Facial ultrasound prevents bruising in dermal filler procedure

Ultrasound scanning prior to dermal filler treatments results in significant reductions in bruising, which suggests that better vascular visualization can improve procedural outcomes, reports a recent study.

“This study provides quantitative evidence that ultrasound scanning prior to filler injection significantly reduces bruising,” the investigators said. “While bruising does not definitively indicate intravascular injection, it often reflects vascular trauma that may increase this risk.” [J Clin Aesthet Dermatol 2020;13:E53-E58]

This prospective quality improvement study assessed the impact of preprocedural ultrasound scanning on bruising outcomes in dermal filler treatments. The investigators compared outcomes between patients who received preprocedural ultrasound scanning (intervention group: n=80) or standard care (control group: n=80) at a single centre.

The Bruising Visibility Scale was used to evaluate outcomes, where 1 indicates barely visible bruising, 3 moderately visible bruising, 5 clearly visible bruising, and 6 indicates no bruising. Standardized photographs were taken immediately after the procedure.

“This quality improvement initiative was not subject to Institutional Review Board oversight per institutional policy and national guidelines,” according to the investigators. [Nurs Educ Perspect 2021;37:5-15]

Following standardized protocol, three experienced providers carried out the procedures using a MindRay 16 MHz ultrasound device for the intervention group. Each provider completed 40 h of ultrasound training and more than 100 supervised scans.

In chi-square analysis, bruising incidence significantly decrease following preprocedural ultrasound scanning (χ2=29.928; p<0.05). [J Am Acad Dermatol 2025;93:1526-1528]

Furthermore, participants who underwent ultrasound scanning prior to dermal filler treatment were more likely to experience bruise-free outcomes than those who did not (70 percent vs 28.8 percent; odds ratio, 5.77, 95 percent confidence interval, 2.98‒11.18).

“These findings provide quantitative evidence supporting the integration of ultrasound guidance in aesthetic practice,” the investigators said.

Blind injections

An earlier study has shown significant variations in vascular patterns among patients, which make blind injections riskier. [J Plast Reconstr Aesthet Surg 2023;84:656-669]

“These findings are relevant given the growing number of aesthetic providers,” the investigators said. “Ultrasound mapping may serve as a key safeguard.” [J Plast Reconstr Aesthet Surg 2023;86:150-154]

The current study is limited by its single-centre design and immediate assessment. Future multicentre studies with longer follow-up are needed, and a split-face design may better isolate the role of ultrasound, according to the investigators.

“Though broader inclusion would enhance generalizability, this cohort reflects typical aesthetic patients,” they added.

Complications

The increasing prevalence of dermal filler procedures has led to a rise in complications as well. “Even experienced injectors cannot reliably account for individual vascular variations,” the investigators said. [J Plast Reconstr Aesthet Surg 2023;86:150-154]

A study by King and colleagues showed that vascular complications from dermal fillers are rare but can be catastrophic, possibly leading to tissue necrosis, blindness, or stroke. [J Clin Aesthet Dermatol 2020;13:E53-E58]

“Ultrasound scanning prior to dermal filler injection has been proposed to optimize outcomes by allowing real-time visualization of vascular structure,” the investigators said. “Until now, no quantitative studies have demonstrated its efficacy in reducing complications.” [J Clin Aesthet Dermatol 2020;13:E53-E58]