The utility of ultrasound imaging in acute and chronic complications of injectable facial fillers
Over the last years, injectable facial fillers have been growing in the popularity of elective aesthetic procedures. In most cases, this procedure, when used with stringent patient selection criteria, appropriate filler selection and injection technique can lead to successful cosmetic outcomes. Since complications happen no matter how skilled or experienced physicians are, the knowledge of possible pitfalls is essential for the identification and proper diagnosis. Ultrasound imaging offers the highest spatial resolution in detection of superficially located lesions. We present cases of mild and severe complications that can occur after filler injection. Some adverse events occur immediately after filler injection and should be managed instantly. To identify a possible cause of filler-related complications, Doppler ultrasonography can be used to estimate the blood flow through blood vessels. However, the ultrasonography allows an appropriate dermatologic evaluation which includes identification of skin changes such as necrosis. The diagnosis and management of chronic complications remain difficult because the diagnostic procedure may be performed by various healthcare professionals. Clinically suspicious palpable masses might be evaluated at ultrasonography as properly injected filler, granuloma or tissue fibrosis. Ultrasonography can be considered as a useful tool not only for the diagnosis, but also as a support of treatment of early and late complications. Under ultrasound guidance, hyaluronidase or steroid can be precisely injected and fine needle aspiration can be placed exactly into the filler deposit. In this article, the case reports were described with the aim of providing important information about the usage of ultrasound imaging in diagnosis and treatment of complications after facial fillers.