Dermal fillers are one of the most popular non-surgical treatments available today, and in skilled hands they are very safe. But there is something important that many patients do not know: the blood vessels inside your face do not follow a standard map. They vary from person to person — sometimes significantly — and they are completely invisible from the outside. This is why I believe ultrasound assessment before filler treatment is so valuable. It gives your practitioner a real-time view of what is actually beneath your skin, before a single needle is placed.

What is ultrasound, and what does it show?

You are probably familiar with ultrasound from pregnancy scans. The same technology, used with a small handheld probe against the face, can show your practitioner your skin layers, fat, muscle, bone — and most importantly, your blood vessels, live on a screen. This means they can see exactly where your vessels are, how close they sit to the intended injection area, and adapt their technique accordingly. It takes the guesswork out of the process entirely. - _“No two faces are the same beneath the skin. Ultrasound lets your practitioner treat your face — not an average one.”

Which areas carry the most risk?

Certain parts of the face have more variable and delicate blood supply than others. These are the areas where knowing the exact location of vessels matters most:

Temples: Deep vessels sit close to the bone and vary greatly between individuals.

Under eyes: Very fine vessels in shallow tissue — one of the most delicate areas to treat.

Lips: The arteries running through the lips vary in depth and position from person to person.

Nose: Poor blood supply in this area means any vascular event carries higher risk.

Chin:The point where key vessels exit the bone varies widely and cannot be detected by touch alone.

In all of these areas, if a vessel is accidentally compressed or nicked during injection, the results can range from bruising to more serious complications. Ultrasound allows these risks to be identified and avoided before treatment begins.

Case one: a temple complication

One patient came to me after a temple filler treatment. She had a rash spreading toward her hairline, swollen veins visible across her temple, and a black eye — warning signs of a vessel being compressed by the filler product.

CLINICAL CASE · TEMPLES - Filler compressing the deep temporal artery

1 Identified Ultrasound showed filler pressing directly on the deep branch of the temporal artery at the bone — a vessel invisible from the surface. Doppler imaging confirmed restricted blood flow.

2 Treated A dissolving enzyme was injected under direct ultrasound guidance, delivered precisely to where the compression was occurring.

3 Confirmed Blood flow was watched returning to the vessel on screen, in real time, before the patient left.

✔ RESOLVED

Case two: a chin complication — and an important lesson

This second case carries a message that every patient should hear. A client attended for a treatment and, at the end of the appointment, their injector noticed some filler product remaining in the syringe. The injector said: _“We have a little bit of filler left over — let’s pop some in your chin.”_ No additional assessment was done.

The chin was injected at the midline using a technique that places filler directly against the bone. The patient later presented in significant distress — with skin discolouration, blistering, and visible changes to the tissue. She had already undergone multiple attempts to dissolve the filler with no improvement. Her skin was showing signs of necrosis: tissue beginning to break down due to loss of blood supply.

The chin has a small but critical vessel that runs along the midline, beneath the fatty tissue between the two halves of the chin muscle. It is not visible from the outside, and its exact position varies. Without imaging, it cannot be located.

CLINICAL CASE · CHIN - Misplaced filler compressing the midline vessel of the chin

1 Identified Ultrasound revealed a large volume of misplaced filler sitting directly on this midline vessel, compressing it. This explained why previous dissolving attempts had failed — the enzyme had not been delivered to the right location.

2 Treated Hyaluronidase was injected under ultrasound guidance, targeted precisely into the filler mass pressing on the vessel.

3 Confirmed The compression was relieved. Blood supply to the area was restored and the patient’s condition began to resolve.

✔ RESOLVED

What this means for you as a patient

Ultrasound does not change the treatment itself. The same filler, the same technique, the same results — just with the added assurance that your practitioner can see what they are working with. It makes treatment more precise, and it gives both of you genuine confidence.

When you book a filler appointment, it is perfectly reasonable to ask: _“Do you use ultrasound assessment before treatment?”

A practitioner who does is one who is committed to understanding your individual anatomy — not just following a general guide.

And if a practitioner ever suggests using leftover product on an area that was not part of your original plan — it is entirely reasonable to say no.

“Ultrasound does not change the art of aesthetics. It simply ensures that the art is practised with full knowledge of the canvas.”

About the author

Dr Lisa M. Hackett is an ultrasound educator with over thirty years of experience in soft tissue ultrasound, specialising in bringing real-time imaging into aesthetic clinical practice to improve patient safety. Read more information about her here.