Ultrasound to improve the safety of hyaluronic acid filler treatments

J Cosmet Dermatol. 2018 Dec;17(6):1019-1024. doi: 10.1111/jocd.12726. Epub 2018 Aug 6.


Background: Hyaluronic acid fillers are known for a reliable safety profile, but complications do occur, even serious vascular adverse events.

Objective: To improve the safety of hyaluronic acid filler treatments.

Methods: Ultrasound is used to image hyaluronic acid fillers.

Results: Before a filler treatment is performed with ultrasound, previous filler treatments can be brought in to sight and vascular mapping can be performed. In case of adverse events, the filler and the surrounding tissues are visible. Dislocation, abscesses, and vascular adverse events can be seen. Under ultrasound guidance, hyaluronidase can be injected directly into the filler deposit.

Conclusion: Ultrasound examination can be an important tool to improve the safety of hyaluronic acid filler treatments.

Keywords: complications; cosmetic dermatology; filler; hyaluronic acid; safety; ultrasound.

MeSH terms

  • Blood Vessels / diagnostic imaging*
  • Cosmetic Techniques / adverse effects
  • Dermal Fillers / administration & dosage*
  • Dermal Fillers / adverse effects
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Skin / blood supply
  • Skin / diagnostic imaging*
  • Ultrasonography, Doppler
  • Ultrasonography, Interventional


  • Dermal Fillers
  • Hyaluronic Acid