Why do I scan with ultrasound before injecting filler?

By Dr Andy Taylor · Published 3 November 2026 · Last reviewed 3 November 2026

Treatment at our clinic: Ultrasound-guided fillers

I scan your face with ultrasound before I inject filler, so that I can see where most of your blood vessels are rather than relying on surface landmarks alone. The arteries in the face vary in position and depth from person to person, and filler entering a blood vessel is the most serious risk of the treatment. The scan gives me information about your face. It does not remove every risk, and I explain why below.

Why do blood vessels matter?

Filler is placed under the skin to restore volume or shape. Rarely, filler enters or presses on an artery and blocks the blood flow. This is called vascular occlusion. In a survey of US dermatologists covering 1.7 million syringes, it was reported about once in every 6,400 syringes when a needle was used, and about once in every 41,000 when a blunt cannula was used. Most of the patients affected had no lasting effects.¹ Because the doctors reported their own cases, I think the true rate may be higher.

Very rarely, a blocked vessel affects eyesight. Published cases most often followed injection into the nose, and sight recovered fully in only a minority.² This is why I take the blood supply of the face seriously at every appointment.

Why are surface landmarks not enough?

Injectors learn where the main facial arteries usually run. Usually is not always. A 2025 review of 12 studies found that the depth of the facial artery varies widely between people. It lies about 10 mm deep near the corner of the mouth and about 2.4 mm deep at the inner corner of the eye. The authors suggest an ultrasound scan at the first consultation for the area beside the nose.³

What does the scan show?

Doppler ultrasound shows blood flowing in a vessel. It can detect nearly all of the arteries of the face. One expert review recommends mapping them before injecting the forehead, the area between the eyebrows, the temples, the nose and the lines beside the nose.⁴ Ultrasound also shows filler that is already in place.⁵ If you have had filler elsewhere, I can see where it sits before I recommend anything further.

I use ultrasound routinely in my NHS work as a consultant anaesthetist, so scanning is part of how I work, not an extra. I use it to plan where the filler goes and to see the tissue layers I am injecting into.

What happens at your appointment?

Every treatment starts with a face-to-face consultation, including your medical history and what you want to achieve. If filler is not right for you, I will say so. I scan the area with a small handheld probe and use the scan to plan the treatment. The treatment itself takes about 30 to 45 minutes, plus the scan, and most fillers contain a numbing agent. You may not be treated at your first appointment: I will explain your options, the risks and the costs, and give you time to decide. A review appointment follows about two weeks later.

The law does not allow filler to be given for cosmetic reasons to anyone under 18.⁶

What can ultrasound not do?

No study has yet shown that scanning before filler lowers the number of complications. Blocked vessels are rare, so a study would need to be very large to show a difference. The evidence for ultrasound is strongest when a problem is suspected. Small published series show that a scan helps the injector find the filler and the affected vessel, and treat it in a targeted way.^7,8 The clinic follows a written plan for managing complications.

So the scan is not a guarantee. It gives me more information about your face before I inject, and I would rather have that information than not.

Is it right for you?

If you are thinking about filler, or want to know where previous filler sits, book a consultation. We will talk through what you want, scan the area and give you a written plan with prices.

Sources

1. Alam M et al. Rates of vascular occlusion associated with using needles vs cannulas for filler injection. JAMA Dermatology 2021;157(2):174-180.
2. Beleznay K et al. Update on avoiding and treating blindness from fillers: a recent review of the world literature. Aesthetic Surgery Journal 2019;39(6):662-674.
3. Trzeciak M et al. The depth of the facial artery: a meta-analysis. Aesthetic Plastic Surgery 2025;49(13):3793-3802.
4. Lee W. Hyaluronic acid filler injection guided by Doppler ultrasound. Archives of Plastic Surgery 2023;50(4):348-353.
5. Schelke LW, Decates TS, Velthuis PJ. Ultrasound to improve the safety of hyaluronic acid filler treatments. Journal of Cosmetic Dermatology 2018;17(6):1019-1024.
6. Botulinum Toxin and Cosmetic Fillers (Children) Act 2021, section 1.
7. Schelke LW et al. Ultrasound-guided targeted vs regional flooding: a comparative study for improving the clinical outcome in soft tissue filler vascular adverse event management. Aesthetic Surgery Journal 2023;43(1):86-96.
8. Azizi N et al. Ultrasound-guided hyaluronidase injections for the management of filler-induced arterial ischemia. Aesthetic Surgery Journal Open Forum 2025;7(3).