Journal Logo


Use of Doppler Ultrasound to Avoid Injection Complications

Lambros, Val M.D.

Author Information
Plastic and Reconstructive Surgery: October 2019 - Volume 144 - Issue 4 - p 724e
doi: 10.1097/PRS.0000000000006082
  • Free


There is justifiable concern over the unintended injection of facial arteries with fillers in the face. These events can have a range of consequences, including soft-tissue loss, scarring, blindness, and stroke. In the facial aesthetic literature of the last few years, there has been a tsunami of articles describing the arterial anatomy of the face for the explicit purpose of reducing arterial injection and embolic events.

One cannot argue with understanding anatomy, nor with the articles, which have been uniformly excellent. However, it seems to me that avoiding embolic events is not just a question of knowing where vessels might be but where they actually are.

I propose that clinicians use a Doppler vascular ultrasound device for areas of concern. Using such a device gives the clinician a very accurate estimation of artery position in the x and y axes and a notion of where the artery lies in depth. Such knowledge is much more accurate than anatomic drawings and is specific to the individual patient.

The cost of a typical device is less than the profit from a few injections and will work for years. Batteries are cheap.

I use ultrasound routinely in certain parts of the face and take comfort in not hearing pulsations in areas occupied by my cannula. Though no one can state for sure that the occurrence of a rare event is influenced by methods that purport to avoid the rare event, the use of an ultrasound device is inexpensive, effective at locating vessels, and the best we currently have.


The author has no financial interest to declare in relation to the content of this article

Val Lambros, M.D.
Department of Plastic Surgery
University of California, Irvine
Irvine, Calif.


Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:

  • Text—maximum of 500 words (not including references)
  • References—maximum of five
  • Authors—no more than five
  • Figures/Tables—no more than two figures and/or one table

Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at We strongly encourage authors to submit figures in color.

We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

Copyright © 2019 by the American Society of Plastic Surgeons