Ultrasounds praised for treating and preventing cosmetic filler complications

Research presented at the annual meeting of the Radiological Society of North America this week in Chicago, US, suggests that ultrasounds may aid in treating complications from cosmetic fillers.

The popularity of cosmetic fillers has increased in the last couple of years. According to the American Society of Plastic Surgeons, there were 5.3 million treatments in the US in 2024. The association stresses that these procedures are not without risk.

Misplaced hyaluronic acid fillers can result in complications like vascular occlusion, which disrupts blood flow in arteries.

“Vascular occlusion events in the face can be devastating, because, if they’re not properly treated, they can cause necrosis and even facial deformation,” says study author Rosa Maria Silveira Sigrist.

The scientists studied complications at four radiology centers, one dermatology center, and one plastic surgery center using vascular ultrasounds. The tests were conducted between May 2022 and April 2025, evaluating 100 patients.

The tests found that 42% of patients had absent flow to the perforator vessels — vessels that connect superficial arteries to deep arteries in the face. Meanwhile, 35% of cases showed the absence of flow to major blood vessels associated with the nasal artery.

Sigrist emphasizes that the area around the nose is a particularly high-risk injection site, as the nasal vessels communicate with the external carotid system via the facial arteries. Through the internal carotid system, it communicates through the retina of the eye.

Damage to those vessels may lead to blindness and stroke.

Locating injections

To treat complications from fillers, clinicians inject hyaluronidase, which breaks down the hyaluronic acid in fillers. The new research aims to guide clinicians in ensuring that these injections are targeting the correct spot.

“If injectors are not guided by ultrasound, they treat based on where the clinical findings are and inject blindly,” says Sigrist.

“If we can see the ultrasound finding, we can target the exact place where the occlusion occurs. Rather than flooding the area with hyaluronidase, we can do guided injections that use less hyaluronidase and provide better treatment results.”

She adds that ultrasounds can also be beneficial when the fillers are being injected, increasing precision and decreasing the risk of complications, while also using less filler material.

The framework also helps radiologists recognize patterns of filler-related complications, enabling them to start treatment before serious injuries occur.