The study found that in 42 percent of vascular complication cases that occurred after a hyaluronic acid injection, the flow of blood to perforator vessels in the face was absent.
While cosmetic filler injections can cause vascular complications, they can be avoided with the use of ultrasound mapping, according to a new study.
Study author Rosa Maria Silveira Sigrist and her research team found that in 42 percent of vascular complication cases that occurred after a hyaluronic acid injection, the flow of blood to perforator vessels was absent.
Perforator vessels link together facial arteries of various depths.
Sigrist is an attending radiologist and Ph.D. candidate at the University of São Paulo Department of Radiology in Brazil.
Vascular occlusion can occur when arterial blood flow is interrupted as a result of the filler material's misplacement.
What concerns Santa Monica-based board certified dermatologist Tanya Kormeili the most is the nasal artery.
"It scares me to see how often inexperienced injectors are placing fillers in the nose, nasolabial folds and under the eyes given that stroke and vision loss are at stake," Kormeili told NTD.
Sigrist's study further found that in 35 percent of cases, vascular occlusion occurred when abnormal blood vessel flow was associated with lateral nasal artery involvement.
The filler causes vascular occlusion by taking up space, according to American Academy of Facial Plastic and Reconstructive Surgery member Eric Carniol, a double board certified facial plastic surgeon in Englishtown, New Jersey.
"This is not a material that floats around naturally in vessels in this large glob," Carniol told NTD. "Injection into a vessel can carry it downstream, clogging the smaller drain. This also makes it tough to treat."
American Society of Plastic Surgeons data shows that in 2024, more than 5.3 million hyaluronic acid filler treatments were administered in the United States alone.
Sigrist advocates for injectors to use ultrasound results like a map to guide them.
"They treat based on where the clinical findings are and inject blindly but if we can see the ultrasound finding, we can target the exact place where the occlusion occurs," she added.
Medical professionals who inject fillers vary in their level of training and currently, only a small percentage of injectors use ultrasound technology, according to cosmetic dentist Arun Narang of Smile By Design Dental.
"Ultrasound requires additional training, more time, and extra investments," Narang told NTD. "The worst scenario without ultrasound for injectors is missing the signs of an occlusion, which, unrecognized, can lead to skin necrosis and can cause scarring."