Background: The use of hyaluronic acid (HA) for facial rejuvenation is increasing every year. However, complications can be disastrous because they can cause necrosis, blindness, and stroke. In 2021, the author described a 3-step technique to prevent intravascular injections, but it is time-consuming and difficult to implement.

Objectives: The aim of the authors of this article is to propose a quicker and simpler ultrasound-guided filling technique using high-frequency ultrasound to avoid intravascular injections.

Methods: The investigator introduced a vascular mapping technique that takes <3 min to identify the position of the arteries to introduce the cannula or needle in a different plane. The investigator retrospectively reviewed 503 patients who were injected with 1109 cc of HA utilizing vascular mapping in different areas of the face to evaluate vascular complications.

Results: The most common injection sites were the nasolabial fold (324 cases), marionette lines (157), and lips (106). The chin was injected in 48 patients, the temple in 34, the nose in 26, and the glabella in 23. In 34.7%, 13.2%, and 2.9% of the glabella, nasolabial folds, and temple, respectively, arteries with significant diameters (>0.8 mm) were present at the injection sites. There were no cases of vascular complications.

Conclusions: Except for the glabella, only a small percentage of patients have arteries with larger calibers in the injection area. These arteries can be identified before the procedure using quick Doppler ultrasonography (DUS). The use of DUS to map the site of filler injection can help physicians reduce the risk of intravascular injection

Danilo Augusto Teixeira MD, MSc

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