ORIGINAL COMMUNICATION Venous Architecture of the Glabellar to the Forehead Region YUSUKE SHIMIZU, 1 * NOBUAKI IMANISHI, 2 TATSUO NAKAJIMA, 1 HIDEO NAKAJIMA, 1 SADAKAZU AISO, 2 AND KAZUO KISHI 1 1 Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan 2 Department of Anatomy, Keio University School of Medicine, Tokyo, Japan The precise venous anatomy of the glabellar to the forehead region remains unknown. This study aimed to detail the venous architecture of the glabellar region to the forehead in conjunction with that of the supratrochlear artery to reduce the risk of venous congestion of flaps in this area. Fifteen fresh human cadavers were examined here. In five specimens, contrast medium was injected only into the venous system; in 10 specimens, two different types of contrast media were injected into the arterial and venous systems, respec- tively. A total of 30 hemifacial specimens were radiographed stereoscopically and observed microscopically. In all the cadavers, a distinct vein (termed as the ‘‘transverse nasal root vein’’) connected the bilateral angular veins. One or two large ascending veins branched from the transverse nasal root or angular vein, coursing toward the forehead skin. Numerous small veins branched out from the large ascending vein(s), forming a subdermal polygonal venous net- work. Small ascending veins arose from this network and coursed toward the dermis, draining venous flow from the dermis. Three different-sized valves prevented the reflux of blood in the venous pathway. The large ascending vein(s) and supratrochlear artery ran parallel only in the medial canthal area. Tiny venous vasa vasorum surrounded the adventitia of the supratrochlear ar- tery and anastomosed with the polygonal venous network, while a few small veins from the vasa vasorum ascended toward the dermis. Understanding the venous architecture of this region is expected to facilitate the safe elevation of V V C 2012 Wiley Periodicals, Inc. Key words: vein; transverse nasal root vein; supratrochlear artery; valve; vasa vasorum INTRODUCTION The arterial anatomy of the glabellar to the fore- head region is well described in the literature (Shum- rick and Smith, 1992; Whetzel and Mathes, 1992; Blandini et al., 1996; Wild and Hybarger, 2001; Kelly et al., 2008); however, only a few reports have dis- cussed the venous anatomy of this region (Taylor et al., 1990; Houseman et al., 2000; Kleintjes, 2007). The region between the glabella and the forehead is a clinically important site as it is used for raising several types of glabellar and forehead flaps, which are commonly used in mid-facial reconstruction. In these surgeries, if kinking of the skin paddle can be avoided by using an appropriate flap design, almost no arterial complications develop because of the abundant blood supply from the facial subdermal *Correspondence to: Yusuke Shimizu, Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: yyssprs@gmail.com Received 17 April 2012; Revised 29 June 2012; Accepted 5 July 2012 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/ca.22143 V V C 2012 Wiley Periodicals, Inc. Clinical Anatomy 00:000–000 (2012) various flaps in the area. Clin. Anat. 00:000–000, 2012.