Skip to main content

Doppler Ultrasound-Guided Hyaluronic Acid Filler Injection Techniques

  • Chapter
  • First Online:
Minimally Invasive Aesthetic Surgery Techniques

Abstract

HA filler could have tragic complications such as skin necrosis and ocular complications. To prevent these tragic vascular complications, it is essential to know the vascular anatomy. Doppler ultrasound is a well-known device used in detecting arteries of the face. In this chapter, we shall discuss about Doppler ultrasound-guided HA filler injection techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cotofana S, Mian A, Sykes JM, Redka-Swoboda W, Ladinger A, Pavicic T, Schenck TL, Benslimane F, Ingallina F, Schlattau A. An update on the anatomy of the forehead compartments. Plast Reconstr Surg. 2017;139(4):864e–72e. https://doi.org/10.1097/PRS.0000000000003174.

    Article  CAS  Google Scholar 

  2. Cong LY, Phothong W, Lee SH, Wanitphakdeedecha R, Koh I, Tansatit T, Kim HJ. Topographic analysis of the supratrochlear artery and the supraorbital artery: implication for improving the safety of forehead augmentation. Plast Reconstr Surg. 2017;139(3):620e–7e. https://doi.org/10.1097/PRS.0000000000003060.

    Article  CAS  Google Scholar 

  3. Tansatit T, Phumyoo T, Jitaree B, Sawatwong W, Rungsawang C, Jiirasutat N, Sahraoui YME, Lee JH. Ultrasound evaluation of arterial anastomosis of the forehead. J Cosmet Dermatol. 2018;17(6):1031–6. https://doi.org/10.1111/jocd.12755.

    Article  Google Scholar 

  4. van Loghem JAJ, Humzah D, Kerscher M. Cannula versus sharp needle for placement of soft tissue fillers: an observational cadaver study. Aesthet Surg J. 2017;38(1):73–88. https://doi.org/10.1093/asj/sjw220.

    Article  Google Scholar 

  5. Pavicic T, Yankova M, Schenck TL, Frank K, Freytag DL, Sykes J, Green JB, Hamade H, Casabona G, Cotofana S. Subperiosteal injections during facial soft tissue filler injections-is it possible? J Cosmet Dermatol. 2020;19(3):590–5. https://doi.org/10.1111/jocd.13073.

    Article  Google Scholar 

  6. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27. https://doi.org/10.1097/01.prs.0000265403.66886.54.

    Article  CAS  Google Scholar 

  7. Pavicic T, Webb KL, Frank K, Gotkin RH, Tamura B, Cotofana S. Arterial Wall penetration forces in needles versus cannulas. Plast Reconstr Surg. 2019;143(3):504e–12e. https://doi.org/10.1097/PRS.0000000000005321.

    Article  CAS  Google Scholar 

  8. Lee W. Prevention of hyaluronic acid filler-induced blindness. Dermatol Ther. 2020;33(4):e13657. https://doi.org/10.1111/dth.13657.

    Article  CAS  Google Scholar 

  9. Kim J. Novel forehead augmentation strategy: forehead depression categorization and calcium-hydroxyapatite filler delivery after tumescent injection. Plast Reconstr Surg Glob Open. 2018;6(9):e1858. https://doi.org/10.1097/GOX.0000000000001858.

    Article  Google Scholar 

  10. Tansatit T, Apinuntrum P, Phetudom T. A dark side of the cannula injections: how arterial wall perforations and emboli occur. Aesthet Plast Surg. 2017;41(1):221–7. https://doi.org/10.1007/s00266-016-0725-7.

    Article  Google Scholar 

  11. Davidge KM, van Furth WR, Agur A, Cusimano M. Naming the soft tissue layers of the temporoparietal region: unifying anatomic terminology across surgical disciplines. Neurosurgery. 2010;67(3 Suppl Operative):120–9.

    Google Scholar 

  12. Breithaupt AD, Jones DH, Braz A, Narins R, Weinkle S. Anatomical basis for safe and effective volumization of the temple. Dermatol Surg. 2015;41(Suppl 1):S278–83. https://doi.org/10.1097/DSS.0000000000000539.

    Article  Google Scholar 

  13. Philipp-Dormston WG, Bieler L, Hessenberger M, Schenck TL, Frank K, Fierlbeck J, et al. Intracranial penetration during temporal soft tissue filler injection-is it possible? Dermatol Surg. 2018;44(1):84–91.

    Article  CAS  Google Scholar 

  14. Carruthers J, Humphrey S, Beleznay K, Carruthers A. Suggested injection zone for soft tissue fillers in the Temple? Dermatol Surg. 2017;43(5):756–7.

    Article  CAS  Google Scholar 

  15. Lee JM, Kim YJ. Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg. 2015;42(2):232–9.

    Article  Google Scholar 

  16. Lee J-G, Yang H-M, Hu K-S, et al. Frontal branch of the superficial temporal artery: anatomical study and clinical implications regarding injectable treatments. Surg Radiol Anat. 2015;37(1):61–8.

    Article  Google Scholar 

  17. Sykes JM, Cotofana S, Trevidic P, Solish N, Carruthers J, Carruthers A, et al. Upper face: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):204s–18s.

    Article  CAS  Google Scholar 

  18. Trinei FA, Januszkiewicz J, Nahai F. The sentinel vein: an important reference point for surgery in the temporal region. Plast Reconstr Surg. 1998;101(1):27–32. https://doi.org/10.1097/00006534-199801000-00006.

    Article  CAS  Google Scholar 

  19. Jung W, Youn KH, Won SY, Park JT, Hu KS, Kim HJ. Clinical implications of the middle temporal vein with regard to temporal fossa augmentation. Dermatol Surg. 2014;40(6):618–23.

    CAS  Google Scholar 

  20. Scheuer JF 3rd, Sieber DA, Pezeshk RA, Gassman AA, Campbell CF, Rohrich RJ. Facial danger zones: techniques to maximize safety during soft-tissue filler injections. Plast Reconstr Surg. 2017;139(5):1103–8. https://doi.org/10.1097/PRS.0000000000003309.

    Article  CAS  Google Scholar 

  21. Lee W, Kim JS, Oh W, Koh IS, Yang EJ. Nasal dorsum augmentation using soft tissue filler injection. J Cosmet Dermatol. 2019. https://doi.org/10.1111/jocd.13018. Epub ahead of print. PMID: 31157508.

  22. Moon HJ. Injection rhinoplasty using filler. Facial Plast Surg Clin North Am. 2018;26(3):323–30. https://doi.org/10.1016/j.fsc.2018.03.006.

    Article  Google Scholar 

  23. Choi DY, Bae JH, Youn KH, Kim W, Suwanchinda A, Tanvaa T, Kim HJ. Topography of the dorsal nasal artery and its clinical implications for augmentation of the dorsum of the nose. J Cosmet Dermatol. 2018;17(4):637–42. https://doi.org/10.1111/jocd.12720.

    Article  Google Scholar 

  24. Beleznay K, Carruthers JD, Humphrey S, Jones D. Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg. 2015;41(10):1097–117. https://doi.org/10.1097/DSS.0000000000000486.

    Article  CAS  Google Scholar 

  25. Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthet Surg J. 2019;39(6):662–74. https://doi.org/10.1093/asj/sjz053.

    Article  Google Scholar 

  26. Harb A, Brewster CT. The nonsurgical rhinoplasty: a retrospective review of 5000 treatments. Plast Reconstr Surg. 2020;145(3):661–7. https://doi.org/10.1097/PRS.0000000000006554.

    Article  CAS  Google Scholar 

  27. Moon HJ, Lee W, Do Kim H, Lee IH, Kim SW. Doppler Ultrasonographic anatomy of the midline nasal dorsum. Aesthet Plast Surg. 2021;45(3):1178–83. https://doi.org/10.1007/s00266-020-02025-1.

    Article  Google Scholar 

  28. Lee Y, Oh SM, Lee W, Yang EJ. Comparison of hyaluronic acid filler ejection pressure with injection force for safe filler injection. J Cosmet Dermatol. 2021;20(5):1551–6. https://doi.org/10.1111/jocd.14064.

    Article  Google Scholar 

  29. Lee W, Oh W, Moon HJ, Koh IS, Yang EJ. Soft tissue filler properties can be altered by a small-diameter needle. Dermatol Surg. 2020;46(9):1155–62. https://doi.org/10.1097/DSS.0000000000002220.

    Article  CAS  Google Scholar 

  30. Lee JH, Hong G. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler. Arch Plast Surg. 2018;45:214–21.

    Article  Google Scholar 

  31. Wong CH, Mendelson B. Facial soft-tissue spaces and retaining ligaments of the midcheek: defining the premaxillary space. Plast Reconstr Surg. 2013;132(1):49–56. https://doi.org/10.1097/PRS.0b013e3182910a57.

    Article  CAS  Google Scholar 

  32. Kpodzo DS, Nahai F, McCord CD. Malar mounds and festoons: review of current management. Aesthet Surg J. 2014;34(2):235–48. https://doi.org/10.1177/1090820X13517897.

    Article  Google Scholar 

  33. Lee W, Cho JK, Koh IS, Kim HM, Yang EJ. Infraorbital groove correction by microfat injection after lower blepharoplasty. J Plast Reconstr Aesthet Surg. 2020;73(4):777–82. https://doi.org/10.1016/j.bjps.2019.11.016.

    Article  Google Scholar 

  34. Kim YS, Choi DY, Gil YC, Hu KS, Tansatit T, Kim HJ. The anatomical origin and course of the angular artery regarding its clinical implications. Dermatol Surg. 2014;40(10):1070–6. https://doi.org/10.1097/01.DSS.0000452661.61916.b5.

    Article  CAS  Google Scholar 

  35. DeLorenzi C. Complications of injectable fillers, part I. Aesthet Surg J. 2013;33(4):561–75. https://doi.org/10.1177/1090820X13484492.

    Article  Google Scholar 

  36. Landau M. Hyaluronidase caveats in treating filler complications. Dermatol Surg. 2015;41(Suppl 1):S347–53. https://doi.org/10.1097/DSS.0000000000000555.

    Article  Google Scholar 

  37. Shamban A, Clague MD, von Grote E, Nogueira A. A novel and more aesthetic injection pattern for malar cheek volume restoration. Aesthet Plast Surg. 2018;42(1):197–200. https://doi.org/10.1007/s00266-017-0981-1.

    Article  Google Scholar 

  38. Lee SH, Lee HJ, Kim YS, Tansatit T, Kim HJ. Novel anatomic description of the course of the inferior palpebral vein for minimally invasive aesthetic treatments. Dermatol Surg. 2016;42(5):618–23. https://doi.org/10.1097/DSS.0000000000000700.

    Article  CAS  Google Scholar 

  39. Mendelson BC, Jacobson SR. Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg. 2008;35(3):395–404.; discussion 393. https://doi.org/10.1016/j.cps.2008.02.003.

  40. Toure G, Nguyen TM, Vlavonou S, Ndiaye MM. Transverse facial artery: its role in blindness after cosmetic filler and botulinum toxin injections. J Plast Reconstr Aesthet Surg. 2020;S1748-6815(20):30717–8. https://doi.org/10.1016/j.bjps.2020.12.042.

    Article  Google Scholar 

  41. Day DJ, Littler CM, Swift RW, Gottlieb S. The wrinkle severity rating scale: a validation study. Am J Clin Dermatol. 2004;5(1):49–52.

    Article  Google Scholar 

  42. Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg. 2012;129(1):263–73. https://doi.org/10.1097/PRS.0b013e3182362b96.

    Article  CAS  Google Scholar 

  43. Ezure T, Amano S. Involvement of upper cheek sagging in nasolabial fold formation. Skin Res Technol. 2012;18(3):259–64. https://doi.org/10.1111/j.1600-0846.2011.00567.x.

    Article  Google Scholar 

  44. Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 2008;121(6):2107–12. https://doi.org/10.1097/PRS.0b013e31817123c6.

    Article  CAS  Google Scholar 

  45. Surek CK, Vargo J, Lamb J. Deep pyriform space: anatomical clarifications and clinical implications. Plast Reconstr Surg. 2016;138(1):59–64. https://doi.org/10.1097/PRS.0000000000002262.

    Article  CAS  Google Scholar 

  46. Beer GM, Manestar M, Mihic-Probst D. The causes of the nasolabial crease: a histomorphological study. Clin Anat. 2013;26(2):196–203. https://doi.org/10.1002/ca.22100.

    Article  Google Scholar 

  47. Lee JG, Yang HM, Choi YJ, Favero V, Kim YS, Hu KS, et al. Facial arterial depth and relationship with the facial musculature layer. Plast Reconstr Surg. 2015;135(2):437–44.

    Article  CAS  Google Scholar 

  48. Lee W, Kim JS, Moon HJ, Yang EJ. A safe Doppler ultrasound-guided method for nasolabial fold correction with hyaluronic acid filler. Aesthet Surg J. 2021;41(6):NP486–92. https://doi.org/10.1093/asj/sjaa153.

    Article  Google Scholar 

  49. Moon HJ, Lee W, Kim JS, Yang EJ, Sundaram H. Aspiration revisited: prospective evaluation of a physiologically pressurized model with animal correlation and broader applicability to filler complications. Aesthet Surg J. 2021;41(8):NP1073–83. https://doi.org/10.1093/asj/sjab194.

    Article  Google Scholar 

  50. Braz A, Humphrey S, Weinkle S, Yee GJ, Remington BK, Lorenc ZP, et al. Lower face: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):235s–57s.

    Article  CAS  Google Scholar 

  51. Lee SH, Lee M, Kim HJ. Anatomy-based image processing analysis of the running pattern of the perioral artery for minimally invasive surgery. Br J Oral Maxillofac Surg. 2014;52(8):688–92.

    Article  Google Scholar 

  52. Ricketts RM. Perspectives in the clinical application of cephalometrics. The first fifty years. Angle Orthod. 1981;51(2):115–50. https://doi.org/10.1043/0003-3219(1981)051<0115:PITCAO>2.0.CO;2.

    Article  CAS  Google Scholar 

  53. Hur MS, Kim HJ, Choi BY, Hu KS, Kim HJ, Lee KS. Morphology of the mentalis muscle and its relationship with the orbicularis oris and incisivus labii inferioris muscles. J Craniofac Surg. 2013;24(2):602–4. https://doi.org/10.1097/SCS.0b013e318267bcc5.

    Article  Google Scholar 

  54. de Maio M, Wu WTL, Goodman GJ, Monheit G; Alliance For the future of aesthetics consensus committee Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers: focus on the lower face. Plast Reconstr Surg. 2017;140(3):393e–404e. https://doi.org/10.1097/PRS.0000000000003646.

  55. Peng JH, Peng HP. Classifications and injection strategy for lip reshaping in Asians. J Cosmet Dermatol. 2020;19(10):2519–28. https://doi.org/10.1111/jocd.13635.

    Article  Google Scholar 

  56. Jeong TK. Mouth corner lift with botulinum toxin type a and hyaluronic acid filler. Plast Reconstr Surg. 2020;145(3):538e–41e.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cho, H.W., Lee, W. (2022). Doppler Ultrasound-Guided Hyaluronic Acid Filler Injection Techniques. In: Lee, W. (eds) Minimally Invasive Aesthetic Surgery Techniques. Springer, Singapore. https://doi.org/10.1007/978-981-19-5829-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-5829-8_7

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-5828-1

  • Online ISBN: 978-981-19-5829-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics