title: Ultrasound detection and identification of cosmetic fillers in the skin.
abstract: BACKGROUND
  While the incidence of cosmetic filler injections is rising world-wide, neither exact details of the procedure nor the agent used are always reported or remembered by the patients. Thus, although complications are reportedly rare, availability of a precise diagnostic tool to detect cutaneous filler deposits could help clarify the association between the procedure and the underlying pathology.
  
  
  OBJECTIVE
  The aim of this study was to evaluate cutaneous sonography in the detection and identification of cosmetic fillers deposits and, describe dermatological abnormalities found associated with the presence of those agents.
  
  
  METHODS
  We used ultrasound in a porcine skin model to determine the sonographic characteristics of commonly available filler agents, and subsequently applied the analysis to detect and identify cosmetic fillers among patients referred for skin disorders.
  
  
  RESULTS
  Fillers are recognizable on ultrasound and generate different patterns of echogenicity and posterior acoustic artefacts. Cosmetic fillers were identified in 118 dermatological patients; most commonly hyaluronic acid among degradable agents and silicone oil among non-degradable. Fillers deposits were loosely scattered throughout the subcutaneous tissue, with occasional infiltration of local muscles and loco-regional lymph nodes. Accompanying dermatopathies were represented by highly localized inflammatory processes unresponsive to conventional treatment, morphea-like reactions, necrosis of fatty tissue and epidermal cysts; in the case of non-degradable agents, the associated dermatopathies were transient, resolving upon disappearance of the filler.
  
  
  CONCLUSIONS
  Cosmetic filler agents may be detected and identified during routine ultrasound of dermatological lesions; the latter appear to be pathologically related to the cosmetic procedure.
authors.affiliation: Department of Radiology, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile. xwo@tie.cl
authors.forename: X
authors.initials: X
authors.lastname: Wortsman
authors.forename: J
authors.initials: J
authors.lastname: Wortsman
authors.forename: C
authors.initials: C
authors.lastname: Orlandi
authors.forename: G
authors.initials: G
authors.lastname: Cardenas
authors.forename: I
authors.initials: I
authors.lastname: Sazunic
authors.forename: G B E
authors.initials: GB
authors.lastname: Jemec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage*; D003358:Cosmetics / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D017886:Durapatite; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D006820:Hyaluronic Acid / Q000031:analogs & derivatives; D066298:In Vitro Techniques; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D012827:Silicone Oils; D012828:Silicones; D012867:Skin / Q000000981:diagnostic imaging* / Q000187:drug effects*; D013552:Swine; D014463:Ultrasonography
chemical_list: D001672:Biocompatible Materials; D003358:Cosmetics; D003879:Dermatologic Agents; D012827:Silicone Oils; D012828:Silicones; D006820:Hyaluronic Acid; D019904:Polymethyl Methacrylate; D017886:Durapatite; C445361:Restylane