CHICAGO — Color Doppler ultrasound could help radiologists identify vascular adverse events caused by cosmetic fillers, suggest findings presented December 3 at the 2025 RSNA annual meeting in Chicago, IL.
Rosa Maria Silveira Sigrist, MD, from the University of São Paulo in Brazil, shared research that suggests that ultrasound can detect the absence of blood flow in the perforator vessels and major vessels in the face in people getting hyaluronic acid cosmetic fillers.
“If injectors are not guided by ultrasound, [patients are treated] based on where the clinical findings are and [are injected] blindly,” Sigrist said. “But if we can see the ultrasound finding, we can target the exact place where the occlusion occurs.”
While cosmetic filler procedures continue to grow in popularity in the U.S., they come with their share of risks. One serious complication from hyaluronic acid filler treatments is the disruption of blood flow in facial arteries, also known as vascular occlusion. This stems from the misplacement of filler material.
Sigrist and colleagues studied filler-related vascular complications across four radiology centers, one dermatology center, and one plastic surgery center between 2022 and 2025. The research included 100 patients who were evaluated with color Doppler ultrasound. Of these, 98 received hyaluronic acid fillers and 79 received hyaluronidase before undergoing ultrasound imaging.
Color Doppler ultrasound shows vascular occlusion from hyaluronic acid fillers. Here, blood flow is absent in a segment of an artery on the lip.RSNA
Perforator vessels (42%) and absent blood flow in major vessels (35%) made up the most common findings on ultrasound. The team noted other features such as compensatory flow (26%), string sign (18%), and increased peak systolic velocity (16%). It also found no significant associations between hyaluronidase use and specific Doppler findings (p > 0.05).
The researchers also reported a moderate correlation between absent flow in perforators and compensatory flow (Φ = 0.37, p = 0.0004). Lateral nasal artery involvement also showed significant ties with absent major vessel flow (p = 0.0004).
Using color Doppler ultrasound could help clinicians perform guided injections that use less hyaluronidase and lead to better outcomes, Sigrist said in an RSNA statement. She also said that ultrasound is a useful tool for guiding the filler injections themselves by increasing precision for the amount of filler used, leading to fewer complications.