Learning objectives
•To explain the usefulness of high resolution ultrasound (HRUS) in the identification and quantification of different cosmetic fillers.
•To review the new role of the radiologist in the diagnosis and recognition of complications derived from cosmetic filling agents.
•To describe the various sonographic patterns of resorbable and non-resorbable cosmetic fillers.
•To outline the normal appearance and anatomy of the skin in HRUS
Background
The use of filling materials for soft tissue augmentation dates from the late 19th century.
Since its discovery,
silicone has been used for multiple medical-aesthetic purposes.
It was prepared in different degrees of density,
from liquid to solid.
Due to the immediate and delayed complications that occurred,
autologous fat was used to fill wrinkles or depressions,
and little by little other types of materials such as collagen,
calcium hydroxyapatitia,
hyaluronic acid,
etc,
were included.
Cosmetic fillers (CF) are principally used to treat wrinkles and sagging...
Findings and procedure details
SONOGRAPHIC PATTERNS OF COSMETIC FILLERS
CF generate different patterns and artifacts in US,
and those depend on the agent.
The most common ones are:
Snowstorm,
Cottony,
Vacuolar,
and
Posterior acoustic shadowing.
Vacuolar Pattern:
Well defined anechoic pseudocyst appearance.
Posterior acousticenhancement with side acoustic shadowing.
No internal vascularity on color Doppler.
Deposits decrease in time or desappear over time.
Hyaluronic Acid and Polyacrylamide
Snow StormPattern:
Hyperechoic deposits with posterior reverberation artifact.
Do not modify their size or characteristics overtime.
Silicone andmethyl methacrylate.
CottonyPattern:
Heterogenous echogenicity with...
Conclusion
HRUS of the skin is a useful tool for diagnosing the type of CF,
its location and quantity,
as well as local blood flow.
The ideal is to make diagnosis with just the ultrasound examination,
avoiding the need for a biopsy or additional imaging studies.
It is an effective tool either for diagnosis as well as for management and detection of complications or adverse reactions.
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