Ultrasound Helps Clinicians Target Filler Complications with Greater Precision

Ultrasound imaging may play a critical role in identifying and treating serious vascular complications associated with hyaluronic acid filler injections, according to new research presented at the 2025 Radiological Society of North America (RSNA) annual meeting.

Researchers led by Rosa Maria Silveira Sigrist, MD, PhD candidate at the University of São Paulo, evaluated 100 patients with suspected vascular events after cosmetic filler injections between May 2022 and April 2025. Data were collected across 4 radiology centers, 1 dermatology clinic, and 1 plastic surgery site. Absent flow to perforator vessels was the most common ultrasound finding (42%), followed by flow absence in major vessels (35%), particularly involving the lateral nasal artery.

"Vascular occlusion events in the face can be devastating, because, if they're not properly treated, they can cause necrosis and even facial deformation," Dr. Sigrist said.

The nasal area presents heightened risk, she noted, due to its vascular communication with both external and internal carotid systems—raising the stakes for potential blindness or stroke.

Treatment typically involves hyaluronidase injections to dissolve misplaced filler. However, ultrasound-guided injections allow for more targeted administration. “Rather than flooding the area, we can target the exact place where the occlusion occurs,” Dr. Sigrist explained.

Beyond treatment, ultrasound may help reduce filler complications from the outset by improving injection accuracy and reducing the volume needed.