Objectives: Nasolabial fold is one of the most common treatment area by filler, but it is also one of the most dangerous area by filler injection. Ultrasonography can help clinicians minimized vascular complication related to filler injection to nasolabial fold. Based on my clinical experiences using ultrasonography, I would like share how to minimize risk of vascular accident of nasolabial fold.

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Objectives: usnderstand how ultrasounds can help us in our daily practice

Introduction: ultrasounds in aesthetic medicine is a quit new topic raised at the attention of all specialists in the field especially to avoid vascular complications but more and more some doctors use us to be more precise and sure to inject in the perfect layer

Materials / method: I honestly do not use always US during my activity in my clinic but there are some occasions where the use of US made my day. In the presentation I show when and how the use of US can get great results in the normal daily practice.

Results: the images and the results obtained are shown in the presentation

Conclusion: US are a new tool in the hands of all aesthetic clinicians. there are some areas where the use of US makes the difference and allow the doctors the improve their techniques, safeness and finally results.

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Objectives: - Understand the stages of vascular adverse events related to filler in darker skin types

- Remark how injection anatomy and complications can be made visible through facial ultrasound

- Learn the principles of ultrasound guided hyaluronidase injection to treat vascular adverse events

- Underline the importance of a multimodal and early wound- and scar treatment for necrosis at late stage

Introduction: A 41y old female patient Fitzpatrick photo type 5 presented 3 days after chin augmentation with hyaluronic acid-based filler with a vascular adverse event at skin ischemia stage 3-4. One day after initial treatment, quarantine was obligatory due to COVID 19 infection with severe symptoms.

Materials / method: A watch and wait approach, 1g of aspirin and tissue warming was decided due to impossibility to asses. Clinical assessment took place 5 days after treatment and negative COVID test, a stage 5 skin ischemia was diagnosed with local vasospasm of the superficial chin fibro-fatty layer via ultrasound. Dissolving via us-guided low-dose hyaluronidase injection (Schelke Protocol) released the vasospasm as well as the pain and pressure immediately, the blood flow was increased in the us-duplex imaging. Wound care and early-induced multimodal scar therapy was performed.

Results: After all, the patient shows minimal scarring and hyperpigmentation, the outcome of the chin augmentation was not influenced, no re-treatment was needed.

Conclusion: Early diagnosis of vascular adverse events is particularly challenging in individuals with darker skin types due to the subtler skin changes observed during the initial stages of ischemia.

Even after presentation at late stage of skin ischemia, ultrasound guided low dose hyaluronidase infiltration helped to restore the blood flow through the superficial perforators, pain and pressure release and avoid severe scarring.

The management of vascular adverse events using ultrasound allows for precise diagnosis and the precise administration of low-dose hyaluronidase injections.

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Objectives: Ultrasound imaging can be used effectively to identify Filler positioned below the surface of the skin. The typical features of Hyaluronic acid (HA) Fillers demonstrate anechoic amorphous accumulations that depend on the original amount of material injected and the final anatomic location of the product. Over time, the sonographic character of Filler can change to become less distinct, more isoechoic and the outline of the aliquot more ill-defined. HA Fillers of different rheologic parameters, degree of crosslinking, and HA concentration may give varying findings during imaging. The ultrasound

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请注明名称（个人，公司，学会等等）: trainer and partner of cutaneous, giving facial ultrasound courses

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Objectives: To demonstrate that for hyaluronidase's effectiveness it is crucial to actively mix it with the hyaluronic acid filler. Relying solely on diffusion is insufficient to ensure the desired outcomes. This implies that the assurance of hyaluronidase effectiveness lies exclusively in ultrasound-guided injections.

Introduction: In our complication filler centre, we encounter patients who have previously been treated by their physicians with hyaluronidase for hyaluronic acid filler complications without success. However, in our clinical setting, ultrasound-guided injections have consistently proven to be successful. What accounts for this difference in outcomes?

Materials / method: We investigated the passive diffusion of hyaluronidase into the hyaluronic filler substance over a period of 24 hours.

Results: Our findings revealed that the hyaluronic acid filler was dissolved by hyaluronidase only after undergoing centrifugation.

Conclusion: In direct conclusion, our study underscores the critical importance of ultrasound-guided injections of hyaluronidase directly into the hyaluronic acid (HA) filler pocket.

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Objectives: The objectives of this study were to investigate the role of dynamic activity of the orbicularis oris muscle (OOr) mucosa insertion in filler redistribution, which contributes to unnatural results after lip enhancement procedures. The study results provide a clear understanding of surface lip anatomy based on dynamic ultrasound (US) assessment and can improve the techniques of lip augmentation procedures to reduce the risk of filler displacement.

Introduction: The issue of unnatural results following lip filler augmentation procedures remains prevalent. This study is based on dynamic US assessment of OOr as a primary factor influencing filler redistribution from the vermilion to the skin part of the lip.

Materials / method: The perioral area of 30 patients were assessed before and from 2 to 6 weeks after lip injection procedures (lip augmentation with hyaluronic acid (HA), filler removing with hyaluronidase) using US devises (15Mhz, 20MHz) and visual analysis with photos and videos of the surface anatomy of the lips.

Results: The marginal part of OOr was identified in every assessed patient. Dynamic US assessment revealed the location of the terminal mucosal insertion into the dry mucosa of the lips, corresponding to subcontour transverse wrinkle of vermilion body. HA filler injection outside the OOr mucosa insertion contributed to filler redistribution into the skin part of the lips, as confirmed in dynamic US examinations. Injections of HA filler along the OOr mucosa insertion and beneath it into the vermilion body is resulted in proper filler placement after full recovery, yielding a more natural result.

Conclusion: The author’s findings could be valuable for understanding the dynamic anatomy of the lips and improving lip augmentation techniques to reduce the risk of filler redistribution due to the contraction of OOr.

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