Clinical value of high-resolution (5–17 MHz) echo-color Doppler (ECD) for identifying filling materials and assessment of damage or complications in aesthetic medicine/surgery
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The purpose of this retrospective study is to evaluate the role of echo-color-Doppler (ECD) imaging in identifying a series of characteristics pursuant to aesthetic filling material such as their degree of absorbability and their potential complications which include their propensity to stimulate the formation of encapsulated foreign-body granulomas. In the latter case, ECD can be of aid by giving indication for surgical therapy.
Materials and Methods
Over a 4-year period, we studied 180 patients (60 ♂) who underwent an aesthetic medical/surgical treatment. We used ECD to evaluate the implant material, its thickness, the injection site, the integrity of dermal layers and the presence of any associated complications.
In 97% (174/180) of our patients, we were able to identify the type of material used; furthermore, 57% of patients had a hyaluronic acid implant, 14% a lipofilling and 29% a non-absorbable filler (with 10% of silicone). In 6/180 (3%), we could not recognize the material used; 89% (161/180) of our patients presented post-injection complications; moreover, 67% showed peri-implant dermal–hypodermal thickening areas with adjacent lymphostasis, 6% displayed an abnormal implant site, and 17% showed inflammation with encapsulated foreign-body granulomas that required subsequent surgical excision. Biopsy samples were obtained from 37/180 patients (21%); among these, 31 patients had an ECD evidence of granuloma and on 6 patients we were not able to define the injected material. Histopathological examination identified 29 granulomas, 5 sterile abscesses and 3 chronic inflammations in the absence of granuloma. ECD showed an overall 78% diagnostic accuracy, with 90% sensitivity and 37% specificity in detecting filler granulomas.
ECD is a low-cost technique that allows to identify filling materials and to assess the complications of an esthetic medical/surgical treatment.
KeywordsSkin ultrasound Color-Doppler high-resolution ultrasound Skin lesion Filler Granuloma
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest related to the publication of this article.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Scotto di Santolo M, Sagnelli M, Tortora G et al (2016) The utility of the high-resolution ultrasound technique in the evaluation of autologous adipose tissue lipofilling, used for the correction of post-surgical, post-traumatic and post-burn scars. Radiol Med 121(6):521–527. https://doi.org/10.1007/s11547-016-0621-x CrossRefPubMedGoogle Scholar
- 5.Wortsman X, Alfageme F, Roustan G, Arias Santiago S, Martorell A, Catalano O, Scotto di Santolo M, Zarchi K, Bouer M, Gonzalez C, Bard R, Mandava A, Gaitini D (2016) Proposal for an Assessment Training Program in Dermatologic Ultrasound by the DERMUS Group. J Ultrasound Med 35:e5–e9.| https://doi.org/10.7863/ultra.15.10068
- 7.Daines SM, Williams EF. Complications associated with injectable soft tissue fillers: a 5-year retrospective review. JAMA Facial Plast Surg 15:226–231Google Scholar