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Objectives: The authors assessed the deposition pattern of HA in adipose tissue and the tissue response at short and intermediate term, including the effects of strong finger pressure after injection.

Introduction: Despite the high numbers of patients are injected worldwide with Hyaluronic acid (HA) fillers, few data are available on filler spread an histologic features after subcutaneous injection.

Materials / method: In five candidates for abdominoplasty or breast reduction, two brands of HA were injected subcutaneously in the area of excision 6 to 98 days before surgery. Ultrasound measurements and films were compared to postoperative histologic findings. Tissue response was scored semiquantitatively.

Results: Real-time ultrasound showed a slightly different deposition pattern of the two brands. Histologically, both were present in large pools of the same magnitude and looked the same. Linear retrograde injection sometimes resulted in a globular deposit, due to elastic recoil of septae. After remodeling and over time, HA deposits became difficult to detect by ultrasound. Firm remodeling of the tissue immediately after injection or time had no significant effect on filler spread or tissue response. Except for one zone of granuloma formation, tolerance for both fillers was good.

Conclusion: HA deposition in adipose tissue occurs in much larger pools than in the dermis. Ultrasound examination is mostly helpful during and immediately after the injection, less so after filler remodeling, or over time. Filler deposition may be less precise and reshaping by finger pressure may have less effect than expected.

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Objectives: 1. Learning how to use dual real-time imaging of vein detector and ultrasound in aesthetic injections.
2. Knowing the prerequisite, purpose, timing, pros, cons, and limitations of dual real-time imaging in aesthetic injections.

Introduction: Dual real-time imaging with vein detector (transillumination) and ultrasound can bridge the chasm between surface anatomy and cadaveric or surgical anatomy. Despite being familiar with facial clinical anatomy and the principles of safe fillers injection, we still never know the real facial anatomic variations of the patient in front of us. Thus, I am going to introduce the role of vein detector and ultrasound in the field of aesthetic injections, and to elaborate how to make our daily aesthetic practice safely and precisely with them.

Conclusion: Better safe than sorry, dual real-time imaging can help and improve our daily aesthetic injections preccisely and safely.

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