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
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