CHICAGO — If a dermatoscope is a third eye for dermatologists, ultrasound (US) “will become your fourth eye,” dermatologist and Mohs surgeon Jane Yoo, MD, MPP, said at the American Society for Dermatologic Surgery (ASDS) 2025 Annual Meeting.

Yoo introduced the ASDS’ first-ever session on US, a technique rapidly gaining more attention in the field.

“Ultrasound enables you to visualize structures in dermatology and aesthetics” that would not be visible otherwise, Yoo said. The devices come in cart-based or hand-held models, even a model that clips onto a dermatologist’s fingertip and “are relatively cheap,” she noted.

The technology emits high-frequency sound waves that travel through the skin so that internal structures are visible. The waves bounce off what’s inside the skin layers and create echoes that result in a visual image, Yoo explained. For more information on the use of US in dermatology, she recommended an overview of diagnostic applications published in the Journal of Cutaneous Medicine and Surgery.

Uses of US

The overview article breaks down US utility by condition. As an example, for hidradenitis suppurativa (HS), the authors noted, “It is difficult to determine the extent of HS by relying only on physical examination. US has a value in recognizing these subclinical deeper findings such as fistulas or fluid collections.”

US can help assess the depth of skin lesions and tumors and help evaluate the depth of a malignancy to aid in selecting the optimal treatment plan, Yoo said.

US can also help monitor progression of inflammatory conditions, she noted. “If you have a patient with psoriasis, you can use high-frequency ultrasound to track the management of their biologic response.”

“It can even help with delivering drugs,” she said. With US, drugs can be targeted more precisely under the skin to improve outcomes. In her view, “every dermatologist here should own one,” she said.

Sharp Drop in Bruising After Fillers

Data show US can also reduce bruising with dermal filler treatments, according to Peter Velthuis, MD, PhD, head of Cosmetic Dermatology and US expert in the Department of Dermatology, Erasmus University Medical Center in Rotterdam, Netherlands, and president of the European Society of Cosmetic and Aesthetic Dermatology.

He was a co-author of a study that evaluated the effect of preprocedural US scanning on bruising outcomes in dermal filler treatments. Among the study findings were that 70% of the patients in the US group had no bruising after injections compared with 28% in the standard-care control group, suggesting that better vascular visualization may improve outcomes.

US can also help identify where prior fillers lie, Velthuis said at the meeting. “We now know from our research that most of the injection spots that we have for the face have a limited space. If there is something there already you will have more spread. Mixing of different fillers is also not a good idea.”

The use of US can also be a marketing advantage, said Velthuis, whose practice has used US for about 11 years. In Netherlands, he said, patients report searching for practices with US capability.

No Contraindications

There’s no contraindication for US. “You can do it on babies, you can do it on pregnant women, of course, and all areas of the face,” he noted.

Issues to consider include the learning curve: Those inexperienced with US will need to leave more time in appointments. It does take training and keeping the device sterile is an added challenge, he said.

“But given all those variants, you want to be able to offer the best possible care to your patients, so I don’t think you can do without it,” Velthuis said.

Rania Agha, MD,assistant clinical instructor in dermatology at the University of Illinois Chicago and the Jesse Brown VA Medical Center in Chicago, agreed, noting that US is “indispensable” in her practice. “I use my ultrasound on everything,” she said at the meeting.

“Given the increasing reports of inadvertent intravascular filler injections — some resulting in severe complications such as blindness due to embolization of ocular arteries — I now perform all filler injections under real time ultrasound guidance,” she said. “This approach enhances safety by allowing precise visualization of vascular anatomy and filler placement.”

Beyond aesthetics, she told Medscape Medical News, she routinely uses US for evaluating lipomas and suspected foreign bodies.

“One notable case involved a patient with a retained splinter in the thumb for over a year,” she said. “Despite prior imaging with x-ray, the foreign body remained undetected. Using high-resolution ultrasound, I was able to localize the splinter, assess its depth, and perform a targeted surgical removal. This technique was essential to avoid breaching the joint capsule and for minimizing procedural risk.”

Agha said that her practice uses both cart-based and handheld US systems. Handheld devices range from $3000 to $6000; cart-based systems can cost from $15,000 to more than $100,000, she said.

For new users, Agha recommends using a handheld device to scan a wide range of cutaneous and subcutaneous lesions.

“Comparing these real-time images with those found in textbooks or peer-reviewed literature can accelerate pattern recognition and anatomical familiarity. Practicing on normal skin is equally important; it allows the clinician to identify key structures such as veins, arteries, subcutaneous fat, and the layered architecture of the skin,” she said.

Agha said training should be included at the residency level and that this is something that should be taken to residency review committees.

Yoo and Agha reported no relevant financial relationships. Velthuis reported being a co-owner of the company Cutaneous, which specializes in education in facial ultrasound.

Marcia Frellick is a Chicago-based healthcare journalist and a regular contributor to Medscape Medical News.