High Resolution Ultrasound of Fillers and Their Implications in Aesthetic Medicine: A Study in Human Cadavers

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The use of fillers for cosmetic or therapeutic purposes is very common and it’s increasing daily. Although it’s true that in most cases the results are as expected, the use of these substances is not free from the development of complications, even when it’s performed by highly trained medical physicians. On the other hand, these substances can be used indiscriminately by untrained personnel leading to a serious public health complication known as iatrogenic allogenosis, which leads to problems related to malpractice. Most of the time, professionals are consulted for a second opinion regarding the use of these substances, because use of these substances might be unknown due to the patients denying or forgetting the use of these. The presence of a previous unknown filler in aesthetic areas that require treatment may trigger severe or irreversible reactions, especially if non-absorbable fillers were injected. High resolution ultrasound is an extremely useful diagnostic tool for the identification of fillers. In this paper we will describe the ultrasound appearance of hyaluronic acid, calcium hydroxyapatite, liquid silicone, silicone oil, biopolymers, and Polymethylmethacrylate (PPMA) and then we compare it with it’s reported appearance in previous studies. The injection of the substances was carried out in human cadavers with the intention of gathering ultrasound images as similar to the imaging behavior of these substances in vivo. The obtained images can be used as precise references in the ultrasound evaluation, diagnosis, follow-up and behavior of the filler materials in the benefit of a comprehensive approach in the management of patients.