Recurrent granulomatous lesions in the facial region are difficult to diagnose. High-resolution dermatological ultrasound it´s an important key to the proper diagnostic orientation in this kind of lesions, by allowing the identification of its etiological factor and establishing the precise anatomical relationships for its proper intervention. We present the case of a young patient with a recurrent granuloma in the nasal ala whose correct diagnosis was made with high-resolution dermatological ultrasound, facilitating the successful treatment.