Injection of hyaluronic acid filler is a common procedure for nasolabial fold correction. However, it poses a risk of vascular compromise, which can result in skin necrosis and blindness.
We aimed to examine the facial arterial pathway in real-time using Doppler ultrasound, to avoid arterial complications during filler injections.
Forty patients (80 cases with nasolabial folds; 2 men and 38 women; mean age, 46.5 years (range, 28-72 years)] underwent examination of the facial artery pathway with Doppler ultrasound before hyaluronic acid filler injection. On the basis of the Doppler evaluation results, the filler injection targeted the subdermal, subcutaneous, and deep to submuscular layers by bypassing the facial artery. The efficacy of the filler injection was evaluated for each patient.
The facial artery was detected lateral to the nasolabial fold in 31% patients, while it was detected at the nasolabial fold in the other cases as follows: subdermal layer in 13% patients, subcutaneous layer in 29% patients, muscular layer in 24% patients, and submuscular layer in 4% patients. The mean Wrinkle Severity Rating Scale score was 3.68 ± 0.76 before injection and 2.28 ± 0.78 3 months after injection. Two patients experienced unilateral bruising of the nasolabial fold, which resolved after 2 weeks without treatment.
Doppler ultrasound can be considered as pretreatment tool for the prevention of vascular complications during filler injections to correct nasolabial folds.

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