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Danilo Augusto Teixeira , Speaker at Dermatology Conference
Hospital of Tropical Diseases, Brazil
Title : A safe doppler ultrasound-guided technique for hyaluronic acid filler in the face


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.

I propose 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, such as necrosis, blindness and stroke.

I will present a Doppler ultrasound-guided filling technique, with a 20 MHZ portable transducer, consisting of three steps: arterial mapping, real-time ultrasound-guided filling, and assessing the perfusion.

The described technique was performed in 820 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.

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).

I 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.

What will audience learn from your presentation?

 Ultrasound-guided filling is the only way to visualize the vascularity of the area to be filled and avoid intravascular injections. With this technique, doctors will be able to avoid the most important complications that can occur during filling: necrosis, blindness and stroke.

 In addition to ensuring safety for your patients during filling, this technique allows you to identify the different types of fillers (hyaluronic acid, calcium hydroxyapatite, polylactic acid, polycaprolactone).

This technique will also be of paramount importance to perform the dissolution of a hyaluronic acid with hyaluronidase for those patients who did not like the result.

The injectors have to be more and more used to this technique because it will be the only way to fill in the future.


Dr. Danilo studied Dermatology at the Federal University of Goiás, Brazil. He joined the fellow of Dermatologic Surgery in College Medicine of ABC in 2013 and the fellow of Mohs Micrografic Surgery in 2014. He received his Master’s degree in Dermatology in 2019 at this institution. Since 2014 he is dermatologic surgery professor at Hospital of Tropical Diseases. In 2020, he published the first case of doppler ultrasound-guided volumizing of the glabella in the world. In 2021, he published a second article describing his technique of doppler ultrasound-guided volumizing. He continues to improve his technique with more than 820 cases.