we'll start with treating this patient and first of all we will evaluate her and she actually needs some filler injection some filler treatment in her marionette lines so in this area when we treat the marionet lines it's very very important for us to map the inferior labal artery because if we hit this AR or if we inject there intravascularly we can actually get skin necrosis in that area so this is our main risk and this is something that really can happen so what we're going to do first we're going to map her inferior labal artery on her right and on her left side first I'll go to the B mode and actually what we can see here is that there is some previous AG a there there is some previous filler there you can actually see it here and what I'll do now I'll go to the Doppler mode and try to find the inferior labal artery and actually I can say it right there so I will stop and then I can measure the distance from the top and the distance from the top is around 4 mm so I will also take a note where it is and as you see it is lateral to the marionette line and so I'm not going to be there I I'll just make a note for myself that it's there here on the lower side of the marionette fold we can also see that the artery is there this is the inferior labal artery and I can also measure it and it's a little bit deeper as we go lower into the fold so I know that I have to be more superficial at some areas especially in the upper part so I will start in this case in injecting quite superficial and so I'm good in this area and also the vessel was lateral to where I'm injecting so it was deeper and lateral to the area of where I am injecting at this moment and so this is for this side and it's done we can now check actually the placement of the filler if the filler is placed as we wanted it to be placed and what we can see now we can see that the hyaluronic acid is here it's in the marionette line area and I can even check the vest vels and check if the vessel is still there and you can see that the vessels are really pumping well and so we are actually good with the injection so we injected into the marionet line and we didn't obstruct or hit any vessel also there is no hematoma and nothing there because we actually injected not at the area where the bigger vessels are are
