hi everyone we are talking safe mapping we are going to do a needle bolus on Grace's cheek so what does that mean we want to check to see if it's safe so just looking at Grace the what we always start with safe mapping is where do we clinically want to put the filler so Grace has a little bit of a volume loss right here so what I do is I take a surgical marker and I just put a little dot of it now this is a junction Violet marker which doesn't wash off so easily with ultrasound gel which is important because we want to be able to Ultrasound over it so to Safe map that spot the first thing we want to do is we want to go to our uh very exciting new clarious settings we have a cheek setting which should be a really nice beginning setting for the cheek so we go to our power doppler and we put our midline marker on and that is going to be right on top of that little dot where we want to put our filler now we have to do our four adjustments because we can't just throw a probe on somebody's face and say yep that's safe we have to be very conscientious which is why we put our DOT here and that's going to line up with our midline marker the next thing we need to do is we need to check a pressure now here's a dense pressure you can see I'm pushing pressure and we're looking at the screen and then a lighter pressure your view changes with your pressure so you always want to do the lightest pressure you can when you're talking about such superficial vessels and superficial structures so that was our pressure check alignment alignment is where we kind of double check that our midline is exactly where our DOT is that we want to put the filler okay then rotation you want to do these tiny little rotations just to make sure you're not missing anything in that spot and then last but not least is your tilt your tilt check is going to be your angle at which you're advancing it's kind of your your foreshadowing the angle at which you're going to be advancing your syringe so if you see this way that is a different angle than this which is a different angle than this you can watch as I tilt down and I tilt straight and I tilt up now in this case I'm anticipating that my syringe is going to be pretty much going in this direction it should be exactly the same angle that you're putting your probe and that's where you're really looking on the screen to see can I put filler there does it look okay because the angle of incidence is the 90 degree reflection of your sound waves okay so the 90 degree reflection is your best view and so you really want it to have the 90 degree the same exact path that your needle is going to take so I've just safe mapped that spot to me I'm very happy with it that is a successful safe map when you're looking at the zygoma The Arc of the zygoma down to bone that hypochoic white line it looks good so I feel good about laying a bolus there and again I just take my hippo cleanse and just dab it one more time just to be sure and then I'm just going that same exact path going down to bone so then we're just going to put a little 0.2 bolus right there and that is it then you can always just massage it down and you would do that for each spot that you're going to inject so if we want to put another drop right there that's what we'll do next so that is our safe map of that needle bolus on the cheek hope you enjoyed foreign
