Hyaluronic acid gel distribution pattern in periocular area with high-resolution ultrasound imaging

Aesthet Surg J. 2014 May 1;34(4):510-5. doi: 10.1177/1090820X14528206. Epub 2014 Mar 25.


Background: High-resolution ultrasound (HRUS) is a useful tool in defining anatomic and dynamic soft tissue relationships in the periocular area. It also allows visualization of hyaluronic acid (HA) gel within the soft tissue.

Objectives: The authors investigate the difference in the distribution pattern between 2 HA fillers in the periocular tissue using HRUS.

Methods: The charts of 10 patients who underwent periocular injection using HA gel filler and were subsequently examined with HRUS were reviewed. Half of the patients (n = 5) were treated with Restylane-L (Medicis Aesthetics, Inc, Scottsdale, Arizona) and the remaining 5 with Belotero Balance (Merz Aesthetics, Inc, San Mateo, California). Ultrasonographic evaluation (Logiq p6; GE Healthcare, Waukesha, Washington) was performed before and immediately after HA filler injection.

Results: The HA appears as a hypoechoic image within the soft tissue plane on HRUS. Restylane-L filler formed a localized hypoechoic image within the tissue, with some spread into bubbles or pearl-like configuration. Belotero Balance spread more widely into the tissue plane and diffused into an elongated or spindle-shaped hypoechoic image.

Conclusions: Our preliminary data suggest that HA gel fillers with differing production technologies show distinct spread and distribution patterns in the periocular tissues on HRUS examination.

Keywords: Belotero Balance; Restylane-LT; cosmetic medicine; filler; high-resolution ultrasound; hyaluronic acid; oculoplastics; periocular hollow; ultrasound.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biocompatible Materials*
  • Cosmetic Techniques*
  • Diffusion
  • Edema / chemically induced
  • Edema / diagnostic imaging
  • Eye
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / adverse effects
  • Hyaluronic Acid / analogs & derivatives*
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Rejuvenation*
  • Subcutaneous Tissue / diagnostic imaging*
  • Ultrasonography


  • Biocompatible Materials
  • belotero balance
  • Hyaluronic Acid
  • Restylane