#United States #Chicago #Hyaluronic Acid #Ultrasound Technology #Vascular Occlusion

Understanding the Role of Ultrasound in Cosmetic Filler Complications

In recent years, cosmetic filler treatments have surged in popularity, especially those utilizing hyaluronic acid. This injectable substance is designed to enhance facial aesthetics by creating volume and smoothing out wrinkles. However, as with many cosmetic procedures, complications can arise. A recent study presented at the annual Radiological Society of North America (RSNA) meeting underscores the importance of ultrasound technology in diagnosing and treating vascular complications caused by these filler injections.

The Rising Popularity of Cosmetic Fillers

According to the American Society of Plastic Surgeons, over 5.3 million hyaluronic acid filler treatments were performed in the U.S. in 2024. While these procedures can yield impressive results, they are not without risks. The most severe complication linked to such injections is vascular occlusion, which refers to the blockage of blood flow in the arteries caused by improperly positioned filler material.

Dr. Rosa Maria Silveira Sigrist and her team from the University of São Paulo conducted an extensive study on this issue, gathering information from four radiology centers, a dermatology center, and a plastic surgery practice between May 2022 and April 2025. They assessed the vascular ultrasound outcomes in 100 patients who experienced complications from filler treatments.

Understanding Vascular Occlusion

The study revealed that one of the most common findings was the absence of blood flow to perforating vessels in 42% of the cases. Additionally, 35% of the patients exhibited no flow in major blood vessels, particularly those associated with the lateral nasal artery. This area, notably around the nose, poses a higher risk since the facial vessels network extensively. Damage to these vessels can lead to serious outcomes, including blindness or strokes. As pointed out by Dr. Sigrist, “Vascular occlusion events in the face can be devastating, because if they are not properly treated, they can lead to necrosis and even facial deformation.”

The Role of Ultrasound in Treatment

To address these complications, clinicians can employ hyaluronidase, an enzyme that breaks down hyaluronic acid. However, the process poses challenges, especially if injectors rely solely on clinical findings without ultrasound guidance. As highlighted by Dr. Sigrist, “If injectors are not guided by ultrasound, they treat based on where the clinical findings are and inject blindly.” In contrast, ultrasound assists in accurately locating the occlusion, enabling targeted injections that minimize the amount of hyaluronidase used and enhance treatment effectiveness.

Enhancing Injection Techniques with Ultrasound

Moreover, ultrasound technology significantly increases precision during the initial filler injections, which not only conserves material but also reduces the potential for complications. While ultrasound mapping is well-established for larger vessels such as carotid arteries, the intricate and variable blood supply in the face presents unique challenges. To aid radiologists in navigating this complexity, Dr. Sigrist’s research establishes a framework for recognizing specific patterns associated with filler-related complications.

This standardized approach aims to empower radiologists to make informed decisions swiftly, thereby preventing severe damage from occurring.

Conclusion

The integration of ultrasound technology into the field of cosmetic procedures represents a significant advancement. By ensuring that injectors have the necessary tools to visualize and understand vascular complexities, the risk of complications can be significantly reduced. Continued research and education in this domain are critical for enhancing patient outcomes and advocating for safety in cosmetic practices.