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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5765_Библиотеки_им_академика_М_И_Перельмана.pdf
182
7 Common Applications ofUltrasound inCosmetic andPlastic Surgery Procedures
a
b
Fig. 7.3 Hyaluronic acid. (a) Clinical image of a patient injected in the
cheeks with high-density hyaluronic acid 1 year previously. (b)
Ultrasound (greyscale, longitudinal view; right cheek) shows multiple
small, anechoic hypodermal deposits (asterisks). Notice the blurry
hypoechogenicity of the hypodermis near the deposits due to an inammatory reaction. (c) Color Doppler ultrasound (longitudinal view)
shows increased vascularity in the periphery of the deposits (in colors).
Abbreviation: (b) margin of the maxillary bone.
7.2 Cosmetic Fillers
183
c
Fig. 7.3 (continued)
184
7 Common Applications ofUltrasound inCosmetic andPlastic Surgery Procedures
a
b
c
Fig. 7.4 Silicone oil. (a) Clinical photograph of a patient with bumps
and swellings in the lips. (b) Ultrasound (greyscale, longitudinal view
of the lips and chin) demonstrates extensive hyperechoic deposits with
posterior reverberation artifact (also known as “snow storm”) in the
upper and lower lip, as well as in the chin. Notice that the deposits
involve the orbicularis muscle of the lips. (c) Color Doppler ultrasound
(longitudinal view) demonstrates increased dermal ow in the upper
and lower lips due to inammation.
7.2 Cosmetic Fillers
185
Fig. 7.5 Polymethylmethacrylate
(PMMA). (a) Clinical picture
showing a patient with erythema
and swelling of both nasofold
lines. (b) ultrasound (greyscale,
transverse view; left nasofold
region) shows multiple hyperechoic spots with mini–comet tail
artifact within the perioral
muscles, the dermis, and the
hypodermis. (c) ultrasound
panoramic view (greyscale with
lter; transverse view) demonstrates the extent of the deposits
(arrow).
a
b
c
186
7 Common Applications ofUltrasound inCosmetic andPlastic Surgery Procedures
Fig. 7.6 Polyacrylamide gel
(PAAG). (a) Clinical photograph
of a patient that palpates bumps
in his cheeks. (b) Ultrasound
(greyscale; right cheek) shows a
round-shaped, anechoic
hypodermal structure (asterisk)
that corresponds to a PAAG
deposit. (c) Ultrasound
(greyscale with lter, panoramic
transverse view; left cheek)
demonstrates multiple round and
oval-shaped, anechoic deposits
of PAAG (asterisks) in the
hypodermis of the cheek. Notice
the posterior acoustic reinforcement of the deposits.
a
b
c
7.2 Cosmetic Fillers
187
a
b
c
Fig. 7.7 Polycaprolactone (PCL). (a) Clinical image of a patient
injected into the tail of the eyebrows. (b) Ultrasound (greyscale, transverse view; left eyebrow) demonstrates hypoechoic deposits (asterisk)
that contain multiple hyperechoic spots that present hypodermal mini–
a
comet tail posterior artifacts. These hyperechoic spots are also detected
in the periphery of the deposits. (c) Ultrasound (greyscale panoramic
view; left frontal region) shows the extent of the deposits.
Fig. 7.8 Calcium hydroxylapatite. (a) Clinical photograph of a patient
injected in both nasofold lines. (b) Ultrasound (greyscale, transverse
view; right nasofold line) demonstrates dermal and hypodermal hyper-
echoic deposits that produce posterior acoustic shadowing. (c) Color
Doppler ultrasound (longitudinal view; right nasofold line). Notice the
increased hypervascularity in the periphery of the deposits (in colors).
188
7 Common Applications ofUltrasound inCosmetic andPlastic Surgery Procedures
b
c
Fig. 7.8 (continued)
7.2 Cosmetic Fillers
189
Fig. 7.9 Ultrasound catalog of common cosmetic llers.
190
7 Common Applications ofUltrasound inCosmetic andPlastic Surgery Procedures
7.3 Other Nonsurgical Aesthetic Procedures
and in rejuvenation. Many compounds are used, some of
them off-label. Examples include pentoxifylline, carnitine,
coumarin, hyaluronidase/collagenase, calcium pyruvate,
Other procedures may produce variable degrees of inammation of the dermis and hypodermis, which is intended in
aminophylline/caffeine, artichoke, melilotus or gingko
biloba, multivitamins, and T3/T4 [16–20].
many cases to stimulate tightening of the skin through the
production of collagen, scarring, and brosis at a late stage
[16–18].
7.3.1.2 Key Sonographic Signs
• Dermal and hypodermal thickening, as well as decreased
echogenicity of the dermis and increased echogenicity of
the hypodermis owing to inammation and/or
7.3.1 Mesotherapy
lymphedema.
• Color Doppler can show hypervascularity due to inam-
7.3.1.1 Denition
mation (Fig.7.10).
Injection of lipolytic or cosmeceutical agents for cosmetic
purposes. Mesotherapy is used to treat cellulitis or alopecia
ab
Fig. 7.10 Mesotherapy. (a) Clinical image of the inner aspect of the
left thigh with erythema for 2weeks after mesotherapy. (b) Ultrasound
(greyscale, transverse view; left thigh) shows thickening of the dermis
and hypodermis with decreased echogenicity of the dermis and
increased echogenicity of the hypodermis. (c) Ultrasound (greyscale,
longitudinal views) comparing right to left thighs side-by-side. (d)
Color Doppler ultrasound (transverse view; left thigh) demonstrates
increased dermal and upper hypodermal vascularity.
7.3 Other Nonsurgical Aesthetic Procedures
c
d
191
Fig. 7.10 (continued)