Ultrasound Imaging of High-Risk Facial Areas for Injectables: A Practical Guide for Common Scenarios.

backgroundDermal filler procedures have become increasingly popular in aesthetic medicine; however, they carry the risk of vascular adverse events (VAEs) that can lead to complications such as tissue necrosis and vision loss.

objectivesThe purpose of this study is to evaluate the clinical utility of high-resolution ultrasound with Doppler analysis (HRUD) in enhancing safety during facial injectable procedures, particularly in high-risk anatomical zones.

methodsA review of common clinical scenarios was conducted to outline when and how HRUD can assist in identifying vascular structures, anatomical variants, and vascular changes post-surgery. These scenarios include creating full or focal vascular maps and pre-injection assessment in postsurgical patients. The HRUD procedure was conducted at a reference center for aesthetic ultrasonography.

resultsHRUD provides real-time visualization of vascular anatomy and its variations, reducing the risk of complications from filler injections. Its use is particularly recommended in high-risk areas such as the forehead, glabella, nose, and pyriform fossa. For postsurgical patients, HRUD aids in navigating altered anatomy, thereby minimizing the risk of VAEs. Conducting a targeted ultrasound evaluation before filler injection can lead to greater precision and fewer complications.

conclusionsHRUD is a valuable adjunct to standard aesthetic practices, significantly enhancing patient safety and improving outcomes. Its integration into pre-injection filler protocols is strongly recommended, especially in complex cases or high-risk facial regions. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .