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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

  • Maria Scotto di Santolo
  • Candida Massimo
  • Giovanni Tortora
  • Valeria Romeo
  • Michele Amitrano
  • Arturo Brunetti
  • Massimo Imbriaco
ULTRASONOGRAPHY
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Abstract

Purpose

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.

Results

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.

Conclusion

ECD is a low-cost technique that allows to identify filling materials and to assess the complications of an esthetic medical/surgical treatment.

Keywords

Skin ultrasound Color-Doppler high-resolution ultrasound Skin lesion Filler Granuloma 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this article.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Maria Scotto di Santolo
    • 1
  • Candida Massimo
    • 1
  • Giovanni Tortora
    • 2
  • Valeria Romeo
    • 1
  • Michele Amitrano
    • 1
  • Arturo Brunetti
    • 1
  • Massimo Imbriaco
    • 1
  1. 1.Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
  2. 2.Department RadiologyAOS dei colli Monaldi- Cotugno–CTONaplesItaly

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