Facial-Ophthalmic Artery Connections and Facial Artery Variability: A CT Angiography-Based Anatomical Study.

PURPOSE: To characterize the terminal branching patterns, dominance, and ophthalmic connections of the facial artery (FA) using bilateral CT angiography in a large adult population, with particular relevance to aesthetic and minimally invasive facial procedures. METHODS: This retrospective study evaluated contrast-enhanced craniofacial CT angiography scans from 385 adults (770 hemifaces). Six major FA branches were assessed bilaterally, including inferior and superior labial, alar, nasal, angular, and forehead arteries. Terminal branching patterns, dominance, ophthalmic-origin angular arteries, and FA-OA anastomoses were analyzed for demographic associations using Chi-square tests. Bilateral symmetry was recorded descriptively based on anatomical configurations. RESULTS: Marked inter-individual variability was observed in facial artery branching, with 70 distinct bilateral pattern combinations identified. The facial artery most commonly terminated as the nasal (35.5%) or alar artery (27.7%). Ophthalmic-origin angular arteries were identified in 19.5% of individuals, and FA-OA anastomoses in 8.3%. Facial artery dominance was significantly associated with increased ipsilateral branch presence and a higher frequency of ophthalmic-origin angular arteries (p < 0.01), while age and sex showed no significant associations with the primary branching outcomes. CONCLUSION: Facial artery branching demonstrates marked inter-individual variability and a substantial prevalence of facial-ophthalmic arterial connections. Knowledge of this vascular anatomy may provide supportive information in addition to standard procedural safety precautions, particularly in interventions involving the nasal dorsum and medial canthus, where vision-threatening ischemic complications are a recognized concern. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .