Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination

  • Simone La PadulaEmail author
  • Barbara Hersant
  • Patrick Helynck
  • Mounia Mezi SidAhmed
  • Jean Paul Meningaud
Original Article Non-Surgical Aesthetic



Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications.

Material and Methods

We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used.


TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046).


Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Aesthetic medicine Injections Fillers Vascular exploration methods Transillumination 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

Ethical approval was given, by FRENCH institutional committee and the relevant Judgement’s Reference Number is 2018-A03400-56. All procedures in the study involving human participants have been performed in accordance with the ethical standards of institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all participants.

Supplementary material

After the vessels had been detected on the side chosen for the TL technique, a skin-marker pencil was used to draw the vascular mapping of the part of the face to be treated. Injection was performer between the skin vessels projection drawings to reduce the risk of bruising and intravascular injection (MP4 124926 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Maxillofacial SurgeryHenri Mondor HospitalCréteilFrance

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