Facial Anatomy & Injection Safety Atlas

Published:

October 27, 2025

Purpose: Provide a defensible, anatomy-led reference for clinicians performing cosmetic injectables, aligned with Australian regulatory and clinical governance frameworks and international safety guidance. It integrates AHPRA cosmetic procedure guidance, NSQHS Standards (Clinical Governance, Medication Safety, Recognising Deterioration), and ACE Group World algorithms for complication management. ¹ ² ³

1. Vascular & Neural Overview

The facial arterial network comprises branches of the external carotid (facial, maxillary, superficial temporal) and internal carotid (ophthalmic, supraorbital, supratrochlear) systems, with venous drainage communicating with the cavernous sinus—creating a pathway for severe sequelae if fillers enter vessels. Motor (facial nerve) and sensory (trigeminal) branches overlay this network; appreciating depth changes from origin to terminal branches reduces risk. ² ⁴ ⁵

2. Superficial & Deep Fat Compartments

Discrete fat pads separated by retaining ligaments drive facial contour and ageing vectors. Restoring volume in the correct compartment (e.g., DMCF, SOOF) avoids distortion. Deep compartments provide projection; superficial compartments affect texture and ptosis. ² ⁶ ⁸

3. Muscular Planes & Functional Vectors

Balancing elevators and depressors through the SMAS plane maintains natural animation. Vector-aware planning limits unnatural outcomes and preserves function. ¹ ⁷ ⁸

4. Facial Danger Zones

High-risk territories (glabella, nose, temple, periocular, nasolabial, lips) require micro-aliquots, preference for cannulas, slow flow, and constant perfusion checks. Variation is common; always adapt to patient-specific anatomy. ² ⁵ ⁸

5. Layer-by-Layer Injection Planning

Plan by target layer: superficial for fine lines, deep fat for contour, periosteal for projection. Crossing planes increases risk; proceed with tactile feedback and low pressure. ² ⁵ ⁸

6. Ultrasound-Guided Injection

High-frequency ultrasound mapping (≥15 MHz) supports arterial identification, cannula tracking, and complication diagnosis in real time, especially for temple, nose, and periocular zones. ⁸ ⁸

7. Escalation & Emergency Integration

For suspected vascular occlusion: stop injection, massage, warm, administer high-dose hyaluronidase as per local protocol, and monitor capillary refill. Visual symptoms demand urgent ophthalmology referral; anaphylaxis requires IM adrenaline per ARC guidance; serious device/medicine issues are reportable to the TGA. ³ ⁹ ¹⁰

8. Documentation & Continuous Education

Record planes, volumes, product batch/lot numbers with photographs of labels; trend outcomes; run peer review and simulation drills; and align CPD to incident learnings. ¹ ² ⁹ ¹⁰

Sources

AHPRA (2025), Guidelines for practitioners who perform cosmetic medical and surgical procedures.., viewed 27 October 2025, https://www.medicalboard.gov.au/ ↩
ACSQHC (2024), National Safety and Quality Health Service (NSQHS) Standards.., viewed 27 October 2025, https://www.safetyandquality.gov.au/ ↩
ACE Group World (2023), Complications management & vascular occlusion algorithm.., viewed 27 October 2025, https://uk.acegroup.online/ ↩
Carruthers J, Carruthers A. Botulinum toxin in aesthetic medicine. Dermatol Surg., Carruthers J, Carruthers A. Botulinum toxin in aesthetic medicine. Dermatol Surg.., viewed 27 October 2025, https://pubmed.ncbi.nlm.nih.gov/ ↩
Beleznay K et al, Blindness following filler injection. Plast Reconstr Surg (2015).., viewed 27 October 2025, https://pubmed.ncbi.nlm.nih.gov/ ↩
Cotofana S et al. Ultrasound-guided filler injections. Aesthetic Surg J., Cotofana S et al. Ultrasound-guided filler injections. Aesthetic Surg J.., viewed 27 October 2025, https://academic.oup.com/asj ↩
Kwon H et al. Midface injection safety & infraorbital artery mapping. J Cosmet Dermatol., Kwon H et al. Midface injection safety & infraorbital artery mapping. J Cosmet Dermatol.., viewed 27 October 2025, https://onlinelibrary.wiley.com/journal/14732165 ↩
Lambros V. Facial aging and injection vectors. Aesthetic Surg J., Lambros V. Facial aging and injection vectors. Aesthetic Surg J.., viewed 27 October 2025, https://academic.oup.com/asj ↩
TGA (2024), Adverse event reporting & Advertising Code.., viewed 27 October 2025, https://www.tga.gov.au/ ↩
Australian Resuscitation Council (2024), Anaphylaxis & BLS guidelines.., viewed 27 October 2025, https://resus.org.au/ ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.