Feature Article: May/June 2022 – Using Ultrasound Facial Mapping to Enhance Precision in Aesthetic Medicine

Using Ultrasound Facial Mapping to Enhance Precision in Aesthetic Medicine

Jeff Morris

Advances in ultrasound technology have resulted in smaller devices that are tailored to specific uses, one of which is facial mapping for aesthetic procedures.

Dr. Luis Martinez has been using facial mapping to enhance precision in his practice, and he will present a lecture and demonstration as part of the Aesthetics track at the next AMMG conference in October, in Denver, Colorado.

“What we’re using is a portable ultrasound,” he said. “In this particular aspect, we’re mapping the face when doing cosmetic injections. The whole idea is to properly evaluate a couple of things.

“One is vasculature, so that when you’re injecting fillers you can inject them in the safest way possible. So this is looking at specific arteries in the face; you want to make sure you are not hitting any of these arteries.

“As the filler market increases — and every year there’s more and more people doing fillers, and more and more cases — it’s inevitable that the absolute number of complications will inevitably increase, because you’re just having more people injected.

“The whole idea is to have practitioners incorporate facial ultrasound as part of the standard of care, when assessing and injecting cases.”

Dr. Martinez said ultrasound can also help to assess previous injections, so if you have a patient who has had filler injections in the past, you can validate that with the ultrasound.

“Not specifically the brand, but the different types of fillers,” he said. “For example, you can tell if it was hyaluronic acid; with the ultrasound, it’s going to look different from a calcium hydroxylapatite filler. Or from a patient who’s had some silicone, which we don’t use here in this country, but may have been done in other countries. Micronized fat will also look different.”

“The different types of fillers being used have different consistencies and will look different under ultrasound. It’s very interesting. So we’re teaching doctors about with the ultrasound and facial anatomy — what to look for and how to look for it. There’s definitely a learning curve component”

Dr. Martinez said using ultrasound is also essential if you have more risky injection sites.

“For instance, I had a lady who wanted some filler in the glabellar region, in between the eyebrows above the bridge of the nose; she had a very defined deep wrinkle that would not go away with neurotoxins. Usually that area has risky zones because of vasculature, arteries coming out of there, so nobody really wanted to touch her. I did ultrasound there, was able to assess exactly where the arteries were, and was able to successfully inject without fear of hitting any of the arteries. The complications can get very nasty if you inject filler into a vascular area. But using ultrasound, safety is enhanced as well as efficacy.”

Another advantage, said Dr. Martinez, is that with ultrasound you can also evaluate patients that may have complications, and assess and treat them if you catch it fast enough.

“Technically, If you intervene fast enough, and you can localize the area with the ultrasound, you can inject some enzymes to degrade the hyaluronic acid and avoid long term  complications.”

The ultrasound Dr. Martinez uses is from a company called Butterfly, which he finds particularly versatile, but there are at least two other companies with ultrasounds that will work for facial mapping.

“For a properly trained physician, most of these ultrasounds will do,” he said. “What I’m going to teach doctors is what they can see on the screen and how to interpret what they are seeing.”

Dr. Martinez said he has been doing ultrasound in general for quite a few years on other parts of the body and has also been doing fillers for a long while. “What changed is I started integrating ultrasound into the facial aesthetics.”

“Granted, not every patient needs to be scanned, but part of what I’ll be teaching is how to evaluate that.”

Dr. Martinez’s main clinic is XanoGene, in San Juan, Puerto Rico; he is also Medical Director of Hormone Therapy of Orlando in Orlando, Florida.

For more information about the upcoming Age Management Medicine Conference in Denver, visit agemed.org