2025 SCALE: Enhancing Injection Safety and Precision with Ultrasound Guidance

At the 20th anniversary of Music City Symposium for Cosmetic Advances and Laser Education (SCALE), Benjamin Ascher, MD, gave a lecture titled “Why Injections Under Ultrasound Guide Are Crucial in Aesthetic Medicine.” Dr. Ascher explained shifts in facial injection practices, specifically emphasizing the integration of live ultrasound imaging into aesthetic and reconstructive procedures. Drawing from more than 40 years of clinical experience injecting on the blind mode with only the anatomical skills in his mind, he addressed the urgent need of an eye under the skin, for enhanced safety, growing regulatory pressure, and the technological innovations that enable practitioners to visualize underlying anatomy during injection. 

Key takeaway messages from the lecture included:

THE RISING THREAT OF VASCULAR COMPLICATIONS
Dr. Ascher highlighted an alarming rise in vascular adverse events, including necrosis and blindness, associated with facial fillers. The global aesthetic community has observed a dramatic increase in complications due to the proliferation of both physician and non-physician injectors, he said. Estimates indicate that vascular compromise occurs in more than 100,000 patients annually with progressing to irreversible blindness. 
This surge necessitates a re-evaluation of current practices. Traditional blind injection techniques are no longer sufficient in an era with increasing patient volume, anatomical variability, and higher expectations for safety. Dr. Ascher stressed the importance of understanding live patient-specific vascular anatomy and urged clinicians to adopt techniques that reduce risk, particularly in high-risk zones such as the glabella, nose, naso labial and periorbital region.

INTEGRATION OF ULTRASOUND GUIDANCE FOR ANATOMICAL PRECISION
He introduced a transformative approach: real-time ultrasound-guided injections. This method enables practitioners to visualize the different anatomical levels beneath the skin, including vessels, fat layers, as well as existing filler products, in real time. By allowing for identification of critical structures such as the angular, supraorbital artery or facial artery vessels, this technique significantly enhances injection accuracy and minimizes complications.
Traditional techniques often rely on the injector’s mental map of anatomy, which fails to account for individual variation. The speaker emphasized that even experienced injectors are “blind” without imaging and are prone to missing anatomical targets. The integration of ultrasound guidance addresses this gap, transitioning from mental guesswork to evidence-based navigation.
Devices such as high-frequency 15-MHz transducers were highlighted as ideal for superficial facial structures. Dr. Ascher highlighted the newly designed Sibus-In Finger Probe—which he refers to as a true adaption to regular aesthetic injection. The design features a curved transducer and allows for greater field facial access. It is compatible with both hands-free application and ergonomic positioning, liberating the injector’s hand for precise needle or cannula control. Moreover treated “echographic”needles and canula allow for better visualization of these during injection.

REGULATION, EDUCATION, AND DEVICE INFORMATION ARE DRIVING CHANGE
Regulatory changes in regions such as Florida and the United Kingdom were also discussed. For instance, Florida has already mandated as a law the use of ultrasound guidance to ensure safety when performing gluteal fat grafts. Dr. Ascher explained that the surgeon performing the procedure must use ultrasound guidance when placing and navigating the canula, and the surgeon must also maintain the ultrasound recordings in the patient’s medical record.  
This evolving legal landscape places additional pressure on aesthetic practitioners to embrace technology that ensures traceability and safety.
In response, SIBUS-IN is developing tools and resources to aid clinicians in this transition. Among these is a new imaging system equipped with a 24-inch display and portable configurations for clinical flexibility. Additionally, an educational atlas and upcoming hands-on training events will focus on improving clinician familiarity with ultrasound anatomy, echo-guided cannula and needle use, and patient-specific vascular mapping.
Dr. Ascher concluded by inviting attendees to upcoming educational sessions and product demonstrations including “Thinking Paris Class: An Anatomy and Aesthetic Treatments Class” in Paris, France from January 26-27, 2026, and “ISUGMIA: International Summit on Ultrasound-Guided Injection in Medical Aesthetics” on January 28, 2026, in Paris. 

The overarching message was clear: the era of blind injections is ending. With real-time imaging, injectors can deliver safer, more accurate outcomes, making ultrasound guidance not merely a tool, but a standard of care in facial aesthetics.

For additional information on the upcoming events contact, doctorbenjaminascher@gmail.com.