High-resolution ultrasonic diagnostics in post-contouring oedema

Abstract

Background . The use of injectables is becoming ever more popular in aesthetic medicine. However, no clear guidelines are provided for the diagnosis and treatment of their early and late complications. Objectives . Assessment of ultrasonic diagnosis capacity for facial skin and soft tissue evaluation in post-contouring facial oedema. Methods . A case-control cohort study of post-procedural oedema was conducted. Two cohorts were selected: women having oedema after facial contouring with hyaluronic acid fillers and those without evident somatic displays. The cohorts differed by the filler’s presence (infiltration surrounding geleomas) or absence (soft tissue infiltration) in the swelling as diagnosed with ultrasound. Subsequent high-resolution ultrasonography (HRUS, B-mode and Doppler imaging). Results . HRUS was used to examine 67 women with oedema after facial contouring. The patients aged 22 to 65 years had filler injections in soft facial tissues 2 weeks to 3 years prior to the visit. The fillers contained hyaluronic acid in 67 cases. Swelling was acute, with a wavelike recurrent course. According to HRUS, 30 patients had the filler in the oedema projection, 30 — in adjacent zones, 6 had no filler in oedema and 1 had fibrosis-associated oedema. The main HRUS traits of filler-induced oedemas were facial contour distortions and a uniformly amplified echogenicity of surrounding tissues. Conclusion . Patients with oedema after aesthetic contouring should have an ultrasound examination of facial skin and soft tissues for differential diagnosis, evaluation of the swelling degree and filler presence in soft tissues. Oedema typically develops in 3-4 months after the injection procedure. Hyaluronidase injections in the swelling zone are less effective without ultrasonic control.