Venous Tributaries of the Lip: Implications for Lip Filler Injection

Amanda K. Moorefield, Kansas City University
Zak Rose-Reneau, Kansas City University
Barth Wright, Kansas City University
Christopher C. Surek, Kansas City University



Demand for lip filler injection continues to increase. Despite the current literature’s acknowledgement of the role both venous and arterial vasculature play in minor and major side effects, research addressing the venous vasculature of the lower one-third of the face is scarce. The purpose of our study was to create a venous map demonstrating areas of venous pooling that one should avoid when injecting, thus improving the safety and overall aesthetic appearance of the lips postaugmentation.


A photographic analysis of the venous vasculature of 26 participants was performed using a vein transilluminator to display the venous flow around the perioral region. The data were analyzed for commonalities among participants and then compared with common lip filler injection techniques and locations.


Venous tributaries were identified in all patients, with a slight variation in pattern, superior to the upper vermillion border between the nasolabial fold and philtral column on each side of the mouth. Venous tributaries were noted about 1.0–1.5 cm lateral to the oral commissures extending inferiorly to the chin and along the labiomental crease. Four areas of venous pooling were deemed significant: a small area ~2 mm superior to cupid’s bow, an area along the middle tubercle of the upper lip, an area along the wet-dry line of the lower lip, and an area centrally along the vermillion border between the lower lip tubercles.


Perioral venous mapping provides a guide for injectors performing facial and lip enhancement procedures in identifying areas at risk for injury due to venous pooling. Avoiding these anatomically vulnerable regions can minimize the potential for inflammation and tissue necrosis associated with intravenous injection and prevent dissatisfactory aesthetic results such as lumps, excessive bruising, swelling, or asymmetry.