When having filler injected to the cheeks and under eye area, is a cannula syringe a better option?

I moved back from Chicago a year ago and was traveling back each time I needed filler injections. I am looking for a local office who specializes in this area. I talked to one office that said they prefer to use regular syringes rather than Cannula syringes. My doctor who treated me in Chicago said it was a better way to fill those areas and it kept the bruising and swelling down. Your opinion would be appreciated.

Doctor Answers (12)

Filler Injection

+2
You have asked a very timely question.   I am not aware of any studies in which a controlled comparative study has been performed demonstrating the superiority of either technique.  These types of studies we call evidence based medicine.  Without an evidence based medicine type of study it becomes a matter of physician personal preference.  It is probably best to have your physician use whatever works best for them and their patients.


Summit Facial Plastic Surgeon

Dermal fillers for eyes

+2
Your question is a good one and a timely one.  I have a great deal of experience in lower eyelid injections for hollowing and bags.  I have used needles for this purpose for several years.  I do not consider myself a quick adaptor nor am I the last one on the block to incorporate new technology.  I almost exclusively use cannulas in the lower eyelids. They give me an enormous amount of control in distribution of product and allow me to get into places I could not enter without significant risk of bruising and swelling with the use of needles alone.  I do continue to use needles for many areas of the face, but I am a big advocate for cannulas in the lower eye region no matter how volume depleted the patient is or what layer I need to inject in. 

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Fillers in the face can be placed using both cannulas and needles, it depends on the filler, location and personal choice

+2
There is no right or wrong answer about using needles vs. cannulas for filler injection into the face. With the new Voluma, we are placing larger volumes deeper on the bone, so needles are all that we need. For patients who need more diffuse filling, I find cannulas are easier to use and produce less bruising. Around the eyes is another area of personal choice. I find that patients get less "black and blue" eyes using cannulas. Also, there may be a lower incidence of complicaations around the eye using cannulas.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

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Cannula Versus Needle For Fillers

+2
There is no right or wrong answer.  Cannulas typically give less bruising, swelling, and risk of complications; although anytime something is introduced into or under the skin there can be a complication.  It all depends on the injection and his/her technique.  I typically use cannula in the tear trough location but use both needle and cannula for the cheeks.  Its very individualized depending on the persons goals. You wont go wrong in the hands of an experienced injector.  I suggest taking Arnikare pills prior to treatment, as this may decrease your risk of swelling and bruising from the procedure. I wish you the best of luck, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 39 reviews

Cannulas or needles

+2
I always use a syringe with a needle for fillers around the tear troughs. I usually use restylane and dilute it so that it goes in easier and is more malleable so that there is less tendency for lumps.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Microcannulas are better for microsculpting. Needles are good for threading fine lines and wrinkles.

+2
Hi chi910,

I have been using Dermasculpt microcannulas since 2012.  It has taken has helped me to raise the bar on my injectable filler results, from a sculpting standpoint.  In the past when I used the regular needles, I thought of injecting fillers using a threading technique more like "chalking" or piping frosting through a piping bag and nozzle.  Initial techniques used the sharp needle to inject intradermal "with in the skin" fillers to pop out wrinkles in the smile lines and marionette lines.  Injecting a thread of filler on the edge of the lip can give that "edgy" appearance which can be good for apply lipstick, but is also a dead give away that the lips have been injected.

With the blunt microcannulas, I do like the fact that bruising is minimal to none, and the safety factor of inserting a microcannula into a blood vessel is *almost* impossible.  With a blunt microcannula, it is more likely to bump into a small blood vessel and simply rip through it and cause a bruise, as opposed to smoothly inserting the sharp needle into the blood vessel like an IV and injecting a damaging amount of filler into the vessel.  

After I read an article from the American Journal of Ophthalmology, "Iatrogenic Retinal Artery Occlusion Caused by Cosmetic Facial Filler Injections" that 7 cases of fat injections, 4 cases of hyaluronic acid injections, and 1 collagen injection had this catastrophic outcome.  Of these, injection sites were the glabellar region (7 cases), nasolabial fold (4 cases), or both (1 case).

It is common knowledge that injecting the eyebrow region is risky, but I had no idea that 4 cases were from the nasolabial folds, which is a very common area to be injected.  

Initially I was only using these expensive disposable cannulas for lower eyelid fillers, and still used the provided needle for nasolabial folds, but now I also use it for nasolabial folds (smile lines) after reading this, in addition to lips, marionette lines, cheeks, temples, etc.  The only place I still used a needle for filling is acne scars.  It is hard to get the microcannula to break up the scar tissue under the acne scars.  The microcannula is guided into layers of tissue which have natural planes such as the subcutaneous fat.  Areas of acne scars have loss of fat directly under these scars and the microcannula can't cut through the scar tissue and tends to deploy the filler around the the acne scar causing a "doughnut" effect instead of cutting and breaking up the scar tissue tethering the acne scar down as with a regular needle.

Using the microcannula to inject filler is very similar to the technique used for fat grafting.  Essentially small drops or granules of filler are injected in multiple layers and it appears that the natural tissue is expanding.  In a way, I think of if as sprinkling the filler like a fine powder under the skin and slowly building up the indented areas to create a feathered transition for a smooth overall contour (follow the weblink for an example).  In order to make so many passes with the cannula the rounded tip guides the blunt needle between fat cells and blood vessels, instead of injecting it in unnatural layers and locations.  

The same multiple pass technique using a needle will increase the risk of bruising even more than the threading technique, since the additional needle passes will eventually nick a blood vessel.  The lower eyelid area is rich with veins.  I would get bruising in the lower eyelid area almost 50% of the time when using the needle, now bruising will occur in 1 of 20 patients and typically only on the one of the two sides, with the other eye being fine.  Using a needle, it may be better to inject a blob of filler then try to massage it flat which is why Belotero and Juvederm are popular, since it is very smooth and easy to massage flat.  Injecting blobs of filler also increases the risk of lumps if for some reason the filler does not want to be flattened out with molding or massaging.  

Having performed both microcannula filling and needle filling techniques, I can safely say that it would be very difficult for me to achieve the result in the Web reference link below using a needle.  Even if I injected small amounts in hundreds of small passes with the needle to avoid a lump, when the eventually will occur, the bruising will make it hard for me to see what I am sculpting.  This may result in stopping the injection session and waiting for the bruising and swelling to come down, before I continue.  This would obviously be a big inconvenience to the patient, and what is stopping the bruising from happening in the follow up session.  The lack of bruising is not so much for the patient (which is great) but to help me avoid bruising, so I can see what I am doing as I sculpt with the microcannula.

For the patients safety, I think all injectors of injectable fillers should use microcannulas (even for nasolabial folds, google the Korean article).  These microcannulas cost an average in the $5 per cannula, as opposed to the needle which is "free" and provided with each syringe of filler.  Additionally, to further reduce the chance of bruising, the skin puncture site is the main area where the bruising can occur using the microcannula technique.  In order to insert a blunt tipped needle through the skin, each microcannula is paired with a needle which is slightly bigger gauge than the cannula.  To minimize bruising to the skin puncture site, I inject lidocaine with epinephrine (adrenaline) which constricts the blood vessels in the area of the skin puncture, as well as fully numbs the skin puncture site prior to the skin puncture.  This provides additional comfort for the patient.

I hope this comprehensively answers your question.  Welcome to the New York Metro area!

Best,

Dr. Yang

P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

George Yang, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Eyelid injections

+2
The technique and type of filler are dependent on the individual patient's problem and the expertise of the plastic surgeon. There are also neurotoxins (Botox, Dysport) chemical peels, laser procedures, and minor surgery procedures that may also be considered. Experience matters. Hope this helps.
 

George C. Peck, Jr, MD
West Orange Plastic Surgeon
5.0 out of 5 stars 16 reviews

Using the Cannula technique for injectables

+2
There are many factors that go into the choice of cannula or traditional needle for filler, such as the area being injected, depth of injection, patient anatomy, the type of product/filler being injected and the desired result.  In general, however, the cannula is excellent for filler treatments around your eyes, such as the the lower eyelids, lid-cheek junction, etc.  However, for very superficial injections, if needed, the cannula is not used and a small caliber needle is used.  Without knowing more about your individual case or see you in person, it is impossible to give you more specific information. 

Good Luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

It depends on your doctor.

+1
Whether to use a Cannula or a syringe under the eye area really depends on the injector. I usually use a Cannula in the upper lid because I am treating in one plane. In the lower lid, I prefer a syringe because I want to stimulate collagen and treat in various layers. The most important thing is that the doctor is comfortable with one technique or the other. There have been no studies showing that one is significantly better than the other. It really depends on the comfort that your doctor has with the techniques.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

For Injecting Fillers & Volumizers Microcannulas & Needles Can Both Be Used Successfully

+1


The reality is that cannulas and needles both have their place and the choice of which to use depends mostly upon the skill and experience of the individual injector. I began using microcannulas abroad in my Israel practice--where they were approved long before they entered the U.S. market.

Microcannulas are essentially small bore, blunt-tipped needles (i.e. no sharp tips). Like regular needles for injection, they come in various gauges and lengths to serve injecting different locations on the face and elsewhere. The purported advantage of injecting fillers and volumizing agents with microcannulas is that in theory they cause less bruising and swelling.

While microcannulas possess the potential advantages noted above, they have certain other disadvantages. Small bore, thin cannulas tend to bend more easily, making precise placement of the injected material a bit more difficult. Because they are blunt they require the use of a larger bore, sharp needle to create an entry point in the skin--something that in itself may create an area for bruising. And because they are blunt, and thus cannot easily penetrate tissue, they typically require a great deal more pushing and manipulation to get them through tissue.

Needles, on the other hand, owing to their sharp tips, move effortlessly through tissue, don't require a second step of first making a puncture site with a larger bore needle, and permit more accurate placement of material in my estimation and experience. In addition, if the non-injecting hand manipulates and tents the tissue as the needle goes through, bruising can be avoided or eliminated--even when the backs of the hands are injected.

I have seen significant bruising from patients injected with cannulas and none with those injected with needles and vice versa. And even some of cannula's biggest proponents admit that there are certain areas of the face that demand the use of needles.

Despite the hype, hooplah and physician marketing that has surrounded the introduction of microcannulas onto the American scene for the injection of fillers and volumizers, in the end, the results of the injection depend largely upon the skill, expertise and experience of the physician injector more than the cannula or needle attached to the syringe.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.