RSNA: Ultrasound Study Reveals Vascular Complications Associated with Cosmetic Fillers

Emerging research demonstrates\that the use of cosmetic fillers may be associated with an array of vascular complications in the face.

For the retrospective multicenter study, recently presented at the Radiological Society of North America (RSNA) conference., researchers utilized Doppler ultrasound as well as microvascularity software in some cases to assess 100 patients who exhibited clinical signs of possible vascular adverse events (VAEs) in the face after the use of cosmetic filler injections. According to the study, 98 percent of the cohort had received hyaluronic acid (HA) fillers and 79 percent had previously been treated with the enzyme hyaluronidase.

The study authors found that color Doppler ultrasound revealed a variety of facial VAEs including:

• absent flow in perforator vessels (42 percent);

• absent flow in major vessels (35 percent);

• compensatory flow (26 percent);

• string sign (18 percent); and

• increased peak systolic velocity (16 percent).

“Recognizing Doppler ultrasound patterns may help radiologists more precisely identify cosmetic filler-induced VAEs and support timely clinical decision-making,” noted study co-author Rosa Maria Silviera Sigrist, M.D., Ph.D.(c), an attending radiologist in the Department of Radiology at the University of Sao Paulo in Brazil, and colleagues.

(Editor’s note: For additional coverage of the RSNA conference, click here.)

Dr. Sigrist added that ultrasound guidance can be beneficial when employing hyaluronidase to treated filler-related complications from HA fillers.

“ … If we can see the ultrasound finding, we can target the exact place where the occlusion occurs,” maintained Dr. Sigrist. “Rather than flooding the area with hyaluronidase, we can do guided injections that use less hyaluronidase and provide better treatment results.”

Reference

1. Sigrist RMS, Chammas MC, Wortsman X, et al. Doppler ultrasound findings in filler-related vascular complications: a multicentric study. Presented at the Radiological Society of North America (RSNA) annual meeting, November 30-December 4, 2025, Chicago.