Dermal Fillers, Vascular Occlusion and Ultrasound: A Helpful Tool or a Dangerous Distraction?

Haus Of Ästhetik
Dec 10, 2025
5 min read

This week, the BBC published findings from researchers presenting at the Radiological Society of North America (RSNA), showing how ultrasound can identify blocked arteries in patients suffering complications from dermal fillers in the face. The article highlights severe outcomes: skin loss, deformity, and in rare cases, blindness, triggered by a vascular occlusion.

The reporting is valuable. Facial filler complications remain poorly understood by the public, and often underestimated by non-medical injectors. The message that dermal fillers can carry risk is important, especially when treatment can be bought online, injected in a kitchen, or delivered by someone without knowledge of facial vasculature.

However, the article also raises a second question:

Should vascular ultrasound now be mandatory before filler treatments?

Some voices argue yes.

The evidence, clinical reality and skill-gap argue for caution.

Understanding the Risk: What Is Vascular Occlusion?

A vascular occlusion occurs when filler is injected into or compressing an artery, stopping blood flow. Without urgent treatment, tissue can die, leading to scarring, deformity, or in rare cases where arteries communicate with the eye, vision loss.

This is why regulated medical practice insists on:

• trained injectors

• anatomical knowledge

• face-to-face assessment

• risk-based injection technique

• immediate access to hyaluronidase

You cannot safety-proof an injection site by guessing.

But nor can you safety-proof it by poorly using an ultrasound probe.

Ultrasound Can Support Safety, But It Is Harder Than It Looks

Ultrasound in aesthetic medicine is often presented like a car parking sensor for arteries.

Find the blood vessel → avoid injecting there.

In reality, the concept is far more complex.

The BBC article refers to the study of 100 complications, where ultrasound showed absent flow in connecting arteries. This approach is useful when a complication has already occurred — particularly when performed by a consultant radiologist or vascular specialist using high-frequency probes and experience built over years.

However, making pre-treatment ultrasound mapping standard practice assumes:

• every injector can interpret vascular ultrasound

• face anatomy is static and identical

• high-frequency ultrasound skills transfer easily

• vascular occlusions present in a predictable way

• ultrasound shows blockages reliably in small arteries

None of these are true.

Facial Ultrasound Requires Specialist Training

(And Most Injectors Do Not Have It)

You asked whether a 7.5 MHz probe is used for facial mapping. In practice, most facial vascular ultrasound is done using higher frequency linear transducers, typically 7.5–12 MHz. This allows visualisation of superficial structures.

A 3.5 MHz probe, by contrast, is used for abdominal and deep soft tissue scanning.

The skills required for both are not interchangeable.

To illustrate the point clearly:

Aesthetic injectors are being encouraged to use a tool typically used by:

• vascular sonographers

• interventional radiology teams

• consultant radiologists

• surgical peri-operative teams

Using ultrasound well is a medical imaging profession, not a weekend course.

A clinician with 15 years’ experience performing interventional ultrasound, specialising in vascular access, understands:

• how to identify micro-vessels

• how to interpret absence of flow

• how to differentiate artefact from reality

• how vessel diameter affects Doppler

• how variation in anatomy presents

• how depth and angle influence the image

These are the skills that prevent misinterpretation.

They are not skills a novice acquires in a short workshop.

The False Comfort of Ultrasound for Non-Experts

The danger is not ultrasound itself, it is the illusion of safety.

A poorly interpreted scan can:

• give false reassurance

• delay urgent treatment

• waste the critical window for hyalase flooding

• distract from visual and tactile clinical signs

In real vascular occlusion, the priority is speed.

Injecting hyaluronidase to flood the affected area (not “target the single point”) can be the difference between recovery and necrosis.

In a live occlusion:

• blood flow is absent

• vessels are tiny

• Doppler may show no signal

• operator skill defines what is visible

A clinical blanch, severe pain, mottling, or livedo is often a better real-time indicator than an injector trying to interpret a pixelated Doppler pattern.

As the RSNA study itself shows, even with expert operators, blockages were missed in some areas, especially small connecting arteries. This is exactly why ultrasound cannot yet be offered as a reliable universal safeguard by non-specialists.

The Evidence: Prevention Comes From Anatomy More Than Scanning

Published data consistently shows the most protective factors against occlusion are:

deep knowledge of facial vascular anatomy
(including variation, not diagrams)
layer-appropriate injection technique
(aspiration is unreliable, placement is key)
understanding of “danger zones”
(glabella, dorsum, alar base, nasolabial, infraorbital)
slow, low-pressure injections
(reduced embolic risk)
micro-bolus technique
(less vessel displacement)
cannula use in high-risk areas
(when indicated)
rapid response and hyaluronidase availability
(early flooding has best outcomes)
adverse visual signs recognised immediately
(not delayed by equipment setup)

As Jalian et al. (2021) note, “rapid clinical recognition and immediate hyaluronidase injection remains the cornerstone of management”, not ultrasound localisation (Dermatol Surg. 2021).

Similarly, Funt (2022) concludes that “ultrasound may provide value in expert hands, but limitations of resolution and operator skill mean it cannot replace core anatomical understanding” (Aesthet Surg J. 2022).

And a review by Casabona et al. (2020) highlights that the limitation of ultrasound in arteries smaller than 0.5–1.0 mm makes real-time mapping unreliable for many filler-related events (J Clin Aesthet Dermatol. 2020).

So, Should Ultrasound Be Used? Yes, in the Right Hands

Ultrasound is something we use in interventional radiology routinely, with probes suited to the anatomy, and skills formed over thousands of procedures, not a short training course.

In aesthetics, ultrasound can be valuable when:

• used by a trained radiology-experienced clinician

• used to map vessels before advanced procedures

• used to investigate complex late complications

• used within a multi-disciplinary complication network

But it becomes a risk when:

• used to replace anatomical knowledge

• treated as plug-and-play safety

• used to delay urgent hyalase in active occlusion

• promoted by non-medical trainers

The greatest irony is that in severe occlusions:

ultrasound is often unable to detect flow simply because there is none, meaning a novice operator may believe they are seeing a normal scan when the vessel is already compromised.

The BBC Article is Right About One Thing: Regulation Is Needed

The British Association of Aesthetic Plastic Surgeons (BAAPS) made a vital point in the BBC report:

“These risks are why we have campaigned for restricting medical procedures like injectable treatments to those with medical training.”

This is the real safety measure.

Not ultrasound, qualification.

You protect patients by ensuring injectors:

• understand complication pathways

• have access to emergency drugs

• can recognise signs early

• know when to escalate

• take medical histories properly

• can differentiate normal swelling from necrosis

• operate in a clinical environment

You do not protect patients by buying a £4,000 probe for Instagram.

Our Position at Haus of Ästhetik

We support evidence-based improvements in safety.

We welcome advances in complication imaging, including ultrasound, when done by appropriately trained medical professionals, especially those with backgrounds in interventional radiology, vascular ultrasound and cross-sectional anatomy.

But we will never present ultrasound as a universal guarantee, nor will we imply that a device can replace anatomical mastery, lived clinical experience, or real emergency management.

Overall the best place to get Dermal Fillers in Derbyshire, is at a place who are trained to a high level such as the Level 7 standard in the Bakewell Clinic, who have the equipment and means to address any concerns, and are accredited by Saveface.

When a vascular occlusion occurs, the only correct priority is:

Rapid assessment + immediate hyaluronidase flooding,
Not delayed scanning and investigational mapping.

References

Sigrist RMS et al. “Ultrasound Assessment of Dermal Filler Vascular Complications.” Presented at RSNA Annual Meeting, 2025.
Casabona G. “Diagnosis and treatment of filler complications.” J Clin Aesthet Dermatol. 2020;13(8):E57-67.
Funt D. “Avoidance and Management of Dermal Filler Complications.” Aesthet Surg J. 2022;42(3):NP34-45.
Jalian HR et al. “Filler-Induced Vascular Compromise.” Dermatologic Surgery. 2021;47:110-120.
Beleznay K et al. “Avoiding and Treating Blindness from Fillers.” Plast Reconstr Surg. 2015;137:227-236.
Signorini M et al. “Global Aesthetics Consensus: Avoidance and Management of Filler Complications.” Plast Reconstr Surg. 2016;137:961-971.