title: Clinical implications of ultrasound artifacts in the cervicofacial area following injection of permanent facial fillers.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, 612-896, Republic of Korea.
authors.forename: Kwang Hwi
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, 612-896, Republic of Korea. rjhrad@empal.com.
authors.forename: JiHwa
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, 612-896, Republic of Korea.
authors.forename: OkHwa
authors.initials: O
authors.lastname: Kim
authors.affiliation: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, 612-896, Republic of Korea.
authors.forename: JungHee
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, 612-896, Republic of Korea.
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Pusan Paik Hospital, Inje University College of Medicine, Gaegum-dong, Busanjin-Gu, Busan, 633-165, Republic of Korea.
authors.forename: YoungMi
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Radiology, Pusan Paik Hospital, Inje University College of Medicine, Gaegum-dong, Busanjin-Gu, Busan, 633-165, Republic of Korea.
authors.forename: DongWook
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeun-daero, Haeundae-Gu, Busan, Republic of Korea.
authors.forename: JiYeon
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D003357:Cosmetic Techniques / Q000009:adverse effects*; D005145:Face / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012828:Silicones; D014463:Ultrasonography
chemical_list: D012828:Silicones
keywords: Artifact; Facial filler; Ultrasound