Ultrasound-Guided Filler Injections: Map the Arteries, See the Filler, Choose the Probe

The best-practice paper on the upper face names two workflows, "scan before injecting" and "scan while injecting" (Sigrist 2024). Each answers its own question, and a saved record closes the visit.

• Before: Survey the treatment area in B-mode for existing filler, its depth and its plane. Switch to Color or Power Doppler, trace each artery through the planned entry points, and choose an entry point and plane clear of the vessel (Schelke 2018; Lee 2023).
• While: Hold the probe over the target, follow the needle or cannula tip into the plane, then watch the product spread. In the temple, the same paper uses live imaging to confirm the cannula's plane (Sigrist 2024).
• After: Save a still or cine loop of each deposit. At the next visit, or if a complication appears, the record shows where the product went.

Two recent studies put numbers on mapping before injection.

• In a randomized parallel study of 120 patients receiving hyaluronic acid in the lower face, Doppler mapping found vascular signals in 63.3% of the mapped group and changed the injection plan in 53.3%. Bruising on day 3 was 23.3% in the mapped group against 48.3% in the landmark group (P = 0.004), and the mapped group needed fewer needle passes and had fewer early adverse events (Li 2026).
• A 3-year review covered 503 patients and 1,109 cc of hyaluronic acid injected after a vascular map that took under 3 minutes. Arteries wider than 0.8 mm sat at the planned site in 34.7% of glabellas, 13.2% of nasolabial folds and 2.9% of temples. The series recorded no vascular complications (Teixeira 2025).

Vascular events after filler are rare: a Dutch estimate put them at 1 in 6,558 procedures (Schelke 2020). A 2024 review of published cases of blindness after filler found no recovery of vision in 68.2% of the 318 cases with outcome data (Doyon 2024).

Start in B-mode at the shallowest depth that holds the target, then open a Color or Power Doppler box over the planned entry point. Rest the probe on a thick layer of gel or a gel pad with light pressure, because excessive pressure compresses the vessels (Teixeira 2025). Sweep slowly across the whole treatment area, switch to PW Doppler on each vessel you find to confirm an arterial waveform, and save the clip. The 20 MHz frames below were captured in a 20 mm window with a PRF of 1.0 kHz.

In the 503-patient mapping series above, the glabella had the highest share of large arteries at the planned site: about one glabella in three had an artery wider than 0.8 mm there (Teixeira 2025). The supratrochlear artery sits about 3.3 mm under resting skin and moves when the patient frowns (Cotofana 2020a), so map and mark with the face at rest. On the nose, the dorsal nasal artery runs about 2.5 mm deep at the nasion (Ortiz Middleton 2025). Beside the nasal ala, in the deep pyriform space, the angular artery averaged 3.6 mm under the epidermis (Franceschelli 2024). A 2026 study combining Doppler and cadaver dissection found the nasal arterial network highly variable and asymmetric (Nguyen 2026). All of this sits in the first 5 mm, where the 24 MHz of the L24Pro gives the finest detail.

In 41 volunteers scanned by ultrasound, the superior labial artery averaged 5.6 mm and the inferior labial artery 5.2 mm below the skin. Both ran most often in the submucosal plane (58.5%), then within the orbicularis muscle (36.2%), and in the subcutaneous plane in 5.3% (Cotofana 2020b). A 2026 meta-analysis put pooled labial artery depths at 4.59 to 4.90 mm (Trzeciak 2026). A Doppler sweep along each lip shows which plane the artery takes in this patient before the first bolus, and B-mode shows any older product already in the lip.

The best-practice paper on the midface maps the tear trough, nose, nasolabial fold and zygomatic region. Its example images show the infraorbital artery at 18 MHz and the tear trough at 20 MHz, and it singles out the angular artery near the nose in the medial tear trough (Vasconcelos-Berg 2024). The infraorbital artery's main trunk and its nasal and zygomaticomalar branches run in different planes (Hufschmidt 2019), so trace each branch from the foramen before placing product along the orbital rim. Existing filler in the tear trough shows on B-mode as a deposit the next treatment has to account for.

Over the zygoma, ultrasound shows the skin, subcutaneous tissue, SMAS, zygomatic muscles and bone, and the SMAS separates the superficial and deep fat compartments (Vasconcelos-Berg 2024). The same paper images superficial subcutaneous cheek tissue at 24 MHz. The facial artery deepens from 6.27 mm at the mandibular border to 8.04 mm at the lateral nasal ala (Pourani 2025). A 16/20 MHz probe with a 40 mm window holds the cheek layers and the artery in one view, which is why the L20Pro is my default for midface and nasolabial work.

The upper-face paper describes three injection planes in the temple: subdermal, interfascial between the temporal fascial layers, and supraperiosteal on bone (Sigrist 2024). Ultrasound maps the superficial and deep temporal vessels before injection and confirms the cannula's plane during it. Higher up, on the middle forehead along the vertical line through the lateral canthus, the frontal branch of the superficial temporal artery sat 2.7 mm under the skin (Phumyoo 2020).

FaceAtlas AI runs on an Android tablet or phone connected to an L14, L14Pro, L20, L20Pro, L24 or L24Pro.

• Filler Scan recognizes seven materials: HA, collagen, PLLA, PCL, CaHA, PMMA and PVA. It reports depth, size and distribution, with abnormality screening, complication evaluation and injection-depth verification.
• The 21-point protocol scans the same sites from forehead to jawline at every visit, recording skin and fat thickness and the depth to the SMAS at each one.
• Dual View shows the raw scan beside the AI tissue layers, and Color Power Doppler shows live flow.
• Reports: each visit closes with a Facial Ultrasound Assessment PDF in any of 11 languages, ready for side-by-side comparison at the next appointment.

The L14Pro, L20Pro and L24Pro each include three months of FaceAtlas AI. On the L14, L20 and L24, and on a Pro after its three months, a license costs $50 a month or $500 a year. A lifetime license costs $999 once and is sold until 11:59 PM Pacific Time on December 31, 2026. Each license activates one 64-bit Android device running Android 8.0 or later. The full feature list is on the FaceAtlas AI page.

The 2025 consensus lists Spectral Doppler as mandatory (Velthuis 2025), and PW Doppler is the spectral mode on all six probes in the L14, L20 and L24 families. Each runs it beside Color and Power Doppler in the free Suresult app on iOS, Android and Windows, stores images and clips on the device and exports DICOM. Needle Enhance brightens the needle on the L14Pro, L20, L20Pro, L24 and L24Pro. The L14 shows an on-screen grid with in-plane and out-of-plane guides.

Each sibling keeps its Pro's frequencies and depth range with 192 elements and 2 hours of scanning per charge, and runs the same Doppler modes. FaceAtlas AI runs on all three with a license from $50 a month. The siblings cost $2,139 for the L14, $3,000 for the L20 and $3,441 for the L24.

Suresult gel pads come 50 to a pack at $140, shipping and tax included. Each pad is sterile, individually sealed, adhesive and 35 mm across by 4 mm thick. It stays on through Doppler, the needle passes straight through it, and one pad serves one client.

Suresult checkout prices include shipping, customs clearance, duties and applicable taxes, delivered door to door: No Hidden Fees. Orders leave within 24 hours on business days. Delivery then takes 1–7 business days to Europe, North America and Oceania and 3–10 to Asia, Africa and South America.

• Each of the six probes carries a two-year warranty, with optional three- and five-year plans, and a 30-day trial.
• All six are IP67-rated, dust-tight and waterproof.
• All six are drop-tested.
• All six are 510(k)-cleared under K211321.

If you inject across the whole face, start with the L20Pro at $3,720. If most of your work is lips, tear troughs and the glabella, the L24Pro at $4,185 gives the finest superficial detail. If facial work shares the probe with body treatments and MSK, take the L14Pro at $3,441. For the frequency choice in more depth, see the L14, L20 and L24 model chooser.