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

Abstract

A four-round modified Delphi consensus was held concerning the question, 'What are the prerequisites for using ultrasound imaging in cosmetic filler injections'? Fifteen international experts in the field from seven different relevant medical specialties and 11 countries were included. An extensive list of topics was discussed in rounds 1 and 2. Statements were drawn up for voting in rounds 3 and 4. Experts had a consensus (>70% agreement) on most of the statements. With regard to equipment, a minimum linear 15 MHz transducer (probe) is recommended for both learning and regular diagnostics. Hand-held devices can be used in both circumstances. B-mode, Color-Doppler, Spectral Doppler, and picture/video archiving are mandatory, Power-Doppler is recommended. Experts find ultrasound imaging prior to injection mandatory in certain areas with high risk for vascular adverse events, as well as for the management of complications. It is recommended to identify prior fillers before injecting. An ultrasound-guided injection is recommended in many parts of the face for fillers, toxin and injection lipolysis. A sterile probe cover and sterile gel are necessary in these cases. Ultrasound-guidance is necessary for precise intralesional injections, needed in filler complication treatment. An extensive list of training and practice topics is given that should be learned before one can start using ultrasound imaging in cosmetic filler injection practice. Ultrasound imaging for minimal invasive aesthetic procedures has met a significant surge in attention, both in publication numbers and in prominence at major conferences. For physicians and institutions exploring this field, many critical decisions must be made, particularly concerning the prerequisites for using ultrasound imaging in cosmetic filler injections. Guidelines from international experts addressing these topics would provide valuable insights and facilitate the adoption of ultrasound technology in this field.

Keywords: Complications; Consensus; Facial ultrasound; Soft-tissue Fillers.