Clinical implications of ultrasound artifacts in the cervicofacial area following injection of permanent facial fillers.

PURPOSE: To evaluate ultrasound (US) findings in the cervicofacial area following injection of permanent facial fillers during a long-term follow-up period.

METHODS

Fifty-seven consecutive patients with a history of previous facial filler injection were enrolled at a single institution between 2010 and 2014. All patients were female, and the mean age of the patients was 60.8 years. The mean follow-up period following injection of facial fillers was 16.6 years (range 2-30 years). We analyzed US findings in the face (injection site) and neck (noninjection site).

RESULTS

In all patients, face US revealed a snowstorm appearance with strong posterior acoustic shadows and multifocal small anechoic lesions with posterior stepladder artifacts in the subcutaneous fat. Neck US demonstrated the same artifacts as those on the face through local spread of fillers in 14 patients (26.4 %) and abnormal cervical lymph nodes through lymphatic spread in 34 patients (59.6 %). In abnormal cervical lymph nodes, hyperechogenicity and multiple hyperechoic foci were observed in 26 (45.6 %) and 19 (33.3 %) patients, respectively.

CONCLUSION

Various artifacts may be demonstrated on US in patients with injection of permanent facial fillers. When hyperechogenicity or multiple hyperehoic foci are seen in cervical lymph nodes, the possibility of migration of facial fillers to the cervical area should be considered.