Rocha Paula Stéfany, Guerra Thais Almeida, Teixeira Danilo Augusto
Department of Dermatology, Tropical Diseases Hospital, Goiânia, Brazil.
J Cosmet Dermatol. 2022 Jul;21(7):2783-2787. doi: 10.1111/jocd.14492. Epub 2021 Sep 29.
Knowledge of facial anatomy is essential for professionals intending to inject hyaluronic acid (HA) into that region, but due to the considerable anatomical variations in region, it does not guarantee the complete safety of the procedure. Similarly, procedures widely disseminated among professionals, such as aspiration and the use of cannulas, do not ensure total safety against vascular occlusion events caused by the filler.
This article describes a technique for injecting hyaluronic acid into the face guided by Doppler ultrasonography (DUS) in order to ensure greater safety against vascular occlusion events secondary to the procedure.
We describe a Doppler ultrasound-guided filling technique, with an 18 MHZ transducer, consisting of three steps: arterial mapping, real-time ultrasound-guided filling, and assessing the perfusion.
The described technique was performed in 480 patients and can be adopted in the routine of professionals who inject hyaluronic acid, especially in areas at high risk for vascular events. Its use results in greater safety against vascular occlusion events secondary to the procedure, without the need for prior aspiration. We conclude that there is a local vasodilation right after the filling that makes it difficult the possibility of extrinsic compression exerted by the filler on the vessel. Furthermore, the product moves to deep planes even with the bevel facing up (toward the epidermis).
We believe that in the future the use of Doppler ultrasound-guided filling technique will be mandatory for professionals who intend to perform HA injection, to both ensure patient safety and provide legal protection for the professional.
对于打算在面部注射透明质酸（HA）的专业人员来说，面部解剖知识至关重要，但由于该区域存在相当大的解剖变异，这并不能保证手术的完全安全性。同样，在专业人员中广泛传播的操作，如回抽和使用套管，也不能确保完全避免填充物引起的血管阻塞事件。
本文描述一种在多普勒超声（DUS）引导下将透明质酸注射到面部的技术，以确保在手术继发血管阻塞事件时具有更高的安全性。
我们描述一种使用18兆赫探头的多普勒超声引导填充技术，包括三个步骤：动脉定位、实时超声引导填充和评估灌注。
所描述的技术在480例患者中实施，可被注射透明质酸的专业人员应用于日常操作，尤其是在血管事件高风险区域。其使用可提高手术继发血管阻塞事件时的安全性，无需事先回抽。我们得出结论，填充后立即出现局部血管扩张，使得填充物对血管施加外部压迫的可能性降低。此外，即使斜面朝上（朝向表皮），产品也会移动到深层平面。
我们认为，未来对于打算进行HA注射的专业人员来说，使用多普勒超声引导填充技术将成为强制性要求，既能确保患者安全，又能为专业人员提供法律保护。
