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Objectives: - Make injection anatomy of facial HIGH RISK ZONES visible through facial ultrasound

- Boost awareness of the "highest risk injection zones" of the central face to prevents devastating complications

Introduction: SOft tissue fiuller injection is a popular treatment since the last 25 years. It can lead to inflammatory and vascular complications with blindness being the most devastating complication. Ultrasound is a helpful tool to make high risk zones and their indiviudual anatomy visible prior to injection and also to manage filler related complications and to recognize localization of filler deposits.

Materials / method: Over the past 25 years, soft tissue filler injections have gained widespread popularity in aesthetic medicine. However, these procedures carry risks, including inflammatory and vascular complications, with blindness being the most severe. Ultrasound has become a crucial tool for identifying high-risk zones and individual anatomical variations before injection, as well as for managing filler-related complications by accurately locating filler deposits. This presentation examines the role of ultrasound in improving the safety and effectiveness of soft tissue filler injections.

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Objectives: The efficiency of using ultrasonography in clinical settings is a subject of controversy with pros and cons. The utilization of ultrasonography for cosmetic purposes on the face is a relatively recent advancement. Ultrasonography offers patients a sense of security during skin rejuvenation procedures, aiding practitioners in identifying blood vessels, nerves, and layers.

Introduction: However, a fundamental understanding of facial anatomical structure is essential, as ultrasonography presents these structures in two dimensions, potentially leading to difficulties.

Materials / method: Ultrasonography frequencies typically range from 10 MHz to 15 MHz when applied to the face. Frequencies lower than this range are suitable for visualizing deeper layers, making it challenging to focus on facial depth, while higher frequencies are used for observing skin layers.

Effective utilization of ultrasound begins with the identification of key reference points. For instance, recognizing structures like procerus for the upper face, LLSAN for the mid-face, and DAO for the lower face facilitates comprehension of surrounding structures.

Results: Doppler functionality aids in locating blood vessels, helping differentiate between veins and arteries. Unlike body ultrasound, pressure is not applied during facial observation due to the small and surface-level anatomical structures. However, excessive gel application is necessary to enhance visibility, which presents a drawback.

Over-application of gel; however, leads to the formation of air bubbles causing posterior acoustic shadowing, rendering anatomical structure observation difficult. Moreover, excessive gel application hinders ultrasonography-guided procedures.

Conclusion: Ultrasonography is also beneficial in preventing vessel damage, particularly in identifying sentinel veins, facial vessels, and anterior cervical veins. For example, in the case of the sentinel vein, injecting botulinum neurotoxin in lateral canthal rhytide and frontalis areas often leads to bleeding. Furthermore, the use of ultrasound is advantageous when reducing the volume of the submandibular gland, as its varied location and size can be challenging to palpate. The presence of the anterior cervical vein and facial vessels in proximity to the submandibular gland makes ultrasound a valuabl

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Objectives: The field of aesthetic medicine is constantly growing and attracting always more practitioners all over the world. with the increase of the number of procedures, the side effects are always more frequent. Although the practitioners are very prepared and have a good knowledge of Anatomy, Injecting in major vessels and having vascular compromise is still possible because of Anatomical variation in every unique patient. Also when a patient comes to our practice, we never know what type of dermal fillers exactly have been injected in the past, permanent or resolvable ones.

Conclusion: The future of aesthetic medicine practice is first the safety. The aim of this lecture is to introduce the landmarks and the reference lines in facial Ultrasound guided Anatomy. The Ultrasound Anatomical assessment of the face before and during filler procedures should be a ritual for every practitioner.

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