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17 (and counting) reasons why I use ultrasound in my Aesthetic Practice

Updated: Jan 12, 2023



Ultrasound is a recent introduction to facial aesthetics and is taking aesthetic practice by storm. And to an entirely safer level.


Instead of injecting blind, you can precisely see where your filler has been placed. And reduces the risk of the many feared complications of injecting filler into the face.


Here are some and a growing number of reasons why I routinely use ultrasound in my aesthetic practice. I'll update when I think of more…


So, for now:


1. Safety


Aesthetic Ultrasound takes safety in injectables to a new level.


Seeing is believing, and knowing exactly where my filler is going means avoiding many of the complications I previously feared.


Which filled me with dread over 10 years ago after leaving a one-day course (see my next Blog on how your injector may... or may not have been trained). So much so that I went off to get properly trained.


2. Precision and accuracy


Now, I can place fillers exactly where I want. Guessing you are at the correct depth just by feeling or clicks and pops as you enter fatty compartments is a thing of the past. Or hitting bone (which is painful and wincing) to ensure I am at the correct depth.


By the way, I used to wince and apologise too.


Watching the filler leave the "needle" to fill the right place (and space) is satisfying and much safer for you.


3. Injecting where you would not previously go.


There are certain areas of the face where some injectors will not venture. No injector can genuinely tell you their injections are safer than others, however experienced or credible they may appear, even on YouTube clips.


High-risk areas, such as the temple, the nasolabial fold (especially the pyriform space by the side of the nose - see my facial artery blog), the "no go" glabellar region (the area between the eyebrow), and the nose, can now be injected with "relative" ease.


Before the introduction of ultrasound, this could not be achieved.


4. Less filler waste


Most fillers are supplied in 1ml syringes. Sometimes this is not enough or is far more than is needed. Still, we carry on injecting until the syringe is empty.


Watching the filler fill a space means there is no longer any temptation to overfill, leading to the all too common problem of “filler migration".


Or, worse still, the excess pressing on nearby blood vessels later when you leave the clinic and are "safely" at home.


5. Better product selection


Some areas of the face need different filler types. Deep fillers provide support from beneath and volume above. They also tend to last longer and are more resilient.


Putting them too superficial means you will get a lump or bump, which is more difficult to remove or dissolve.


Using ultrasound means placing these fillers at the correct depth or choosing a more suitable, less "bumpy" one.


6. Layering filler is much easier.


One of the newest techniques to make its way into aesthetic practice is laying different products over one another.


One deep and then a softer product, a more skin and "contour friendly" one above.


A great area to do this is the mid-face, where we can mimic the natural fat compartments of the face.


Using ultrasound, you can place the deeper product first, then layer the other precisely "on top". Neat!


That means minimal "mixing" and dilution of different, expensive fillers, which can now be placed in the correct tissue layer above and below!


More importantly, it is much better and cost-effective for you.


7. Needle visualisation from the skin to the point of injection


One of the significant upgrades to the Clarius Ultrasound L20 is the addition of needle enhancement.


The Clarius is the first ultrasound device using AI-powered features and is specially built to give high-resolution images in medical aesthetics.


20-megahertz, to be exact. It is also easy and light to use.


Seeing where your needle enters and is going is all the reassurance I need that the needle is going where I want.


Add with needle enhancement, and the needle lights up!


No more changing needle entry points or pushing up to the needle hilt as I am too far away!


Less bruising and pain for you and embarrassment for me.


I also hate making two holes when I should have only needed one.


8. I can avoid blood vessels.


Several important blood vessels supply the face. Some are large and easy-ish to feel, and some are small, hidden and not visible.


Ultrasound takes the guesswork about where the artery is away.


9. Checking for vascular occlusion


Delayed blood vessel blockage (vascular occlusion or VO) is an uncommon occurrence that is often not spotted until a few hours (too late) after your aesthetic injection.


As a rule, the deeper the filler is placed, the longer it takes for you to notice a "vascular" event.


The beauty of ultrasound is that you can immediately check blood flow in the vessel in those risky areas.


So it's not putting the onus on you to ring your injector with concern as part of your skin turns white or blue.


10. Deciding whether you have a Bruise or a Blood vessel blockage


One of the common concerns we have as injectors is differentiating between areas of bruising or blood vessel blockage.


Most of us use the element of doubt and dissolve the filler straight away. Or, more concerningly, we keep our fingers crossed and wait for it to disappear.


Annoying as bruises are, at least a bruise will not leave a permanent scar. Delayed treatment of blood vessel blockage will.


And time is paramount. The earlier you are treated, the better the outcome. So why leave this to chance?


Pressing on the skin to see "capillary refill" (the pink returning as blood flow returns) is, at best inaccurate and causes unnecessary skin-risking delays. It's your face, by the way, not ours.


11. Better filler dissolving.


Dissolving your filler can be painful. And an expensive business if your injector is unscrupulous.


Also, does your injector know how much enzyme dissolver, hyalase, they need to use? Not just in volume but amount? I doubt it. As I don't, despite the numerous "guidelines" that prevail.


Most flood the area and hope for the best.


More is only sometimes better. And could leave your natural hyaluronic acid wanting and can also be "dissolved away". Potentially leaving you with crevices and depressions under your skin.


Using ultrasound, you can place the enzyme correctly and in the right amount. And see the immediate effects.


12. I can now measure the depth of my injections.


Again, using the ultrasound, measuring the exact depth of filler placement, the depth of the bones underneath, and the location of blood vessels I need to avoid is now possible.


All this can be recorded, kept on file and reviewed for future injections.


13, Seeing where your old filler was placed.


Many patients I see have had filler before. Some with exceptional results, and some with not so good. Unlucky for some.


Not knowing what filler you have had before is common. Or where it was injected. "I had a bit here and there" is too familiar and concerning.


With ultrasound, I do not leave this to chance and always check where the old filler has been placed. One to avoid it, the other to advise you if you need more.. or not.


14. Ultrasound-guided nerve blocks will make your injections more comfortable and easier for us.


With the ultrasound, it is possible to see where the nerves are located and numb an area to be injected first.


While most injectors claim their patients don't experience pain, I tend to disagree.


While the weak argument is that pain is one of the first signs of injecting into a blood vessel, in my mind, this is too late!


Why not avoid this in the first place and use ultrasound instead? And make your injections pain-free.


By the way, injecting a local anaesthetic into a blood vessel during a nerve block in the face is not for the faint-hearted. So make sure your injector is well-trained in life support skills. And uses ultrasound first.


15. Diagnosing lumps and bumps


Fillers can give you lumps and bumps. Sometimes these occur early, and most can be simply massaged away.


Lumps called granulomas or nodules can happen a few weeks, months or even years after your filler injection.


Knowing exactly what these lumps and bumps are can be guesswork, which may mean you are unnecessarily put on antibiotics and steroids to make them disappear.


Ultrasound again can leave your injector with less doubt.


16. Better results


Accurately placed fillers in the right volume and depth will give better results for the months and, hopefully, years to come.


And you are less likely to experience some of the later complications associated with poorly placed, blindly injected fillers of the past.


17. Peace of mind


Having introduced ultrasound into my aesthetic practice, I now have peace of mind after every filler injection.


A worthwhile investment which you cannot put a price on!


Where did I start using ultrasound?


As an anaesthetist, I started using ultrasound almost 15 years ago to see nerves before numbing an area of the arm or hand.


Ultrasound is the gold standard in anaesthetic practice and will become the same in facial aesthetics.


Let's set the bar now for aesthetic fillers.


Without one, you should not be allowed to inject.


Although the ultrasound machines are expensive, they are worth their weight in gold for the peace of mind they bring to my patients and me.


Ultimately, you must decide how safe your filler injections will be.


I know what I would want… so join the Ultrasound revolution now.





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