{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:29:47Z","timestamp":1790702987512,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The midface is a key area in facial aesthetics, highly susceptible to age-related changes such as fat pad absorption, bone resorption, and loss of skin elasticity. These changes lead to the formation of prominent folds, such as the nasolabial fold. In addition, critical vascular structures and non-vascular components, such as the facial artery, angular artery, and parotid gland, make this region prone to complications during filler injections. High-frequency ultrasound (HFUS) offers real-time, radiation-free visualization of facial anatomy, enabling injectors to accurately target the desired treatment planes and avoid critical structures. This article is the second in a series of articles on ultrasound-guided facial injections and focuses on the midface. It provides a detailed overview of the sonographic anatomy of key areas, including the nose, tear trough, nasolabial fold, zygomatic, and preauricular regions. Step-by-step techniques for ultrasound-guided filler injections are described, emphasizing the importance of scanning both before and during injections to ensure safe filler placement. By using ultrasound in this area, injectors can possibly minimize risks such as vascular occlusion and other complications, such as the Tyndall effect and intra-parotid injection. With ongoing advancements, ultrasound-guided injections are expected to become more refined, enhancing both aesthetic outcomes and patient safety.<\/jats:p>","DOI":"10.3390\/diagnostics14222544","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T09:59:11Z","timestamp":1731491951000},"page":"2544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Best Practices for the Use of High-Frequency Ultrasound to Guide Aesthetic Filler Injections\u2014Part 2: Middle Third of the Face, Nose, and Tear Troughs"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8981-2755","authenticated-orcid":false,"given":"Roberta","family":"Vasconcelos-Berg","sequence":"first","affiliation":[{"name":"Margarethenklinik-University Hospital of Basel, CH-4051 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0676-4020","authenticated-orcid":false,"given":"Stella","family":"Desyatnikova","sequence":"additional","affiliation":[{"name":"The Stella Center for Facial Plastic Surgery, Seattle, WA 98101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Bonavia","sequence":"additional","affiliation":[{"name":"Margarethenklinik-University Hospital of Basel, CH-4051 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7041-3079","authenticated-orcid":false,"given":"Maria Cristina","family":"Chammas","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Navarini","sequence":"additional","affiliation":[{"name":"Margarethenklinik-University Hospital of Basel, CH-4051 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5780-4136","authenticated-orcid":false,"given":"Rosa","family":"Sigrist","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sigrist, R., Desyatnikova, S., Chammas, M.C., and Vasconcelos-Berg, R. (2024). Best Practices for the Use of High-Frequency Ultrasound to Guide Aesthetic Filler Injections\u2014Part 1: Upper Third of the Face. Diagnostics, 14.","DOI":"10.3390\/diagnostics14161718"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1093\/asj\/sjac353","article-title":"Doppler Ultrasound-Guided Filler Injections: Useful Tips to Integrate Ultrasound in Daily Practice","volume":"43","author":"Izidoro","year":"2023","journal-title":"Aesthetic Surg. J."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wortsman, X. (2022). Textbook of Dermatologic Ultrasound, Springer.","DOI":"10.1007\/978-3-031-08736-3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00266-016-0756-0","article-title":"Facing the Worst Risk: Confronting the Dorsal Nasal Artery, Implication for Non-surgical Procedures of Nasal Augmentation","volume":"41","author":"Tansatit","year":"2017","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"NP486","DOI":"10.1093\/asj\/sjaa153","article-title":"A Safe Doppler Ultrasound-Guided Method for Nasolabial Fold Correction with Hyaluronic Acid Filler","volume":"41","author":"Lee","year":"2021","journal-title":"Aesthetic Surg. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1111\/jocd.13018","article-title":"Nasal dorsum augmentation using soft tissue filler injection","volume":"18","author":"Lee","year":"2019","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1055\/s-0043-1770078","article-title":"Hyaluronic Acid Filler Injection Guided by Doppler Ultrasound","volume":"50","author":"Lee","year":"2023","journal-title":"Arch. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/asj\/sjab351","article-title":"Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned from Functional Anatomy","volume":"42","author":"Calomeni","year":"2022","journal-title":"Aesthetic Surg. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1097\/DSS.0000000000003051","article-title":"Handheld Doppler Localization of the Angular Artery to Reduce Intravascular Injection in Tear Trough Rejuvenation","volume":"47","author":"Noell","year":"2021","journal-title":"Dermatol. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e15045","DOI":"10.1111\/dth.15045","article-title":"Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening","volume":"34","author":"Wollina","year":"2021","journal-title":"Dermatol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3246","DOI":"10.1111\/jocd.16012","article-title":"Periorbital venous stasis may be involved with filler induced malar edema-A duplex ultrasound-imaging-based case series","volume":"22","author":"Schelke","year":"2023","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1111\/jocd.13838","article-title":"Evaluation of facial artery course variations and depth by Doppler ultrasonography","volume":"20","author":"Ten","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.fsc.2015.07.004","article-title":"Injectable Filler Techniques for Facial Rejuvenation, Volumization, and Augmentation","volume":"23","author":"Bass","year":"2015","journal-title":"Facial. Plast. Surg. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1002\/ca.23919","article-title":"Hyaluronic acid filler injection for deep nasolabial folds: A novel intraoral approach","volume":"35","author":"Yi","year":"2022","journal-title":"Clin. Anat."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/DSS.0000000000003756","article-title":"Investigating the Anatomic Location of Soft Tissue Fillers in Noninflammatory Nodule Formation: An Ultrasound-Imaging-Based Analysis","volume":"49","author":"Schelke","year":"2023","journal-title":"Dermatol. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/jocd.15319","article-title":"Filler injections in the pre-auricular space: Be aware of the parotid gland","volume":"22","author":"Schelke","year":"2023","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1002\/jum.15621","article-title":"Ultrasonographic Subclinical Signs of Inflammation of the Lacrimal, Parotid, and Submandibular Glands in Users of Cosmetic Fillers","volume":"40","author":"Wortsman","year":"2021","journal-title":"J. Ultrasound. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1007\/s00266-022-03221-x","article-title":"Studying Dynamics of Mid-face Lifting during Hyaluronic Acid Filler Injection Using Ultrasound Imaging","volume":"47","author":"Li","year":"2023","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/asj\/sjae091","article-title":"Update on Blindness from Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases","volume":"44","author":"Doyon","year":"2024","journal-title":"Aesthetic Surg. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/jocd.16037","article-title":"Ultrasound assessment of the nose vasculature: A review of the common method of non-surgical filler-based rhinoplasty","volume":"23","author":"Shekarriz","year":"2024","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/asj\/sjab310","article-title":"The Layered Anatomy of the Nose: An Ultrasound-Based Investigation","volume":"42","author":"Alfertshofer","year":"2022","journal-title":"Aesthetic Surg. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/asj\/sjab378","article-title":"Commentary on: The Layered Anatomy of the Nose: An Ultrasound-Based Investigation","volume":"42","author":"Tepper","year":"2022","journal-title":"Aesthet Surg J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e3924","DOI":"10.1097\/GOX.0000000000003924","article-title":"Anatomical Study of the Dorsal Nasal Artery to Prevent Visual Complications During Dorsal Nasal Augmentation","volume":"9","author":"Tansatit","year":"2021","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wu, W.T., Chang, K.V., Chang, H.C., Kuan, C.H., Chen, L.R., Mezian, K., Ricci, V., and \u00d6z\u00e7akar, L. (2022). Ultrasound Imaging of Facial Vascular Neural Structures and Relevance to Aesthetic Injections: A Pictorial Essay. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071766"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3256","DOI":"10.1111\/jocd.16430","article-title":"Nasal filling guided by high frequency ultrasound: Reducing risks","volume":"23","author":"Bravo","year":"2024","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1111\/jocd.16346","article-title":"Depth of the subcutaneous tissue in the nose: Application to filler injection","volume":"23","author":"Yi","year":"2024","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/jum.16433","article-title":"Ultrasonographic Evaluation of Facial Artery in the Nasolabial Fold for Gender Differences and Symmetry Between Hemifaces","volume":"43","author":"Boz","year":"2024","journal-title":"J. Ultrasound. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3177","DOI":"10.1111\/jocd.14241","article-title":"Supraperiosteal application of hyaluronic acid with cannula: Is it possible?","volume":"20","author":"Bravo","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1111\/jocd.13089","article-title":"Lifting vs volumizing-The difference in facial minimally invasive procedures when respecting the line of ligaments","volume":"18","author":"Casabona","year":"2019","journal-title":"J. Cosmet. Dermatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2544\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:31:38Z","timestamp":1760113898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,13]]},"references-count":29,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["diagnostics14222544"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14222544","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,13]]}}}