Судинна оклюзія після введення філера: розпізнайте, підтвердьте допплерографією, лікуйте під контролем УЗД

Treat blanching, a violet net-like pattern along one artery or a capillary refill over 3 seconds against the other side as a vascular occlusion: start hyaluronidase at once and scan to find the blocked artery. For that scan I recommend the Suresult L20Pro at $3,720. In Schelke’s 2023 series of 39 events that a mean 1,519 IU of flooding had not resolved, hyaluronidase placed beside the blocked trunk under Doppler restored flow in under a minute at a first dose averaging 95 IU, and all 39 healed without scars. The L20Pro scans at 16/20 MHz, above the 15 MHz floor of the 2025 Delphi consensus, reaches from the dorsal nasal artery 2.5 mm under the skin to the facial artery 8 mm deep beside the ala, and runs Color, Power and PW Doppler with Needle Enhance in the free Suresult app, with three months of FaceAtlas AI included.

An event scan asks three things of a probe: enough frequency to resolve arteries 2.5 to 8 mm under the skin, Color and PW Doppler that read slow flow, and a charged battery and a paired tablet the moment a patient blanches. The 2025 Delphi panel of 15 experts from 11 countries set a linear probe of at least 15 MHz as the minimum, accepted handheld devices, and made ultrasound-guided injection mandatory in complication management. Prices checked October 26 and 27, 2026.

Frequency decides which arteries show. The Delphi minimum is a 15 MHz linear probe, with a footnote that 12 MHz serves in some cases, and Velthuis’s 2021 Doppler guide reports that 12 MHz does not always show the small infraorbital and supraorbital arteries. The six centers in Sigrist’s 2026 series scanned every event at 18 to 24 MHz. In Desyatnikova and Schelke’s 2022 handheld series, 18 patients with filler occlusions recovered completely after 50 to 300 U per event (median 100), placed with a Philips Lumify at 12 MHz, a Clarius L20 at 20 MHz or a GE Vscan Air at 12 MHz. The WFUMB 2025 position paper makes Color Doppler a requirement in every aesthetic study and calls PW Doppler essential to rule out an occlusion. The frequency bands behind these choices are set out in the guide to high-frequency ultrasound machines.

Compare carefully what keeping PW Doppler costs, because PW is the mode that measures the flow. Clarius puts PW in its Essentials membership and Butterfly in its Advanced membership; GE, Philips and Suresult include it in the app. Five-year totals for each probe, software included, are in the посібник із вартості УЗД в естетичній медицині.

The Suresult L20Pro covers that range from 16 to 20 MHz with presets from 10 to 40 mm, so the dorsal nasal arteries at 2.5 mm and the facial artery at 8 mm beside the ala sit in one field. Its PW gate’s sample volume, steer and angle are set on screen, and the app reads PS, ED, PI and RI on the trace, the values published event series compare with the other side of the face. Every Suresult L-series probe is 510(k)-cleared under K211321, rated IP67 and drop-tested.

The first signs of vascular occlusion after filler follow the timeline the ACE Group sets out (King 2020): blanching at once, livedo within minutes to tens of minutes, a capillary refill over 3 seconds within minutes, and a blue-gray cast over tens of minutes to hours. The CMAC guideline (Murray 2021) groups the skin changes into five stages, with coagulation able to come before the pustules, with them or hidden under them. CMAC treats pallor and livedo as stages that still reverse: neither one makes necrosis inevitable.

Capillary refill is the bedside test. Press the area for 5 seconds with a fingertip or a small flat object, release, and time the color’s return on both sides. CMAC calls under 2 seconds normal; the ACE Group puts normal at 2 seconds for men under 65, 3 seconds for women under 65 and 4 seconds in elderly patients, and reads anything over 3 seconds as a sign of vascular compromise. A delayed refill points to the artery; a brisk refill on bluish skin points to the venous side, which presents later with a dull pain or none and dark discoloration.

Pain is the least reliable sign. Lidocaine in the syringe masks it, early pain is not always present, and pain away from the injection point is a warning sign of its own (King 2020). Adrenaline mixed with lidocaine masks the blanching, so CMAC leaves it out and allows 30 to 45 minutes to assess a patient after injecting the nose, glabella or forehead. Sigrist’s 100 referrals presented with livedo in 46, blanching in 38, pain in 25, pustules in 20 and ecchymosis in 16.

A bruise is blood that has leaked into the skin; an occlusion is skin that has lost its blood supply. Both turn purple, and the ACE Group notes that the dusky phase of an occlusion mimics a bruise, but a bruise does not blanch. Blanching, and a pattern that follows one artery’s path, belong to the occlusion. Two checks separate them at the chair, blanching under pressure and capillary refill timed against the other side, and Doppler settles the rest.

Two signs carried the diagnosis in Yao’s 2026 series of 57 suspected occlusions after hyaluronic acid injections: a change in skin color (odds ratio 30.4) and a delayed capillary refill (odds ratio 185.9). Together they predicted the occlusions that high-frequency ultrasound confirmed with an area under the curve of 0.944. Ultrasound confirmed 42 of the 57 and cleared the other 15.

A hematoma can hide an occlusion. In Rasheed and Itani’s 2026 case, a large bruise after nasolabial fold and upper-lip filler covered the livedo and the color change, yet capillary refill still ran over 3 seconds in places against the other side. Color Doppler and microflow imaging found the angular and superior labial arteries blocked and the perforators silent, after a blind 24,000 IU of hyaluronidase had failed. Guided injections of 1,560 IU into the deposits, in two cycles, restored flow, and the skin healed within a month.

On Doppler, a filler vascular occlusion shows as absent flow in the perforating arteries (42 of 100 patients) or in a named artery such as the angular or a labial artery (35 of 100), with compensatory flow around the silent area in 26, a string sign in 18, flow diversion in 16 and a peak systolic velocity raised above the other side or the adjacent segment in 16 (Sigrist 2026). Those rates come from the largest Doppler series of filler events, from six centers in Brazil, Chile, Colombia, the Netherlands and the United States. Every one of the 100 patients was scanned with an 18 to 24 MHz linear probe in Color, Power and spectral Doppler, with the velocity scale set near 3 cm/s, abundant gel, minimal probe pressure and the healthy side alongside for comparison. Twelve of the 100 had a normal scan, which the authors attribute to flow in small vessels below the 2 cm/s a scanner detects, or to flow that earlier hyaluronidase had already restored. One patient can show several patterns.

Two patterns travel together: absent perforator flow and compensatory flow around it (phi 0.37). Pattern rates showed no significant difference between the 79 patients who had hyaluronidase before the scan and the 21 who had not. Among 117 arterial involvements, the superior labial artery led (18%), followed by the angular artery (11%) and the inferior labial, supratrochlear and dorsal nasal arteries (9% each). Hyaluronic acid caused 98 of the 100 events and calcium hydroxylapatite 2.

Other series add what B-mode shows at the block. In all 39 of Schelke’s 2023 cases, an anechoic or hypoechoic oval of hyaluronic acid sat beside or around the arterial trunk, the trunk itself was hypervascular, and the symptomatic skin above it was hypovascular and held no filler. Azizi’s 2025 cases showed the blocked artery as a noncompressible tube without flow, and the WFUMB position paper describes a serrated arterial wall with a hypoechoic lumen and an attenuated PW signal just beyond the block. Most filler obstructions are partial, the WFUMB panel notes, so a thin or slowed signal counts as much as an empty vessel. Velthuis’s 2021 Doppler guide adds the hemodynamics: the vessel before the block widens with turbulent red and blue flow, and collaterals dilate around it in a pattern the team calls a Medusa head.

Facial arteries under the skin run slowly: the WFUMB panel puts hypodermal peak systolic velocities at 15 cm/s or less, against a usual detection floor of 2 cm/s. Set the Color scale low, near the 3 cm/s Sigrist’s centers used, lower the pulse repetition frequency and the wall filter until the pulsatile signal stands out, switch to Power Doppler for the faintest flow, and use the PW gate to confirm an arterial waveform and read PSV and RI on both sides. Use abundant gel and keep the probe light: pressure collapses these vessels, and Velthuis’s team scans the nose and the supraorbital area with no pressure at all. Veins compress under the probe; a blocked artery stays a noncompressible tube.

Vascular occlusion treatment starts on the clinical signs, without waiting for imaging: stop injecting, start hyaluronidase, then scan to locate the block, target it under guidance and rescan until flow returns. In Sigrist’s centers hyaluronidase went in promptly once the signs were recognized, and the Doppler scan followed, often on the same day as treatment. The same team writes that occlusions of the perforators and the microvasculature are hard to treat on clinical signs alone, and that patients benefit from Doppler’s localization of the abnormal flow. Keep the probe charged and paired before the first syringe, so the scan starts within minutes. The ACE protocol adds aspirin 300 mg at once, then 75 mg daily.

1. Stop injecting and look at the whole face. Check capillary refill on both sides and along the artery’s course, and video the area in good light before treatment, as CMAC directs.
2. Start hyaluronidase on the clinical signs. Treatment goes ahead of the scan: CMAC infiltrates 1,500 units along the artery’s course and across the whole ischemic area, uses more than one vial when the area is large, and treats to effect (Murray 2021).
3. Scan as you treat. Scan the injected area first, then the full face: the Delphi panel makes the injected-area scan mandatory and recommends the full-face scan. Compare each artery with the other side in Color, Power and PW.
4. Locate the block. Follow the arterial track from the skin sign back to the trunk. Livedo maps onto the perforators of the superficial fat compartments (Schelke 2024, 125 patients), and the filler sits as an anechoic oval at the base of the trunk (Schelke 2023).
5. Target the block under guidance. Bring the needle in plane, under a sterile probe cover with sterile gel, into the perivascular space or into the deposit at the base of the trunk. Schelke’s first doses averaged 95 IU; Urso’s team started at 30 IU and stepped up by 35 to 50 IU to a maximum of 150 IU.
6. Rescan at once. Flow returned in under 60 seconds in Schelke’s 39 patients. Where it stays silent, inject again: in Azizi’s nasal case a second 150 U at 15 minutes brought rebound flow in the dorsal nasal artery, with a resistance index comparable to the other side.
7. Record it. Save clips and the PSV and RI on both sides before and after treatment, and name the equipment in the report: the Delphi panel makes recording mandatory and WFUMB asks for the equipment in every report.
8. Follow up in person. Rescan within 24 hours and again at about a week; Urso’s team rescanned at day 1 and day 20. CMAC reviews every resolved occlusion the next day, and the ACE Group gives each patient an out-of-hours number and assesses any suspected event in person.

Hyaluronidase for vascular occlusion follows one of two dosing schools. Unguided protocols flood the ischemic territory and repeat hourly until the skin recovers: CMAC infiltrates a 1,500-unit vial per round, more than one for a large area, and the high-dose pulsed protocol gives 500 IU for a small area and 1,500 IU for a larger one, as Schelke 2023 describes it. Guided protocols place a fraction of that into the deposit or beside the blocked trunk and stop when Doppler shows flow: Schelke’s first doses averaged 95 IU, and Urso’s ran from 30 IU up to 150 IU. Hyaluronidase crosses the arterial wall: in DeLorenzi’s 2014 cadaver work it broke down hyaluronic acid sealed inside intact facial-artery segments from the outside, at 4 and 24 hours, while saline controls stayed unchanged. CMAC and the ACE Group both treat around the artery rather than inside it, and Boey’s 2025 meta-analysis found no significant difference in resolution between intra-arterial and into-deposit placement (p = 0.36).

Guided treatment holds up across studies. Boey’s 2025 meta-analysis of four studies and 55 patients put complete resolution after ultrasound-guided hyaluronidase at 94.6% (95% CI 80.6–98.7), against about 77.8% for hyaluronidase in general. Two or four split doses beat one large dose in Lee’s 2020 rabbit model: four 125 IU injections 15 minutes apart kept 88.26% of the flap alive and two of 250 IU kept 81.49%, against 74.83% for a single 500 IU. Murray’s 2026 diffusion analysis explains the gap in units: cross-linked filler slows the enzyme’s spread, so placing it inside the deposit at several points does the work that volume does in a flood. CMAC’s own guideline puts guided doses at 35 to 60 units on average, up to 150. Hyaluronidase dissolves the filler, and the probe makes each unit count: it finds the deposit beside the trunk, guides the needle into it in plane and shows flow return on the rescan. Planned dissolving outside an emergency follows its own routine, set out in the guide to розчинення філера під контролем УЗД.

Occlusions also follow calcium hydroxylapatite (Radiesse) and poly-L-lactic acid (Sculptra) fillers, and hyaluronidase still has a role after them. The 2020 CaHA consensus (van Loghem) gives 600 U of hyaluronidase for every 0.1 mL of CaHA injected, checks reperfusion every 30 to 60 minutes, and repeats every 2 hours for 3 to 4 cycles when flow does not return within the hour. Kadouch’s team resolved two CaHA events and one PLLA event with hyaluronidase injected into the lesion under ultrasound, without necrosis or scarring. On ultrasound, CaHA shows as hyperechoic deposits with posterior shadowing, and PMMA as bright dots with comet-tail artifacts (Tao 2022). Sodium thiosulfate dissolved CaHA injected into porcine skin samples (Robinson 2018) but left intra-arterial CaHA intact in human cadaver arteries at 24 hours (Yankova 2021), and a 2024 review calls it too slow for an emergency (Wollina 2024).

Vision loss after filler most often begins immediately or within 10 minutes of the injection (Sansome 2026), and 62.7% of the cases in Doyon’s 2024 literature review presented with no perception of light. An ophthalmic artery occlusion after filler takes vision with ptosis and ophthalmoplegia; a central retinal artery occlusion takes vision alone (Goodman 2020). CMAC cites work showing retinal infarction within 12 to 15 minutes of a complete block. The nose, forehead and glabella account for 40.6%, 27.7% and 19.0% of the 365 cases published from 2018 to 2023, and hyaluronic acid for 79.6% (Doyon 2024).

1. Stop and transfer. Send the patient to the nearest emergency department without delay. The 2026 UK consensus asks every injector to keep the department’s details printed, to go with the patient when possible, and to consider phoning ahead on the way.
2. For hyaluronic acid filler, give hyaluronidase without delaying transfer. The UK consensus allows it where the filler went in or near the supraorbital notch or the supratrochlear vessels, from a clinician competent in the technique and only when it does not significantly delay transfer; it gives retrobulbar and peribulbar injection no place. Goodman’s consensus injects 1,500 units in 2 mL of 1% lidocaine at the filler site and over any skin showing ischemia. Walker’s consensus sends four 1,500 IU vials with the patient.
3. Use the minutes before the ambulance. While transfer is arranged, and as long as they add no delay: ocular massage in 5-second presses with 10 seconds off for up to 5 minutes, the patient supine at 15 to 45°; rebreathing into a paper bag for 10 minutes in every 30; one drop of timolol 0.5% in the affected eye; and 300 mg of aspirin unless contraindicated (Sansome 2026).
4. Write down the times. Walker’s record form logs every intervention, the time of onset, the filler type and amount, the site, needle or cannula, the signs, the treatment after vision loss, the time the ambulance arrived and the first hospital interventions.

The hospital confirms the block. In Huang’s 2019 series of 10 patients who lost vision after cosmetic facial injections (7 autologous fat, 3 hyaluronic acid), color Doppler flow imaging of the orbit showed absent or sharply reduced retrobulbar flow in all six ophthalmic artery occlusions, and absent or reduced central retinal artery flow in the three central retinal artery occlusions. Partial vision at onset predicted improvement (P < .001): of 318 cases with recorded outcomes in Doyon's review, 6.0% recovered fully and 25.8% partly.

The early signs of vascular occlusion in the lips are the skin signs read against the other side of the lip: blanching at once, a violet net-like pattern along the path of the blocked labial artery, and capillary refill over 3 seconds (King 2020). A bruise beside them does not blanch. Lips sit in CMAC’s moderate risk grade, yet they carry a large share of the events: 31 of 162 hyaluronic acid occlusions by needle in Alam’s 2021 survey (19.1%), second only to the nasolabial folds, and the labial arteries in 17 of 44 Dutch referrals. They also recover well. Of the 34 lip occlusions in Alam’s survey, 33 left no sequelae, and all 17 Dutch labial cases recovered fully after Doppler-guided hyaluronidase.

The labial arteries run deeper than the lip line suggests. In Cotofana’s 2020 ultrasound study of 41 volunteers, the superior labial artery lay 5.6 mm deep and the inferior labial artery 5.2 mm, in the submucosal plane in 58.5% of measurements, intramuscular in 36.2% and subcutaneous in 5.3%. A 2026 meta-analysis puts the pooled averages at 4.59 to 4.90 mm (Trzeciak 2026). Both sit inside the 10 mm preset of the L20Pro and L24Pro. Prevention comes before the needle: map the labial arteries before you inject, following each one in Color or Power Doppler from the commissure to the midline.

A lip occlusion from compression can surface the next day. Figueiredo’s 2024 patient arrived 24 hours after 1 mL of hyaluronic acid with lidocaine in both lips, with pain and ecchymosis over the right upper lip, the nose and the oral vestibule. Color Doppler on a 7 to 16 MHz linear probe showed reduced flow in the superior labial artery against the other side, and five hyaluronidase applications totaling 5 mL over 3 hours restored it before discharge. The authors place bruises within a few hours of the injection and compression signs on the following day. Kroumpouzos’s 2023 review of lip and perioral complications puts ultrasound to the next question: it separates an embolus inside the artery from a filler deposit pressing on it. The lip also appears among vision-loss sites: 1 of 226 in the American Academy of Ophthalmology’s 2025 report, and one orbital infarction after hyaluronic acid lip filler in Diala’s 2026 case.

Risk follows the arteries. CMAC grades the glabella, nose and forehead very high; the temples, nasolabial folds, tear troughs, periorbital area and medial cheek high; the lips, perioral area and anterior cheek moderate; and the jawline, marionette area, lateral cheek, submalar area, preauricular area and chin low (Murray 2021, adapted from the Goodman consensus). Each row pairs a site with the arteries measured there and the events counted in published series. Mapping these arteries before the first injection is the subject of the guide to ultrasound-guided filler injections.

The nose leads the most recent vision-loss review, with 40.6% of 365 cases (Doyon 2024). Nose filler necrosis occurred in 0.08% of 8,604 nonsurgical rhinoplasty patients, and vision loss in 0.09% (DeVictor 2021). Its tip and ala depend on an end artery with little collateral flow (King 2020), and Park’s 2011 referral series names the glabella and the nasal ala as the two danger zones for necrosis. A prior rhinoplasty adds to the risk: in Rivkin’s 2,488 nonsurgical rhinoplasty procedures it raised the odds of an adverse event (odds ratio 1.51), and all seven patients in Robati’s 2018 necrosis series had had a cosmetic rhinoplasty more than three years earlier. The dorsal nasal arteries run 2.5 to 2.7 mm under the skin, inside the 10 mm preset of the L20Pro and L24Pro, and Velthuis’s team scans the nose with no probe pressure at all.

Delayed vascular occlusion after filler surfaces hours to days after the injection, once the patient has gone home: published cases began at 6, 15 and 36 hours (Bravo 2015), after 48 symptom-free hours (Chauhan 2019) and at 2 days (Cassiano 2020). It is the smaller group: 38 of the 39 events in Schelke’s 2023 series began immediately, and CMAC places most ischemic changes instantly or within a few hours. For the later ones CMAC lists three mechanisms: an embolus lodging in a narrower arteriole downstream, hyaluronic acid drawing in water until the bolus blocks or compresses the vessel, and platelets gathering on a partial bolus. Hirsch’s 2007 case shows the second: slow swelling after a Juvéderm injection compressed the vessel, and the impending necrosis that surfaced late was managed with hyaluronidase. The ACE Group adds an embolus in skin with poor collateral supply, where the signs surface over the following hours, and filler that sits at a bifurcation and dislodges later into a terminal branch.

Late events reach the eye too: in Taylor’s 2020 anatomical study, blindness was delayed by up to 2 weeks in some cases, and Walker’s consensus sorts vision loss into immediate (minutes), delayed (1 to 24 hours) and late (days to weeks) onset. Kroumpouzos’s 2023 review times perioral complications as immediate within 24 hours, early from 24 hours to 4 weeks, and late after 4 weeks. The ACE Group gives every filler patient an out-of-hours number and sees any suspected event in person, never by photo or message. Guided treatment still helps late: in the Dutch referral series, one infraorbital patient received Doppler-guided hyaluronidase 8 months after the injection and recovered fully.

Skin necrosis after filler announces itself around day 3, when pustules and blisters rise over the ischemic area (Murray 2021; Farmer 2021). Hong’s team found that after 3 days a crust forms over a red base with a fibrous rim, and advised starting treatment no later than day 3 to head off necrosis. Earlier is better at every step. In a rabbit-ear model, 750 IU of hyaluronidase given 4 hours after the filler shrank the necrotic area, while the same dose at 24 hours made no difference (Kim 2011). DeLorenzi reports no partial or complete skin loss under the high-dose pulsed protocol when it started within 2 days of onset, and Alhusain’s 2026 meta-analysis of 21 studies and 231 patients found that treatment within 6 hours improved outcomes, with skin necrosis resolving in 78.4% overall.

Once the skin breaks down, wound care leads. CMAC makes it the priority after 48 hours, or once blisters form at about 72 hours (Murray 2021). Granulation lasts 2 to 4 weeks with the size and depth of the wound bed, and remodeling begins as soon as 21 days after the injury (Farmer 2021). Rescans across that period show whether flow has returned to the territory: Urso’s team rescanned at day 1 and day 20, and Azizi’s at 1 hour, 24 hours and 1 week.

Vascular occlusion occurs after 1 in 6,558 filler treatments by the Dutch national referral center’s count (Schelke 2020, range 1 in 5,300 to 1 in 8,000), and after 1 in 6,410 needle syringes against 1 in 40,882 cannula syringes in Alam’s 2021 survey of 370 US dermatologists. Each study counts a different denominator: treatments, syringes, injection sites or patients. The Dutch center counted every occlusion referred over 25 months against a national estimate of 138,496 filler treatments a year, and Alam’s team asked its dermatologists about 1.7 million syringes injected over the preceding ten years.

Occlusions concentrate where the arteries are: in Alam’s survey the nasolabial folds and lips led the count, and the glabella carried the highest mean severity. Needles produced occlusions about six times as often per syringe as cannulas, and 106 of the 370 dermatologists (28.6%) reported at least one occlusion. The guide to choosing a cannula or a needle by area covers the gauge for each site and how the tip shows on the scan. CMAC asks every injector to recognize the clinical presentation and to have clear protocols and referral pathways in place before the first event.

A vascular occlusion emergency kit starts with hyaluronidase: the 10-Point Plan (Heydenrych 2021) keeps at least five 1,500 IU vials of hyaluronidase in the clinic, the Goodman consensus asks for at least 7,500 units on site, and CMAC reconstitutes at 1,500 units per mL. Store the enzyme below 25 °C and reconstitute it with a local anesthetic without adrenaline (Murray 2021, hyaluronidase guideline).

Suresult’s sterile hydrogel gel pads, Ø 35 × 4 mm, put a 4 mm stand-off between the probe face and the skin, so the probe reads the superficial arteries without pressing them shut: EFSUMB’s dermatologic ultrasound statement calls for gel pads to avoid compressing the superficial vascular plexus (Alfageme 2021). The pad stays on through the scan and the guided injection, and the needle passes through it. Each patient gets a fresh sterile pad. The pads are latex-free and tested for biocompatibility to ISO 10993, fit other brands’ linear probes as well as Suresult’s and have a 5-year shelf life, long enough to wait in the kit between events. A pack of 50 costs $140, shipping and tax included.

A complete record serves the next scan as much as the file. CMAC asks for a video in good light with capillary refill checked along the artery’s track, the whole ischemic area marked, contemporaneous notes with images, and a review the next day even after resolution. The Delphi panel makes ultrasound recording mandatory in complication management, and WFUMB asks every report to name the equipment.

The Suresult app keeps cine loops of 100, 200, 500 or 1,000 frames and exports JPEG, PNG, MP4 and DICOM, so the before-and-after clips and the PSV and RI values on both sides go into the record and the referral letter. FaceAtlas AI, included for three months with each Pro probe, files every visit in the patient’s record with one-click comparison to the last visit, 5-second clips and a Facial Ultrasound Assessment PDF shared by email, Drive or print.

The three Pro probes share a 256-element linear array 25 mm wide, a 4,400 mAh battery rated for 4 hours of scanning, a 145 g housing and the full Doppler set: Color, Power and PW with steer, gain, PRF, wall filter, gate volume and angle on screen, PS, ED, PI and RI on the trace, and automatic vessel flow measurement. Each includes three months of FaceAtlas AI. Their frequency bands and depth presets decide which arteries fill the screen; the L20 vs L24 aesthetic ultrasound guide compares them site by site.

All six Suresult probes in this guide pair over Wi-Fi with the free Suresult app for iOS, Android and Windows, which runs B-mode, M-mode, Color, Power and PW Doppler.

For one probe that covers every facial artery, I recommend the L20Pro at $3,720. For a practice centered on lips, noses and glabellar lines, I choose the L24Pro at $4,185, and for a clinic that scans the body as well as the face, the L14Pro at $3,441. Each Pro ships within 24 hours with a 30-day trial and a two-year warranty that extends to three or five years, and the price at checkout already covers customs and duties: No Hidden Fees.