Seven Takeaways for Ultrasound Imaging of Patients Who Had Cosmetic Fillers

Ultrasound views may provide a variety of insights into deposit patterns and potential complications associated with cosmetic fillers, according to a new literature review.

Here are seven takeaways from the recently published review in Clinical Imaging.

1. While one may see an initial anechoic or hypoechoic presentation with a pseudocystic pattern on ultrasound for patients who have received hyaluronic acid (HA) fillers, the review authors noted gradual decreases of the deposit size that can be affected by injection technique and filler viscosity of the HA fillers.

2. Citing a 2025 study, the researchers pointed out that HA accounted for approximately 50 percent of granulomatous reactions caused by cosmetic fillers.

3. Commonly utilized for facial contouring and augmentation, calcium hydroxyapatite (CaHA) can be undiluted or be employed as a diluted filler that may be mixed with HA, according to the review authors. For patients who had injections of undiluted CaHA, the researchers said ultrasound presentation may reveal hyperechoic deposits and a strong posterior acoustic shadow. While this shadow may or may not show up on ultrasound for mixed CAHA filler formulations, the researchers noted that use of these fillers is marked by less peripheral inflammatory changes for the hyperechoic deposits.

4. Abscess formation can be an early complication with the use of cosmetic fillers. For the ultrasound view, radiologists may note a ragged appearance of abscess cavity walls that is intermixed with adjacent tissue or more of a distinct, hyperechoic presentation, according to the review authors.

5. Inadvertent injection of cosmetic fillers into or in close proximity to blood vessels can lead to vascular occlusion. The researchers said ultrasound imaging in these cases can reveal absent vascular flow in the affected area that may be accompanied by reactive peripheral hypervascularity.

6. The review authors pointed out that HA fillers are commonly involved in vascular occlusion cases and that the forehead, nose and around the eyes are considered high-risk areas for these complications. They emphasized that ultrasound guidance provides enhanced visualization of vascular structures and more precise treatment of complications with lower dosing of hyaluronidase.

7. Noting that granulomatous reactions to foreign bodies can occur years after the use of cosmetic fillers, the researchers said ultrasound views in these cases commonly reveal pseudonodular, hypoechoic nodular or ill-defined hypoechoic tissue around the filler deposits.