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Article by Dr. Paula Pifarré
It is clear that its use for the prevention of complications can be an interesting tool, but there is no consensus among professionals in the sector as to whether or not its use is essential for good clinical practice.
If we impose scientific criteria on market trends or fashions, there are a number of articles that we would like to discuss to clarify doubts and myths related to this new trend.
The images that can be acquired using ultrasound or ultrasound scans have been, and are, fundamental in the development of a good diagnosis in Aesthetic Medicine, providing complementary and extremely important information for clinical practice (Cral W., 2021; Grippaudo et al, 2010; 2011). These images are very useful when “visualizing” anatomical variations, vascular polymorphisms or the presence of previous fillers, permanent or not, applied in the area where we are going to perform a treatment. At the same time, the use of images has begun to be used as a guide for the application of facial procedures, especially hyaluronic acid dermal fillers.
Among its main advantages are
In aesthetic procedures it must be kept in mind that there are facial areas of greater complexity where the aesthetic physician must be extremely careful to avoid complications due to their vascular complexity, which leads to a greater risk of adverse effects and complications that can evolve to necrosis of the treated area. It is in these areas where ultrasound can be of great help to the injector, allowing to evaluate the subcutaneous tissue and adjacent vessels, making it possible to establish safe zones, avoiding adverse consequences such as ischemic or necrotic processes of the epithelial tissue (Wortsman X., 2015).
The correct localization of muscular and vascular structures allows adding precision, safety and success to esthetic procedures. However, a good knowledge of facial anatomy is always required, and this knowledge cannot be replaced by the use of ultrasound.
Image of the course of Anatomy Applied to Aesthetic Medicine (CAAME), course held at the dissection room of the Autonomous University of Barcelona (UAB), where the students practice on fresh cadaveric specimens.
Ultrasound is also a useful tool for the correct identification and characterization of complications that may occur post intervention, such as the presence of edema, inflammation or allergic processes triggered by the application of facial fillers (Wortsman X., 2015). In this sense, if a patient needs a hyaluronidase treatment for example, after an aesthetic procedure with hyaluronic acid, the identification of the exact injection point can be beneficial for the resolution of the problem in a faster and more efficient way (Quezada-Gaón, N., & Wortsman, X., 2016; Habib et al., 2020).
Currently, a movement has emerged within aesthetic medicine that advocates the simultaneous use of ultrasound and injection of facial fillers (Desyatnikova, 2022). These procedures are known as echo-guided protocols. These require the professional to use a portable ultrasound device that allows a correct manipulation or the assistance of an assistant during the injection procedure. Although it offers the advantage of being able to visualize the area in real time, allowing to establish the application plane, it has the disadvantage of requiring great dexterity on the part of the injector, in addition to adding greater discomfort and duration of the procedure for the patient during the application. In addition, it requires a great deal of knowledge on the part of the manipulator to be able to interpret the images at the same time as he is injecting.
In order to incorporate it into an aesthetic medicine practice, it must be evaluated:
Beyond the characteristics and physical properties of the equipment, the contamination of the working area that may occur in the procedures must be taken into account. When using the echo-guided protocols, special care must be taken not to generate contamination of the working area or produce any type of allergy or skin reaction due to the application of the gels necessary for the correct acquisition of the ultrasonic images. If the handler is not sufficiently experienced, the manipulation of the equipment at the same time as the application can generate more problems than real advantages.
Discover the practical course on Dermo-aesthetic ultrasound and Doppler analysis..
In conclusion, ultrasound can never replace anatomical knowledge and the supervised practice of a professional. Its use as diagnostic or to detect previous treatments and correctly diagnose a complication is well accepted and established among Aesthetic Medicine professionals, as well as its use to compare efficiency of hyaluronic acid filler treatments as a standardized means (Nikolis A et al, 2020; Grippaudo et al, 2011). However, there is no unified criterion to recommend its use simultaneously with the application of dermal fillers in echo-guided procedures (Schelke et al, 2020).
Bibliographic references:
1-Cral W. G. (2022). Ultrasonography and Facial Aesthetics. Aesthetic plastic surgery, 46(2), 999–1000.
Grippaudo, F. R., & Mattei, M. (2010). High-frequency sonography of temporary and permanent dermal fillers. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI), 16(3), 265–269.
2-Grippaudo, F. R., & Mattei, M. (2011). The utility of high-frequency ultrasound in dermal filler evaluation. Annals of plastic surgery, 67(5), 469–473.
3-Wortsman X. (2015). Identification and Complications of Cosmetic Fillers: Sonography First. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 34(7), 1163–1172.
4-Quezada-Gaón, N., & Wortsman, X. (2016). Ultrasound-guided hyaluronidase injection in cosmetic complications. Journal of the European Academy of Dermatology and Venereology : JEADV, 30(10), e39–e40.
5-Desyatnikova S. (2022). Ultrasound-Guided Temple Filler Injection. Facial plastic surgery & aesthetic medicine, 24(6), 501–503.
6-Nikolis, A., Enright, K. M., Öhrlund, Å., Winlöf, P., & Cotofana, S. (2021). A randomized, split-face, double-blind, comparative study of the safety and efficacy of small- and large-particle hyaluronic acid fillers for the treatment of nasolabial folds. Journal of cosmetic dermatology, 20(5), 1450–1458.
7-Schelke, L. W., Cassuto, D., Velthuis, P., & Wortsman, X. (2020). Nomenclature proposal for the sonographic description and reporting of soft tissue fillers. Journal of cosmetic dermatology, 19(2), 282–288.
8-Habib, S. M., Schelke, L. W., & Velthuis, P. J. (2020). Management of dermal filler (vascular) complications using duplex ultrasound. Dermatologic therapy, 33(4), e13461.
