Main Imaging Modalities Predicting Face Induced Post-Filler Injection Complications

Reham E. A. AbdElKareem; Salah E. AboElenin; Sherif A. Shama; Moataz M. Montasser; Moustafa M. A. Abdelnaby

Reham E. A. AbdElKareem Department of Radio Diagnosis, Faculty of Medicine, Alexandria University
Salah E. AboElenin Department of Radio Diagnosis, Faculty of Medicine, Alexandria University, Egypt
Sherif A. Shama Department of Radio Diagnosis, Faculty of Medicine, Alexandria University, Egypt
Moataz M. Montasser Department of Radio Diagnosis, Faculty of Medicine, Alexandria University, Egypt
Moustafa M. A. Abdelnaby Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Egypt

Keywords: MRI; Ultrasound; Aesthetic complications; Filler migration

Abstract

Background: The increasing use of dermal fillers in aesthetic procedures has led to a rising number of associated complications. Accurate imaging is essential for diagnosing and managing these complications, especially when symptoms are non-specific or mimic other pathologies. Objective: To assess the diagnostic performance of magnetic resonance imaging (MRI) and ultrasound (US) in the evaluation of post-aesthetic filler-related complications, and to correlate imaging findings with clinical and pathological outcomes. Methods: Twenty female patients with clinically suspected filler complications were retrospectively analyzed. All patients underwent both US and MRI evaluations. Imaging features were assessed regarding filler location relative to the SMAS, and complication characteristics. Data were correlated with clinical follow-up and, when available, histopathology. Results: The most common complications were nodules (55%), migration (45%), and overfilling (35%). MRI showed superior sensitivity in detecting deep complications, achieving 100% detection in abscess, lymphoma, and fat necrosis. US was effective for superficial findings, with 100% detection of overfilling and abscess. US was used for therapeutic measures in some cases. Conclusion: MRI and US are complementary in evaluating filler complications. MRI is superior in deep or complex lesions, while US remains a reliable first-line tool for superficial findings and follow-up.