hello i'm dr steve weiner a facial plastic surgeon from santa rosa beach florida and what i have here is a clarius l20 hd this is the newest version of the clarius and what i'm going to show you is my ultrasound assisted temporal injection and i put on a tegaderm so you take a tegaderm and you put it on the surface of the foot plate and that keeps it sterile now i'm going to use sterile ultrasound gel and take a look at her temporal arteries so now we're going to go into looking at the temple anatomy and looking for the vasculature so first we're going to look in b mode at the temple anatomy and what we can see here is the temporalis the temporal bone the intermediate temple fat pad the two layers of the deep temporal fascia and the superficial temporal fat so this mass and our idea with this injection is to inject below the snats above the superficial layer of the deep temporal fascia so let's change over to the color doppler mode and let's look for the vasculature okay i always do a color box steering for that so back here is our superficial temporal artery right there so there's our superficial temporal artery it's pretty posterior to where we want to be so there it is right there so we're going to be injected inferior to that and deep to that let's look and see if there's any other vasculature we can see here i'm going to look for the deep temple artery again with our injections we're injecting superficially so the deep temporal artery doesn't come into play so now we found the deep temporary it's not quite on the periosteum but again our injections are going to be much more superficial to this but when you do those deep injections finding that d-temporal artery is a good thing because those d-temporal injections can affect this temporal artery so there we have it right there we'll screenshot that let's start the injection and then i'm going to use the ultrasound to confirm placement in that interfacial plane so we're doing a pilot hole this is going to be a 23 gauge cannula 50 millimeters a soft fill cannula and so she's going to insert it through the dermis and then pierce the smash so we get into that interface do you see that pop that pops confirms that we're below this mass and now that interfacial plane should be a glide plane and i i can tell you even without ultrasound that we're most likely there but we're going to confirm it with the ultrasound so let's go and turn it on to b mode and show that we are in that interfacial plane so she's bumping up against the deep temporal fascia and she's going to do a small little bolus of saline to confirm the placement you're actually in you're actually in the deep there we go now we're in the interfacial plane and she's going to inject a little bit of saline to expand that plane and see it's perfect interfacial plane perfect injection now what we're going to do is we're going to take the saline off of the cannula and we're going to replace it with restylane diluted and she's going to inject it into that interfacial plane now we'll confirm the placement and you see the filler is within the interfacial plane and then we can you see here's the deep and here's a superficial and the filler is in between the two fascial planes and then we'll confirm that the artery is intact right there so that's a nice confirmation of the ultrasound placing it into the interfacial plane using clarius l20 hd you
