Background Uncontrolled product spread is an important issue to consider in facial soft-tissue filler injections. Lack of precision can result in a reduction of effectiveness and surface projection, as well as irregularities, and product visibility. Objectives To assess the precision of soft-tissue filler injections in the face using a cannula. Methods This single-center observational study investigated soft-tissue filler distribution in a total of 100 facial injection procedures using real-time non-invasive ultrasound imaging. Outcome parameters included (1) the tissue plane of product distribution, (2) the extent of horizontal as well as vertical product spread at the injection site, and (3) the product surface area taking into account the multifactorial influence of several independent variables. Subjects were followed up to 30 days post-injection. Results 100 facial regions were injected in 8 patients (2 males, 6 females) with a mean age of 37.20 (6.34) years and a mean BMI of 22.21 (1.39) kg/m2. The plane of product distribution remained constant in ~ 90% of cases at day 0 (d0), d14 and d30. Mean horizontal product spread was higher compared to vertical spread, while both significantly decreased over all respective time points with p<0.001. Mean product surface area was 22.51 +/- 16.34 mm2 at d0, 15.97 +/- 11.28 mm2 at d14 and 12.9 +/- 9.15 mm2 at d30. Analysis using generalized linear models revealed that injection volume and injection depth significantly influenced product surface area. Conclusions Injection of soft-tissue filler using a cannula allows precise application of the product within the intended tissue plane. Precision can be improved by injecting less product into deeper tissue layers.
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