Face Perforators: An Anatomical Study.

Background: Successful facial reconstruction requires detailed knowledge of vascular anatomy to ensure flap viability. Although the major arterial supply of the face is well established, the regional distribution and clinical relevance of facial skin perforators remain incompletely defined.

Purpose: To define the regional distribution and diameter of facial perforators using cadaveric dissection and to demonstrate their clinical relevance for perforator-based facial reconstruction.

Methods: Ten hemifacial specimens from 5 adult cadavers (mean age: 43 y) were examined. Following cannulation of the common carotid artery, colored latex was injected under physiological pressure. Facial skin flaps were elevated deep to the subdermal plexus under microscopic magnification. Perforators ≥0.10 mm were documented and measured. The face was divided into 10 anatomic regions. Two clinical cases were included for correlation.

Results: Among all regions, the highest perforator densities were observed in the preauricular (14.53%) and buccal (12.32%) regions. Mean perforator diameters showed marked regional variation, being greatest in the buccal region and smallest in the eyelid region. Consistent dominant perforators were identified in the submental and zygomatico-orbital regions, whereas the remaining facial surface was supplied by numerous small-caliber perforators forming a dense subdermal network. Clinical cases demonstrated successful reconstruction using preauricular and buccal perforator flaps.

Conclusion: Facial skin perfusion is governed by a dual vascular mechanism consisting of consistent axial perforators in specific regions and a diffuse, redundant microperforator network across the remaining facial surface. Recognition of this complementary vascular architecture expands the indications for perforator-based local flaps and provides practical anatomic guidance for safe, flexible, and tissue-preserving facial reconstruction.