High frequency ultrasound can help identify the composition of fillers, their location, and adjacent tissue changes or complications. Place the transducer in suspected areas and look for characteristic image patterns for each filler type.
so in my practice what i use the ultrasound for fillers are for identifying these fillers the location of fillers but also looking at complications from fillers like some people have a lot of swelling around their eye and i've seen patients that have had hyaluronic acid fillers injected in their tear troughs five or ten years prior and still have it present around their eye and when i inject it with hyaluronidase the swelling goes away i've also had some patients complain of some nodules particularly in their lips and you could identify them with the ultrasound and inject the hyaluronidase and resolve the problem so in this case this patient has had filler injecting in her lips so let's evaluate the lips right now so ha filler is going to be anechoic particularly when it's an early or young place filler as it gets a little older over several months sometimes it becomes hypo echogenic and that's because it loses some of its water content so let's take a look at her lips right now and i'm going to show you so she was injected almost with like micro droplets using the tenting technique so you're going to find a lot of very small areas of filler and i'm going to show you like right here this is what ha filler is going to show up for when we do the tenting technique in the lips so right there and then there's another area over here and over here all these are small little pockets of h a filler so let me show you the h a filler why don't you take a peek over here so do you see the ha filler right here and right here and right here and a little bit right there so that means it was perfectly placed it's going to be superficial away from the vascular structures and it it's not swollen there's no edema around it so it was placed pretty well that's awesome all right so i'm just gonna look a little bit more and we can add it we can now i just want to see if i can find other nice pockets of filler okay here's another great picture so here you got a little pocket there a little pocket there so all these uh anechoic black areas are your filler ha filler so it looks perfect to me i wouldn't worry about it it's going to last you about another six months or so okay so that's evaluation of a patient who's had a hyaluronic acid filler injected in her lips using the tenting technique it's very quick and easy to determine whether there's filler in there or not and if you see nodularity sometimes when you see a little nodule you see a posterior enhancement which is typical of a fluid-filled cyst and so we don't see any of that on this either so thank you thank you
