Pre-Injection Doppler Mapping Versus Landmark Guidance for Lower Facial Hyaluronic Acid Injection: A Prospective Safety Study

This study evaluated whether pre-injection Doppler mapping improves vascular safety and early aesthetic outcomes in lower facial hyaluronic acid injection compared with landmark guidance alone. In this prospective parallel-controlled study, 120 participants were randomly assigned to a Doppler mapping group (n = 60) or a landmark-guided group (n = 60). Vascular risk signal detection, post-injection ecchymosis, procedural features, and early aesthetic outcomes were compared between groups. Detectable vascular signals were identified in 63.3% of Doppler-group participants, and injection-plan modification was performed in 53.3%. Ecchymosis incidence on day 3 was significantly lower in the Doppler mapping group than in the landmark-guided group (23.3% vs. 48.3%; P = 0.004). Needle passes, intra-procedural adjustments, and overall early adverse events were also reduced. Aesthetic improvement scores and patient satisfaction were higher in the Doppler mapping group. In multivariable analysis, pre-injection Doppler mapping was independently associated with a lower risk of ecchymosis (OR = 0.38; P = 0.014). These findings suggest that pre-injection Doppler mapping may reduce vascular risk and early local trauma while improving short-term aesthetic outcomes after lower facial hyaluronic acid injection.