the level of the lateral nasal wing, with a mean distance of 7.37 mm (± 4.75 mm). This result is consistent with Gelezhe et al., who reported that in all cases investigated, the main arterial trunk was lateral to the NLS 13 . However, this finding contrasts with Koziej et al., who found that the most frequent position of the FA relative to the NLS was medial in 65.5% of cases 2 . Our study found that with increasing age, the distance between the FA and the NLS decreased. This finding is consistent with the literature, where the distance between the FA and the NLS significantly reduces with age due to ptosis of the fat compartments over the sulcus. Gelezhe et al. reported that at this level, the FA is located within the superficial fat compartment. With aging, the loss of volume in these fat compartments and the downward displacement of soft tissues result in a reduced distance between the FA and the NLS 13 . Additionally, we found that the depth of the FA at the NLS and the inferior border of the mandible decreased with age. This finding aligns with the literature. Gelezhe et al. demonstrated that with aging, the depth of the FA decreases due to fat tissue atrophy and loss of volumetric support. The reduction in subcutaneous fat with aging contributes to the FA becoming more superficial, increasing the risk of injury during aesthetic procedures in this area 13 . When comparing the depths of the FA at the IBM and at the NLS, we observed that the FA becomes more superficial along its course. This finding aligns with literature reports from cadaveric dissections, which indicate that the FA is located in a deep supraperiosteal plane at the mandibular level and in a superficial plane within the superficial fat compartment at the NLS 14 . CONCLUSIONS In conclusion, males exhibited a greater diameter of the FA and increased distances from bony landmarks, including the mandibular angle and zygomatic bone. Along its course, the FA progressively becomes more superficial, positioning itself lateral to the NLS at the level of the lateral alar base. With increasing age, both the distance of the FA to the NLS and the oral commissure, as well as its depth at the IBM, decrease. Sex and age therefore represent key determinant of FA morphology, underscoring the importance of considering these variables to enhance safety and precision during facial clinical procedures. Declarations DISCLOSURES/CONFLICT OF INTEREST The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. FUNDING The authors received no financial support for the research, authorship, and/or publication of this article. Author Contribution S.M.S.-R. and A.M.V.-P. contributed equally to this work. S.M.S.-R., A.M.V.-P., and R.E.E.-O. conceived and designed the study. M.C.-C. and A.M.-M. performed data acquisition and imaging processing. S.M.S.-R., A.M.V.-P., and E.R.T.-M. conducted data analysis and interpretation. S.M.S.-R. drafted the manuscript. A.M.V.-P., D.F.-V., and S.G.-L. contributed to manuscript writing and critical revision. Y.S.-A. provided expert anatomical input and contributed to the interpretation of results. R.E.E.-O. supervised the study and provided final approval of the manuscript. All authors reviewed and approved the final version of the manuscript. References Furukawa M, Mathes DW, Anzai Y (2013) Evaluation of the facial artery on computed tomographic angiography using 64-slice multidetector computed tomography: implications for facial reconstruction in plastic surgery. Plast Reconstr Surg 131(3):526–535. 10.1097/PRS.0b013e31827c6f18 Koziej M et al (2019) Anatomical map of the facial artery for facial reconstruction and aesthetic procedures. Aesthet Surg J 39(11):1151–1162. 10.1093/asj/sjz028 Pilsl U, Anderhuber F, Neugebauer S (2016) The facial artery—the main blood vessel for the anterior face? Dermatol Surg 42(2):203–208. 10.1097/DSS.0000000000000599 Lohn JWG, Penn JW, Norton J, Butler PEM (2011) The course and variation of the facial artery and vein: implications for facial transplantation and facial surgery. Ann Plast Surg 67(2):184–188. 10.1097/SAP.0b013e31822484ae Merz AA, Cheng S (2016) Sex differences in cardiovascular ageing. Heart 102(11):825–831. 10.1136/heartjnl-2015-308769 Avelar LET, Cardoso MA, Bordoni LS, de Miranda Avelar L, de Miranda Avelar JV (2017) Aging and sexual differences of the human skull. Plast Reconstr Surg Glob Open 5(4):e1297. 10.1097/GOX.0000000000001297 Chatham DR (2006) Special considerations for the male patient: things I wish I knew when I started practice. Facial Plast Surg 22(1):25–30. 10.1055/s-2006-939502 Alghoul M, Codner MA (2013) Retaining ligaments of the face: review of anatomy and clinical applications. Aesthet Surg J 33(6):769–782. 10.1177/1090820X13495405 Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB (2021) The facial aging process from the inside out. Aesthet Surg J 41(10):1107–1119. 10.1093/asj/sjaa339 Coleman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 26(1):4–9 Guo Y et al (2024) Analysis of age-related changes in lower facial fat compartments and of the course of blood vessels using computed tomography. Plast Reconstr Surg 153(3):539e–548e. 10.1097/PRS.0000000000010506 Calva D et al (2015) Manson’s point: a facial landmark to identify the facial artery. J Plast Reconstr Aesthet Surg 68(9):1221–1227. 10.1016/j.bjps.2015.05.007 Gelezhe P et al (2021) Three-dimensional description of the angular artery in the nasolabial fold. Aesthet Surg J 41(6):697–704. 10.1093/asj/sjaa152 Cotofana S, Lachman N (2019) Arteries of the face and their relevance for minimally invasive facial procedures: an anatomical review. Plast Reconstr Surg 143(2):417e–426e. 10.1097/PRS.0000000000005201 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 25 Apr, 2026 Reviews received at journal 20 Apr, 2026 Reviews received at journal 04 Apr, 2026 Reviews received at journal 01 Apr, 2026 Reviewers agreed at journal 31 Mar, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 29 Mar, 2026 Reviewers invited by journal 29 Mar, 2026 Editor assigned by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9238303","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":615503397,"identity":"4a6ee7f0-fb79-4301-9d5a-caed872b849d","order_by":0,"name":"Sindy Melissa Sanchez-Romo","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Sindy","middleName":"Melissa","lastName":"Sanchez-Romo","suffix":""},{"id":615503398,"identity":"29f6bfbf-bf6f-4f99-a9de-13847ed51418","order_by":1,"name":"Adrián Manuel Verdines-Pérez","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Adrián","middleName":"Manuel","lastName":"Verdines-Pérez","suffix":""},{"id":615503400,"identity":"18c036b4-fa45-448c-9eed-ca9080067527","order_by":2,"name":"Mario Campos-Coy","email":"","orcid":"","institution":"Hospital Universitario Dr José Eleuterio Gonzalez","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Campos-Coy","suffix":""},{"id":615503401,"identity":"b2bddf32-3240-4063-b12e-05f72360ce76","order_by":3,"name":"Alberto Montemayor-Martínez","email":"","orcid":"","institution":"Hospital Universitario Dr José Eleuterio Gonzalez","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"","lastName":"Montemayor-Martínez","suffix":""},{"id":615503402,"identity":"19521fbb-634d-460d-b499-3a5ce151d54b","order_by":4,"name":"Emilio Rodrigo Tovar-Mandujano","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Emilio","middleName":"Rodrigo","lastName":"Tovar-Mandujano","suffix":""},{"id":615503404,"identity":"19623843-a323-4bcb-974d-8b8a39234466","order_by":5,"name":"David De la Fuente-Villarreal","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"De la","lastName":"Fuente-Villarreal","suffix":""},{"id":615503406,"identity":"6807b49d-fb45-4423-a111-33f5202c9153","order_by":6,"name":"Santos Guzmán-López","email":"","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":false,"prefix":"","firstName":"Santos","middleName":"","lastName":"Guzmán-López","suffix":""},{"id":615503407,"identity":"8c49a624-967d-41fc-b904-91fb0676c43d","order_by":7,"name":"Rodrigo E. Elizondo-Omaña","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBAC+wbmhgNAmrEBwrcBsRsP4NNicIARRUsamE1QCwOSlsNgEr+W442NB39U3JHtZ+9O/FxQc95ubfthoC01NtG4tNj3HGw4IHHmmfHMnrObpWccu5287UwiUMuxtNwGHFrsJIAKDNsOJ264kbtBmoftdrLZAaAIY8NhnFqM5R82HEiEaNn8m+ffuWSz8w/xazGcAQyfgxAt26R52w7Ymd0gYIsB0OUHG84cBvllmzVvX3KC2Q2gLQl4/GJw/PDhjz8qDgNDrHfzbZ5vdvZm59MfPvhQY4NTCwZIBKtMIFY5CNiTongUjIJRMApGBgAAiAdzDpAsJMUAAAAASUVORK5CYII=","orcid":"","institution":"Universidad Autónoma de Nuevo León","correspondingAuthor":true,"prefix":"","firstName":"Rodrigo","middleName":"E.","lastName":"Elizondo-Omaña","suffix":""}],"badges":[],"createdAt":"2026-03-26 22:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9238303/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9238303/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106402074,"identity":"563d3cf2-8017-449e-9ee6-b809bf3e5946","added_by":"auto","created_at":"2026-04-08 09:10:54","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151028,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMorphometric assessment of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstruction. \u003c/strong\u003eLabels indicate the following measurements: \u003cstrong\u003e(A) \u003c/strong\u003ediameter of the FA\u003cstrong\u003e \u003c/strong\u003eat IBM; \u003cstrong\u003e(B)\u003c/strong\u003e distance from the mandibular angle to the FA at the IBM; \u003cstrong\u003e(C)\u003c/strong\u003edistance from the zygomatic arch to the FA; \u003cstrong\u003e(D)\u003c/strong\u003e distance from the oral commissure to the point where the FA crosses the IBM; \u003cstrong\u003e(E)\u003c/strong\u003e angle between the FA and the IBM; \u003cstrong\u003e(F)\u003c/strong\u003e distance of the FA relative to Manson’s point; \u003cstrong\u003e(V) \u003c/strong\u003ecourse of the facial vein. Green dashed lines represent measurement reference axes.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/2a69b9d37ab7c6039e967592.jpeg"},{"id":105982545,"identity":"6121006f-514b-41be-bf6e-c98a6226f91d","added_by":"auto","created_at":"2026-04-02 07:02:46","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127668,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurements of the facial artery (FA) at the level of the lateral alar base.\u003c/strong\u003e\u003cem\u003e \u003c/em\u003e\u0026nbsp;Sagital CTA slice demonstrating the anatomical level selected of the transverse plane (yellow line) (a), axial CTA slice at this level (b) ,\u003cstrong\u003e \u003c/strong\u003eand enlarged zoom-in view of the highlighted region (c). Labels denote the following anatomical structures and measurements: \u003cstrong\u003e(A)\u003c/strong\u003eFA; \u003cstrong\u003e(B)\u003c/strong\u003e nasolabial sulcus (NLS); \u003cstrong\u003e(C)\u003c/strong\u003e depth of the FA from the skin surface; \u003cstrong\u003e(D)\u003c/strong\u003e horizontal distance from the FA to the NLS; \u003cstrong\u003e(V)\u003c/strong\u003efacial vein.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/dfe4d7fbbc67b46c163444ff.jpeg"},{"id":105982547,"identity":"3cbe8f4c-1983-4cfc-8eed-c58d8a346239","added_by":"auto","created_at":"2026-04-02 07:02:46","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":119678,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurements of the facial artery (FA) at the level of the inferior border of the mandible (IBM). \u003c/strong\u003eCoronal CTA slice demonstrating the anatomical level selected of the transverse plane (yellow line) (a), axial CTA slice at this level (b) , and enlarged zoom-in view of the highlighted region (c). The labeled structures indicate: \u003cstrong\u003e(A)\u003c/strong\u003e FA; \u003cstrong\u003e(B) \u003c/strong\u003eIBM; \u003cstrong\u003e(C)\u003c/strong\u003edepth of the FA from the skin surface; \u003cstrong\u003e(V)\u003c/strong\u003e facial vein.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/cdfaedf49354a68957cc108c.jpeg"},{"id":106093804,"identity":"91c7a0be-50ab-4c12-927a-da714f35b34c","added_by":"auto","created_at":"2026-04-03 11:39:17","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":282838,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of sex-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions. \u003c/strong\u003eRepresentative examples are shown for a 70-year-old male \u003cstrong\u003e(a)\u003c/strong\u003e and a 51-year-old female \u003cstrong\u003e(b)\u003c/strong\u003e. Significant differences between sexes were observed in: \u003cstrong\u003e(A)\u003c/strong\u003e diameter of the FA at the IBM, \u003cstrong\u003e(B) \u003c/strong\u003edistance from the mandibular angle to the FA, \u003cstrong\u003e(C)\u003c/strong\u003edistance from the masseteric border of the zygomatic bone to the FA and \u003cstrong\u003e(D) \u003c/strong\u003edistance from the oral commissure to the FA, with males presenting larger values.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/38421e962eaa14a98e0d9151.jpeg"},{"id":105982552,"identity":"0a96dffd-6f79-46c4-8115-0beccb56d60f","added_by":"auto","created_at":"2026-04-02 07:02:47","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":237898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of age-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions.\u003c/strong\u003e\u003cbr\u003e\nRepresentative examples are shown for a 20-year-old male \u003cstrong\u003e(a)\u003c/strong\u003e, a 52-year-old male \u003cstrong\u003e(b)\u003c/strong\u003e, and a 70-year-old male \u003cstrong\u003e(c)\u003c/strong\u003e. Significant age-related differences were identified: \u003cstrong\u003e(A)\u003c/strong\u003e the distance from the oral commissure to the FA decreased with increasing age; and \u003cstrong\u003e(B) \u003c/strong\u003ethe distance from the masseteric border of the zygomatic bone to the FA, with middle-aged\u003cstrong\u003e \u003c/strong\u003esubjects (31–64 years) presenting significantly larger measurements.\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/48d13e7b3aa74254a8b35044.jpeg"},{"id":105982549,"identity":"4c8b6f82-8eb3-48df-afca-97bc535f17e7","added_by":"auto","created_at":"2026-04-02 07:02:46","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":192727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of age-related morphometric differences of the facial artery (FA) at the level of the lateral alar base (a) and at the inferior border of the mandible (IBM) (b), using axial CTA slices . \u003c/strong\u003eRepresentative examples are shown for a 20-year-old male, a 52-year-old male, and a 70-year-old male. Significant age-related differences were identified in: \u003cstrong\u003e(A)\u003c/strong\u003edistance from the FA to the nasolabial sulcus (NLS), \u003cstrong\u003e(B) \u003c/strong\u003edepth of the FA at the NLS, \u003cstrong\u003e(C)\u003c/strong\u003e depth of the FA at the IBM.\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/9f2d8235ce90e29b357b2dfb.jpeg"},{"id":105982551,"identity":"14c0524c-b843-458f-b007-8506692d209a","added_by":"auto","created_at":"2026-04-02 07:02:47","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":136338,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of the depth of the facial artery (FA) at the level of the inferior border of the mandible (IBM) (a) and the lateral alar base (b) using axial CTA slices. \u003c/strong\u003eAt the level of the IBM, the FA lies in a deeper plane (mean depth: 10.50 ± 3.99 mm), whereas at the level of the lateral alar base, the FA becomes more superficial (mean depth: 5.43 ± 2.95 mm), reflecting its upward course along the midface.\u003c/p\u003e","description":"","filename":"floatimage9.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/486e43e253c222cc76869300.jpeg"},{"id":106405635,"identity":"18036ebe-8b41-418d-b6b3-42bf28eec779","added_by":"auto","created_at":"2026-04-08 09:27:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2905531,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9238303/v1/61b15314-9174-439b-8f6f-45bde9fd52bf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Age- and Sex-Related Variability of the Facial Artery: A CTA-Based Morphometric Study Correlated with Facial Anatomical Landmarks","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe facial artery (FA) is a vascular structure of significant importance in facial anatomy, particularly in the context of non-surgical aesthetic procedures such as dermal filler application. Its anatomical variability, influenced by factors such as age and sex, makes it a key focus of study to minimize risks and optimize clinical outcomes. A comprehensive understanding of its morphology and its relationship with specific anatomical landmarks is essential to ensure safety and efficacy in these procedures\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn recent years, the literature has demonstrated a growing interest in the detailed analysis of the FA through cadaveric dissections and various imaging techniques, including computed tomography angiography (CTA). These investigations have enabled the classification of the FA into different types based on its course and termination and have established its relationship with surrounding anatomical structures \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrent literature on the FA primarily addresses its morphological characteristics in the upper and middle thirds of the face; however, it lacks a comprehensive analysis that considers its entire facial trajectory, particularly in the lower third, in relation to age and sex.\u003c/p\u003e \u003cp\u003eSince vascular anatomy undergoes significant variations according to these variables, the objective of this study was to analyze the morphology of the FA using CTA, considering age and sex, and its relationship with anatomical landmarks.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eA descriptive, observational, and cross-sectional study was conducted in the Diagnostic Imaging Service where 201 computed tomography angiography (CTA) studies of the head and neck, previously performed in the service from January 2019 to December 2023, were selected.\u003c/p\u003e \u003cp\u003eCTA scans of individuals of both sexes, aged 18 years or older, with adequate visualization of the FA without trauma or tumors affecting its course, were included.\u003c/p\u003e \u003cp\u003eThree-dimensional reconstructions of these imaging studies were performed using RadiAnt DICOM Viewer version 2023.1. The images were analyzed based on bilateral distance measurements and positional descriptions of the FA in relation to standardized anatomical landmarks, consistently evaluated by a single observer.\u003c/p\u003e \u003cp\u003eThe most prevalent FA variant was determined according to the Furukawa classification, which categorizes the FA as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eType I: Terminates proximal to the superior labial artery.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eType II: Terminates distal to the superior labial artery, near the nasolabial sulcus (NLS).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eType III: Extends up to the lateral nasal or angular artery.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eType IV: Duplex termination with a dominant lateral angular branch.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe distance of the FA was measured relative to specific facial anatomical landmarks using CTA 3D reconstructions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eFA diameter at the inferior border of the mandible (IBM).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDistance from the mandibular angle to the FA along the IBM.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAngle measurement between the FA and the IBM.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDistance from the oral commissure to the point where the FA crosses the IBM.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDistance from the masseteric border of the zygomatic bone to the FA vertically.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAdditionally, the distance of the FA relative to superficial anatomical landmarks was determined, such as the Manson point, defined as the intersection of a line drawn from the lateral canthus of the eye to the mandible and another from the earlobe to the chin, and the NLS. Finally, the depth of the FA in the lower facial third was assessed using sagittal and axial CTA slice at the level of the lateral alar base and IBM (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e The present study was approved by the Ethics and Research Committee under the code AH24-00006.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 201 FA were analyzed, with a mean age of 58 years, and half of the sample falling within the age range of 31 to 64 years. Females constituted 52% of the sample (table 1).\u003c/p\u003e\n\u003ctable style=\"width: 2.1e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Demographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eN = 201\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.56 (16.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e18-30 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e31-64 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e102 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge; 65 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e104 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e97 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Mean (SD) or Frequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe most prevalent variant of the FA was determined based on the Furukawa classification using a sagittal three-dimensional reconstruction. This classification categorizes the FA as follows:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eType I:\u003c/strong\u003e Terminates proximal to the superior labial artery.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eType II:\u003c/strong\u003e Terminates distal to the superior labial artery, near the nasolabial fold.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eType III:\u003c/strong\u003e Extends to the lateral nasal or angular artery.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eType IV:\u003c/strong\u003e Duplex termination with a dominant lateral angular branch.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe most prevalent FA type identified was \u003cstrong\u003eType III\u003c/strong\u003e, with a prevalence of 67.2% (table 2).\u003c/p\u003e\n\u003ctable style=\"width: 2.1e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Types of facial artery according to Furukawa classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eN = 201\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135 (67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Frequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe distance of the FA from bony facial anatomical landmarks was determined using sagittal three-dimensional reconstruction. The measurements included: diameter of the FA at the IBM, distance from the mandibular angle to the FA, angle between the FA and the IBM, distance from the oral commissure to the FA at the IBM and the distance from the masseteric border of the zygomatic bone to the FA (figure 1).\u003c/p\u003e\n\u003cp\u003eA comparison of these measurements based on sex revealed significant differences. In males, the diameter of the FA at the IBM was greater, as well as the distance from the mandibular angle to the FA. Additionally, males exhibited greater distances from the oral commissure to the FA at the inferior border of the mandible and from the masseteric border of the zygomatic bone to the FA (table 3 and figure 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 4. Comparison of sex-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions.\u0026nbsp;\u003c/strong\u003eRepresentative examples are shown for a 70-year-old male \u003cstrong\u003e(a)\u003c/strong\u003e and a 51-year-old female \u003cstrong\u003e(b)\u003c/strong\u003e. Significant differences between sexes were observed in: \u003cstrong\u003e(A)\u003c/strong\u003e diameter of the FA at the IBM, \u003cstrong\u003e(B)\u0026nbsp;\u003c/strong\u003edistance from the mandibular angle to the FA, \u003cstrong\u003e(C)\u003c/strong\u003e distance from the masseteric border of the zygomatic bone to the FA and \u003cstrong\u003e(D)\u0026nbsp;\u003c/strong\u003edistance from the oral commissure to the FA, with males presenting larger values.\u003c/p\u003e\n\u003cp\u003eAn analysis of measurements by age groups also revealed significant differences. A significant difference and inverse correlation (r = -0.440, p = 0.000)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewere observed in the distance from the oral commissure to the FA at the IBM, indicating that this distance decreases with age. Additionally, a significant difference was found in the distance from the masseteric border of the zygomatic bone to the FA among age groups with middle-aged\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esubjects (31\u0026ndash;64 years) presenting significantly larger measurements. However, no significant correlation was identified (r = -0.066, p = 0.350) (table 3 and figure 5).\u003c/p\u003e\n\u003ctable style=\"width: 5.2e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Sex- and age-related morphometric measurements of the facial artery at the inferior border of the mandible\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMeans (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=97)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFemale (n=104)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e18-30y (n=16)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e31-64y (n=102)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;65y (n=83)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDiameter of the FA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.19 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.30 (0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.09 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.14 (0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.15 (0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.25 (0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the mandibular angle to the FA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.73 (4.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.80 (4.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.73 (4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.66 (3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.18 (4.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.19 (4.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAngle between the FA and the IBM (\u0026deg;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.40 (29.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.48 (30.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63.18 (29.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.25 (12.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62.86 (30.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60.20 (32.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.761\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the masseteric border of the zygomatic bone to the FA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46.10 (7.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47.88 (8.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.43 (5.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45.31 (7.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47.36 (6.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.69 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.033*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the oral commissure to the FA\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.14 (6.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.41 (8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47.95 (5.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.012*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.25 (4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.27 (6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46.19 (6.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the FA to the MP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.67 (1.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.42 (1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.89 (2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.01 (2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.63 (1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.65 (1.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Student\u0026apos;s t-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e*Significant value, p \u0026lt; 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFA: Facial artery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMP: Manson point\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 5. Comparison of age-related morphometric differences of the facial artery (FA) at the inferior border of the mandible (IBM) using CTA 3D reconstructions.\u003c/strong\u003e\u003cbr\u003eRepresentative examples are shown for a 20-year-old male \u003cstrong\u003e(a)\u003c/strong\u003e, a 52-year-old male \u003cstrong\u003e(b)\u003c/strong\u003e, and a 70-year-old male \u003cstrong\u003e(c)\u003c/strong\u003e. Significant age-related differences were identified: \u003cstrong\u003e(A)\u003c/strong\u003e the distance from the oral commissure to the FA decreased with increasing age; and \u003cstrong\u003e(B)\u0026nbsp;\u003c/strong\u003ethe distance from the masseteric border of the zygomatic bone to the FA, with middle-aged\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003esubjects (31\u0026ndash;64 years) presenting significantly larger measurements.\u003c/p\u003e\n\u003cp\u003eThe mean distance of the FA to the Manson point was 1.67 mm (\u0026plusmn;1.94 mm). No significant differences were observed based on sex or age.\u003c/p\u003e\n\u003cp\u003eThe mean distance of the FA to the NLS at the level of the lateral alar base was \u003cstrong\u003e7.\u003c/strong\u003e37 mm (\u0026plusmn;4.75 mm). A significant inverse correlation with age was identified (r = -0.175, p = 0.013), indicating that this distance decreases with age. No significant differences were found based on sex (table 4 and figure 6).\u003c/p\u003e\n\u003ctable style=\"width: 4.7e+2pt\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp id=\"_Toc171931650\"\u003e\u003cstrong\u003eTable 4. Comparison of age-related morphometric differences of the facial artery at the level of the lateral alar base and at the inferior border of the mandible\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean (mm) (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e18-30 years (n=16)\u0026sup1;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e31-64 years (n=102)\u0026sup1;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;65 years (n=83)\u0026sup1;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the FA to the NLS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.37 (4.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.21 (3.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.56 (4.96)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.92 (4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepth of the FA at the NLS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.43 (2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.63 (1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.07 (3.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.80 (2.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.007*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepth of the FA at the IBM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.50 (3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.77 (3.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.20 (4.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.77 (3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.040*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Student\u0026apos;s t-test\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFA: Facial artery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNLS: Nasolabial sulcus\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIBM: Inferior border of the mandible\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 6. Comparison of age-related morphometric differences of the facial artery (FA) at the level of the lateral alar base (a) and at the inferior border of the mandible (IBM) (b), using axial CTA slices .\u0026nbsp;\u003c/strong\u003eRepresentative examples are shown for a 20-year-old male, a 52-year-old male, and a 70-year-old male. Significant age-related differences were identified in: \u003cstrong\u003e(A)\u003c/strong\u003e distance from the FA to the nasolabial sulcus (NLS), \u003cstrong\u003e(B)\u0026nbsp;\u003c/strong\u003edepth of the FA at the NLS, \u003cstrong\u003e(C)\u003c/strong\u003e depth of the FA at the IBM.\u003c/p\u003e\n\u003cp\u003eRegarding the location of the FA relative to the NSL, it was found that in 86.1% of cases, the FA was located lateral to the sulcus, regardless of sex or age.\u003c/p\u003e\n\u003cp\u003eThe mean depth of the FA at the level of the lateral alar base was 5.43 mm (\u0026plusmn;2.95 mm), with significant differences observed between age groups, showing a decrease in depth in older subjects, although no significant correlation was identified. At the IBM, the FA had a mean depth of 10.50 mm (\u0026plusmn; 3.99 mm), and a significant inverse correlation with age was observed (r = \u0026minus;0.169, p = 0.016), indicating progressive superficialization with increasing age (table 4 and figure 6). When both levels were compared, the FA demonstrated a clear pattern of superficialization along its ascending course, transitioning from a deeper plane at the IBM to a more superficial plane at the lateral alar base (figure 7).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study described the morphology of the terminal branch of the FA according to the Furukawa classification [1]. In the study by Koziej et al., which evaluated 255 facial arteries using computed tomography in patients, the most prevalent FA type was Type III (lateral nasal or angular) in 40% of cases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. This finding aligns with the observations of Pilsl et al., who conducted CT scans in cadavers and reported Type III FA in 41.7% of cases \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Similarly, Lohn et al., through cadaveric dissections, found that Type III was the most prevalent type, present in 47.8% of cases \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. These findings are consistent with our results, where the most prevalent FA variant was Type III, found in 67.2% of patients.\u003c/p\u003e \u003cp\u003eIn contrast to these studies, the study by Furukawa et al., which employed CT scans in patients, identified Type II (inferior alar) as the most common FA type in 39.6% of cases. These findings highlight the diversity of FA anatomical variants according to ethnicity or geographic region \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhen analyzing the FA measurements, significant sex differences were observed, with males showing a larger FA diameter at the IBM. These differences may be explained by the greater incidence of intimal-medial thickening, calcification, and atherosclerotic plaque development in males during early and middle adulthood \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding FA measurements relative to bony anatomical landmarks, males had greater distances from the mandibular angle to the FA, from the oral commissure to the FA at the IBM, and from the masseteric border of the zygomatic bone to the FA. These findings can be attributed to morphological differences in bone structure between sexes. In males, the midface exhibits more pronounced angles, irregular surfaces, and less anterior projection. The mandible is larger, more angulated, and more squared, whereas in females, both the midface and the mandible are more subtle, rounded, and less prominent \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The prominence of the chin and the greater mouth opening in males create a configuration in which anatomical reference points such as the oral commissure are farther from other facial structures, such as the FA \u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith aging, various anatomical changes contribute to a reduction in the distance between the oral commissure and the FA. Thinning and weakening of the orbicularis muscle, combined with the loss of ligamentous support \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and decreased elasticity in facial retaining ligaments, lead to lip retraction, elongation of the philtrum, and downward displacement of soft tissues, including the oral commissure \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Additionally, facial fat atrophy and redistribution reduce volumetric support, accentuating sagging and bringing anatomical structures closer together \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe mean angle between the FA and the inferior border of the mandible in our population was 61.40\u0026deg; (\u0026plusmn;\u0026thinsp;29.98\u0026deg;). This result is higher than previously reported values. A study in a European population reported an average angle of 50\u0026deg; \u003csup\u003e2\u003c/sup\u003e, while in an Asian population, it was 45\u0026deg; \u003csup\u003e11\u003c/sup\u003e. These differences can be attributed to genetic diversity, variations in bone structure, and differences in soft tissue composition among populations.\u003c/p\u003e \u003cp\u003eCalva et al. highlighted that the Manson point is a reliable anatomical landmark for accurately locating the FA. In their study, the FA was located within an average radius of 2.95 mm from the Manson point in cadaveric specimens and living subjects using Doppler examination \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This finding aligns with our results, where the mean distance from the FA to the Manson point was 1.67 mm (\u0026plusmn;\u0026thinsp;1.94 mm). Additionally, Koziej et al. corroborated this observation, reporting a mean distance of 1.1 mm from the FA to the Manson point, with a 90th percentile value of 2.5 mm, indicating that the FA can be located with high probability within a 3 mm radius of the Manson point \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, 86.1% of the facial arteries were located lateral to the NLS at the level of the lateral nasal wing, with a mean distance of 7.37 mm (\u0026plusmn;\u0026thinsp;4.75 mm). This result is consistent with Gelezhe et al., who reported that in all cases investigated, the main arterial trunk was lateral to the NLS \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, this finding contrasts with Koziej et al., who found that the most frequent position of the FA relative to the NLS was medial in 65.5% of cases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study found that with increasing age, the distance between the FA and the NLS decreased. This finding is consistent with the literature, where the distance between the FA and the NLS significantly reduces with age due to ptosis of the fat compartments over the sulcus. Gelezhe et al. reported that at this level, the FA is located within the superficial fat compartment. With aging, the loss of volume in these fat compartments and the downward displacement of soft tissues result in a reduced distance between the FA and the NLS \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdditionally, we found that the depth of the FA at the NLS and the inferior border of the mandible decreased with age. This finding aligns with the literature. Gelezhe et al. demonstrated that with aging, the depth of the FA decreases due to fat tissue atrophy and loss of volumetric support. The reduction in subcutaneous fat with aging contributes to the FA becoming more superficial, increasing the risk of injury during aesthetic procedures in this area \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhen comparing the depths of the FA at the IBM and at the NLS, we observed that the FA becomes more superficial along its course. This finding aligns with literature reports from cadaveric dissections, which indicate that the FA is located in a deep supraperiosteal plane at the mandibular level and in a superficial plane within the superficial fat compartment at the NLS \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, males exhibited a greater diameter of the FA and increased distances from bony landmarks, including the mandibular angle and zygomatic bone. Along its course, the FA progressively becomes more superficial, positioning itself lateral to the NLS at the level of the lateral alar base. With increasing age, both the distance of the FA to the NLS and the oral commissure, as well as its depth at the IBM, decrease. Sex and age therefore represent key determinant of FA morphology, underscoring the importance of considering these variables to enhance safety and precision during facial clinical procedures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDISCLOSURES/CONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/em\u003e\u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.M.S.-R. and A.M.V.-P. contributed equally to this work. S.M.S.-R., A.M.V.-P., and R.E.E.-O. conceived and designed the study. M.C.-C. and A.M.-M. performed data acquisition and imaging processing. S.M.S.-R., A.M.V.-P., and E.R.T.-M. conducted data analysis and interpretation. S.M.S.-R. drafted the manuscript. A.M.V.-P., D.F.-V., and S.G.-L. contributed to manuscript writing and critical revision. Y.S.-A. provided expert anatomical input and contributed to the interpretation of results. R.E.E.-O. supervised the study and provided final approval of the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFurukawa M, Mathes DW, Anzai Y (2013) Evaluation of the facial artery on computed tomographic angiography using 64-slice multidetector computed tomography: implications for facial reconstruction in plastic surgery. 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Plast Reconstr Surg 143(2):417e\u0026ndash;426e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0000000000005201\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0000000000005201\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"facial anatomy, facial artery, fillers, cosmetic medicine","lastPublishedDoi":"10.21203/rs.3.rs-9238303/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9238303/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe facial artery's variability in course and depth makes it essential to understand its morphology, particularly by age and sex, for safe non-surgical aesthetic procedures.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study analyzes the three-dimensional anatomy of the facial artery in a Latin population using computed tomography angiography (CTA) to assess morphological variations according to age, sex, and anatomical landmarks.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional observational study was conducted at the Radiology and Imaging Department. CTA scans from 201 patients over 18 with clear visualization of the facial artery were analyzed. Using RadiAnt Dicom Viewer software, measurements included the artery\u0026rsquo;s diameter at the mandibular border, distance from the oral commissure and mandibular angle, and depth at specific anatomical points.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean patient age was 58, with equal sex distribution. Type 3 facial artery, extending to the lateral nasal branch, was observed in 67.2% of cases. Males had larger artery diameters and greater distances from the mandibular angle, masseteric border of the zygomatic bone and oral commissure. The facial artery becomes progressively more superficial along its ascending midfacial course. With increasing age, the depth of the facial artery at the inferior border of the mandible and its distances to the nasolabial sulcus and oral commissure decrease.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSignificant anatomical variations in the facial artery by sex and age highlight the need for individualized approaches in aesthetic procedures to enhance safety and effectiveness. This study adds critical data on Latin populations, which is lacking in existing literature, guiding practitioners toward safer, more tailored aesthetic practices.\u003c/p\u003e","manuscriptTitle":"Age- and Sex-Related Variability of the Facial Artery: A CTA-Based Morphometric Study Correlated with Facial Anatomical Landmarks","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-02 07:02:36","doi":"10.21203/rs.3.rs-9238303/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-25T12:06:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-20T20:17:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-04T11:21:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T08:44:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312031960507138088496349936689728102400","date":"2026-03-31T20:13:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174405306024421228516240364329866601780","date":"2026-03-30T06:49:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142831946608320732117293998131397414890","date":"2026-03-30T05:18:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-30T02:00:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287297082586985721232702275764006641873","date":"2026-03-30T00:15:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-29T20:11:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T12:41:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T06:50:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Radiologic Anatomy","date":"2026-03-26T22:22:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fe1d6546-6975-49ac-9032-58690185a73f","owner":[],"postedDate":"April 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-25T12:09:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-02 07:02:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9238303","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9238303","identity":"rs-9238303","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}