The use of ultrasound imaging in aesthetic injectables: A modified Delphi consensus.

Summary

An international panel achieved consensus on prerequisites and best practices for ultrasound in aesthetic injections: at least a 15 MHz linear probe, mandatory B-mode/Color and Spectral Doppler with archiving, and recommended Power Doppler. Ultrasound scanning is mandatory in high-risk vascular areas and for complication management, and ultrasound-guided injections are recommended across many facial regions with strict sterile technique.

Key Findings

• Minimum equipment: ≥15 MHz linear probe; B-mode, Color and Spectral Doppler, and archiving are mandatory; Power Doppler recommended; handheld devices are acceptable.
• Ultrasound prior to injection is mandatory in high-risk vascular areas and for complication management; identify prior fillers before injecting.
• Ultrasound-guided injections are recommended in many facial regions for fillers, toxin, and injection lipolysis; sterile probe cover and gel are required; necessary for precise intralesional injections in complication treatment.

Clinical Implications

Adopt routine pre-injection ultrasound scanning in high-risk zones, document with archiving, identify prior fillers, and use ultrasound guidance (with sterile probe cover/gel) for fillers, toxin, and injection lipolysis; implement a structured training curriculum before clinical use.

Limitations

• Expert consensus without prospective outcome validation; potential panel selection bias.
• No patient-level data to quantify complication rate reduction after implementation.

Future Directions

Prospective, multicenter studies to quantify complication reduction with ultrasound-guided practice and development of competency-based training and certification frameworks.