When Ultrasound Before Filler Isn't Optional. My Op-Ed on Imaging and Risk

Ultrasound before filler is often positioned in the industry as a premium add-on — something a boutique practice offers to justify a higher price, rather than something a standard consultation requires. I disagree with that framing for a specific category of cases, and I want to be precise about which category, because I do not think ultrasound belongs in every filler consultation either.

Where imaging changes what I actually do

The question that determines whether I reach for ultrasound is not the treatment area on its own — it is whether the case has a factor that meaningfully increases the chance of an unexpected vessel location or existing product I cannot account for from history alone. Prior filler from another practice with unclear documentation, anatomy in a historically higher-risk zone, a patient's report of a prior complication, or a revision case where I am correcting someone else's work are the situations where imaging changes what I actually do in the room, not just what I feel reassured about beforehand.

Why I don't use it on every case

I think an industry-wide mandate for universal pre-filler ultrasound would be a mistake, and I say that as someone who owns the equipment and could market it as a blanket standard if I wanted to. For a straightforward, low-risk case with clear history and standard anatomy, imaging adds cost and time without changing the treatment plan. Recommending it universally would be optimizing for the appearance of thoroughness rather than for outcomes, and I think patients can tell the difference when a practice does that.

The question I'd want every complex case to answer

Before any revision or higher-risk filler case, I ask myself one question: would imaging change my management? If the honest answer is yes — if I might choose a different product, technique, or decline treatment altogether based on what I see — then imaging is not optional, regardless of cost or convenience. If the honest answer is no, offering it anyway is theater. I think that single question is a better standard for the industry than either extreme: never image, or always image.

For patients in Alpharetta and North Fulton considering revision filler work or treatment in a previously injected area, I would ask directly whether the practice uses imaging selectively for cases like yours, and why or why not — the reasoning behind the answer tells you more than the answer itself.

— Dr. Iryna Lazuk, MD, Lazuk Esthetics, Alpharetta, Georgia