Background: Juvelook is a hybrid biostimulator composed of poly-D,L-lactic acid (PDLLA) microspheres suspended in non-crosslinked hyaluronic acid. Although its clinical efficacy for tear trough rejuvenation has been increasingly reported, the radiological behavior of this material and its process of tissue integration remain poorly characterized.

Objective: To evaluate the ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics of Juvelook® following tear trough augmentation and to assess its tissue integration and safety over time.

Methods: A patient underwent bilateral tear trough treatment with Juvelook. Imaging assessments were performed immediately after injection, at 2 weeks, and at 6 months using high-resolution ultrasound (15–22 MHz), color Doppler ultrasound, CT, and 1.5-T MRI. Imaging findings were correlated with clinical outcomes.

Results: Immediately after injection, high-resolution ultrasound demonstrated moderate hyperechogenicity corresponding to the implanted material without posterior acoustic shadowing. At 2 weeks, a mild reduction in echogenicity suggested progressive hydration and tissue integration. Color Doppler imaging demonstrated no abnormal vascular changes. CT and MRI revealed no focal hyperdense lesions or significant signal alterations, reflecting the low radiological conspicuity of hydrated PDLLA and non-crosslinked hyaluronic acid. At the 6-month follow-up, ultrasound demonstrated homogeneous tissue architecture with preservation of volume and no evidence of migration, granuloma formation, vascular compromise, or inflammatory complications. Clinically, a marked improvement in tear trough depth and contour was observed. 

Conclusions: Multimodal imaging demonstrated that Juvelook® exhibits characteristic ultrasound findings while remaining largely inconspicuous on CT and MRI. High-resolution ultrasound appears to be the most sensitive imaging modality for evaluating product distribution, tissue integration, and long-term safety. These findings support the use of ultrasound as a valuable tool for the objective assessment of PDLLA-based biostimulators in facial rejuvenation.

Karina Ravera is a radiologist based at Sanatorio Trinidad Mitre, Buenos Aires, Argentina, with clinical and academic interests spanning diagnostic imaging, aesthetic medicine, and advanced imaging technologies. Her research focuses on the application of multimodal imaging—including ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT)—to evaluate aesthetic procedures and improve patient outcomes. Dr. Ravera has contributed to the growing field of evidence-based aesthetic medicine through publications examining collagen-stimulating fillers, facial rejuvenation, and imaging-guided assessment of cosmetic treatments. She also serves as an Assistant Professor at the University of Buenos Aires, where she is involved in medical education and research in diagnostic imaging and aesthetic medicine.