Bold claim: Ultrasound could revolutionize safety in cosmetic fillers by pinpointing vascular complications before they escalate. And this is where the conversation gets interesting: a color Doppler ultrasound approach may help radiologists detect blood-flow problems caused by hyaluronic acid fillers, potentially enabling safer, landmarked injections.
A study presented at the RSNA 2025 meeting in Chicago, led by Dr. Rosa Maria Silveira Sigrist from the University of São Paulo, explored how ultrasound can reveal occlusions in facial vessels. The researchers found that ultrasound can identify the absence of blood flow in perforator vessels and in major facial arteries among patients receiving hyaluronic acid fillers.
The central message is practical: without ultrasound guidance, injections are often guided by external clinical signs and performed somewhat blindly. With real-time ultrasound visualization, practitioners could target the exact site of occlusion rather than guessing, which could improve safety and outcomes.
Context and findings: Cosmetic filler procedures are increasingly popular in the United States, but they carry risks, including vascular occlusion from misplaced filler material. The multicenter study spanned four radiology centers, one dermatology center, and one plastic surgery center, gathering data from 2022 to 2025. It involved 100 patients who underwent color Doppler ultrasound. Among them, 98 had hyaluronic acid fillers, and 79 had hyaluronidase administered before imaging.
Key ultrasound findings included:
- Perforator vessel involvement in 42% of cases
- Absent flow in major facial vessels in 35%
- Compensatory flow in 26%
- String sign in 18%
- Increased peak systolic velocity in 16%
The study did not find a statistically significant link between hyaluronidase use and specific Doppler findings (p > 0.05). A moderate correlation emerged between absent perforator flow and compensatory flow (Φ = 0.37, p = 0.0004), and lateral nasal artery involvement was significantly associated with absent flow in major vessels (p = 0.0004).
Clinical implications: According to Sigrist, color Doppler ultrasound could guide injections to reduce hyaluronidase use and improve outcomes. Ultrasound also holds promise as a precision tool for planning filler doses themselves, potentially minimizing complications by ensuring more accurate deposition.
In short, real-time ultrasound guidance may transform how fillers are injected by enabling targeted treatment of occlusions and more precise filler administration, with the potential to enhance safety and patient results.
