Ultrasound's Role in Managing Vascular Issues from Cosmetic Fillers
A recent study highlights the potential of Doppler high-frequency ultrasound (HFUS) in detecting and managing vascular adverse events (VAEs) associated with cosmetic fillers. Researchers found that among 100 participants, the most common VAEs were absent flow in perforator vessels (42%) and major vessels (35%).
The study, conducted by Rosa Maria Silveira Sigrist, MD, from the University of São Paulo, revealed a high degree of variability in findings, emphasizing the need for comprehensive Doppler pattern recognition for accurate diagnosis and treatment. Compensatory flow in adjacent or branching vessels (26%), string sign (18%), and increased peak systolic velocity (16%) were also noted.
Correlations were established between Doppler abnormalities and absent flow in the lateral nasal artery and columellar artery, both critical areas prone to necrosis and visual complications. Sigrist noted a concerning trend in the growing use of cosmetic fillers, leading to an increase in vascular complications, including necrosis, blindness, and stroke.
Interestingly, the study found no significant differences in Doppler findings between participants who received hyaluronidase (an enzyme that breaks down hyaluronic acid, a common filler material) before ultrasound imaging and those who did not. This suggests that hyaluronidase may not be a critical factor in managing VAEs.
The research involved a diverse group of medical professionals, including radiologists, an aesthetic medical doctor, and a plastic surgeon, who collectively analyzed VAEs from May 2022 to April 2025. The participants, with an average age of 38 and an 88% female representation, completed structured questionnaires on Doppler usage.
Sigrist highlighted a critical issue: the lack of standardized facial Doppler protocols, leading to heterogeneity in examination methods. Only half of the examiners utilized microvascular Doppler technologies, and there was no consensus on peak systolic velocity criteria for facial vascular occlusions.
When asked about the advantages of Doppler HFUS over MRI or CT imaging for filler-related VAEs, Sigrist attributed it to factors like the absence of contrast requirements, the accessibility of ultrasound imaging, and the availability of microvascular technologies, enabling real-time examination of patients.
