WFUMB 2025 position paper: aesthetic ultrasound standardization

In August 2025, the World Federation for Ultrasound in Medicine and Biology (WFUMB) published a position paper in Ultrasound in Medicine & Biology establishing 24 consensus recommendations for dermatologic ultrasound in aesthetic practice [1]. This is the first international consensus document specifically targeting standardization of equipment, technique, nomenclature, reporting, documentation, training, safety, and guided procedure in this rapidly growing area of clinical practice.

This article summarizes what changed, what the position paper recommends, and what it means for clinics, patients, and industry observers. This is editorial coverage and not medical advice.

Why a position paper now

Dermatologic ultrasound for aesthetic applications has expanded substantially in the past five years. Indications include:

• Pre-injection mapping of vascular anatomy to reduce vascular occlusion risk during filler injection.
• Identification of previously injected filler or biostimulator material in patients presenting to a new practitioner.
• Diagnosis and characterization of nodules and complications, particularly after collagen biostimulator injection where late-onset nodules are common [3].
• Ultrasound-guided drainage or treatment of complications.
• Documentation and research outcome assessment.

Despite this growing use, standardization was limited. Different clinics used different equipment frequencies, scanning protocols, reporting templates, and nomenclature. Training was variable. The WFUMB position paper addresses these gaps with a structured consensus.

How the consensus was built

The position paper methodology, as described in the publication [1]:

• A steering committee co-moderated two rounds of questionnaires covering technical and procedural topics.
• An international panel of expert authors voted on multiple-choice questions.
• Results were discussed in a consensus meeting.
• Position statements were accepted if more than 75% of votes supported them — categorized as broad agreement (75–95%) or strong consensus (>95%).
• Topics with 50–75% agreement were considered majority consensus.
• Statements with 50% or less agreement, or repeated failure to reach consensus, were excluded.

This is a robust Delphi-style methodology that gives the resulting recommendations meaningful weight, though it remains an expert consensus document rather than a randomized-trial evidence base.

What the 24 recommendations cover

The position paper covers eight broad areas:

1. Equipment

• Probe frequency recommendations for skin imaging (typically 15 MHz and higher).
• Considerations for color and power Doppler capabilities for vascular assessment.

2. Technique

• Scanning protocols for facial regions, including the temporal, periorbital, midface, jawline, and submental areas.
• Patient positioning and probe handling.

3. Nomenclature

• Standardized terminology for filler, biostimulator, and complication appearances on ultrasound.
• Common terminology to facilitate cross-clinic and cross-publication comparison.

4. Reporting

• Structured reporting template recommendations.
• Documentation expectations for clinical, medico-legal, and research purposes.

5. Documentation

• Image capture standards.
• Patient record requirements.

6. Training

• Recommendations for training pathways for clinicians integrating ultrasound into aesthetic practice.
• Continuing medical education considerations.

7. Safety

• Safety considerations specific to the aesthetic patient population.
• Recognition and management of complications identified on ultrasound.

8. Guided procedures

• Ultrasound guidance for filler injection, biostimulator placement, and complication management procedures (such as hyaluronidase injection for vascular occlusion).

Clinical implications

For clinics and clinicians:

• Standardized terminology facilitates communication between clinics when patients move between providers or seek second opinions on complications.
• Training pathway clarification should reduce variability in operator competency over the next several years.
• Structured reporting improves medico-legal documentation and supports research outcome assessment.
• Equipment recommendations may inform device purchasing and upgrade decisions.

For patients:

• It becomes reasonable to ask whether a clinic uses dermatologic ultrasound, particularly for complication management with biostimulators where late-onset nodules are a recognized issue (see our Sculptra (PLLA) review for context).
• Patients moving between clinics can request that a new provider perform an ultrasound assessment of previously injected material to inform planning.

For industry:

• Device manufacturers will likely respond with feature sets aligned with the consensus recommendations.
• Hyaluronic acid filler, calcium hydroxylapatite, polynucleotide, and PLLA brands may emphasize ultrasound visibility characteristics in marketing.
• Training providers will likely align curricula with the WFUMB consensus.

How this relates to existing aesthetic device consensus work

The WFUMB position paper sits alongside several other recent consensus documents that have shaped aesthetic dermatology practice. The 2021 consensus on the Cohesive Polydensified Matrix hyaluronic acid filler range published in Clinical, Cosmetic and Investigational Dermatology established product-specific best practice recommendations [2]. Earlier evidence on biostimulator complications, such as the 2024 Brazilian multicenter case series of 55 complications [3], underscored the need for standardized assessment tools.

The WFUMB position paper complements these by providing the imaging and visualization standardization layer rather than product-specific guidance.

Limitations and unresolved questions

• Expert consensus is not equivalent to randomized-trial evidence; some recommendations reflect best clinical judgment rather than strong empirical proof.
• Implementation will vary by country, regulatory environment, and training infrastructure.
• Cost and access to high-resolution ultrasound equipment remain barriers in some practice settings.
• Patient selection criteria for routine pre-injection ultrasound versus selective use are still evolving.

Bottom line

The WFUMB 2025 position paper is the first international consensus document standardizing aesthetic dermatologic ultrasound, covering 24 recommendations across equipment, technique, nomenclature, reporting, training, safety, and guided procedures [1]. It is unlikely to mandate universal adoption but will shape how clinics integrate ultrasound into complication management and procedural planning over the next several years. Patients and clinicians can use the document as a reference when discussing ultrasound capability in clinic selection or planning.

This article is editorial coverage of the published position paper and does not constitute medical advice. Clinical implementation should be guided by qualified practitioners.