Fern Pattern Technique of Injecting Restylane

Do you know anyone who does this technique? Is it better than the usual linear approach for lip augmentation? Is it good around the mouth for wrinkles? Does it last longer than linear?

Doctor Answers 13

This is just a funny name for high dermal HA filler placement

It is a tough market out there.  Doctors find it essential to repackage what they are doing with new procedural names to help distinguish what they do from others and better communicate to potential patients.  There is nothing new about a doctor giving a name to their particular way of doing something.  Of course it can create some confusion because the public may think that it is a service that no other physician is offering.  The so-called "Fern Pattern Technique" is one such example of this.  The physician who coined this expression uses the term to describe high dermal placement of hyaluronic acid filler in the skin to "stiffen' the skin as a means of soften fine skin lines.  This may sound like a great approach and it is.  However, it is not a novel approach, in fact this is precisely one of the ways the FDA understood that these products would be used for cosmetic purposes when it issued approval for the cosmetic use of Restylane and Juvederm.  Any experienced injector uses the "Fern Pattern Technique," but very few doctors know this method by this name.  In requesting service, my advice is tell the doctor what you are looking for and let them worry about how they accomplish your treatment.

Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

This was a Restylane only technique when it first came out.

This mentioned technique was devised by Tim van Eijk for the use of Restylane in the smile lines (nasolabial folds). The method was promoted by the company as a way to treat a dynamic line by injecting the material in different angles and sides in the shape of fern. Competitors went on producing studies showing how this technique can lead to increased trauma to the area and cause complications. In any case, the paradigm for treating the face with fillers has shift to treating volume rather than lines. This makes the method close to becoming obsolete. Further more, needles have fallen out of favor in most places in the world. Cannulas have been used instead, which allows greater material to be injected in one spot and spread out to the area of interest.

Hassan Galadari, MD
Dubai Dermatologist

Techniques for injecting Restylane are individualized

There are several techniques for injecting dermal fillers such as Restylane: linear threading, serial puncture, fern pattern, fanning. An expert injector will be able to use whatever technique is best for each area and each patient. If someone claims that their special technique will make it last longer then I would go elsewhere.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 42 reviews

Does Restylane Technique Matter?

As all panel members seem to suggest, techniques are many and will vary based upon patient's goal, injection site, product being used, depth of placement, etc. 

What is most important is that your practitioner individualizes your treatment plan, keeps you involved in the proces, outlines options, and delivers a satisfying outcome.




Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Restylane and juvederm injected by a gentle hand and artistic sense

Linear, serial, retrograde, anterograde, lattice...are all techniques used for injecting Restylane, Juvederm, Radiesse, and other fillers.  NOt all techniqes work in all patients.  Sometimes injections of the tissues to the side of the crease help support the skin and there is less drop of the skin down creating less of a fold.  This is seen when the mid cheek is volumized and the smile fold becomes less obvious.  If you inject to the side of the fold with the fern technique it may help support the line but you wouldn't want to inject the other side towards the lip as that would magnify the impression of the crease.  What is important is that the phsician has an artistic eye, a gentle delivery and an understanding of physics and architecture.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 38 reviews

Filler technique

In a published report in a peer reviewed journal, the "fanning" technique was most likely to cause significant bruising.  Choose a physician based on training, reputation, and board certification.  Do not try to find someone who touts a specific technique.

Hope that helps.

Madeline Krauss, M.D.

Madeline Krauss, MD
Boston Dermatologic Surgeon
4.0 out of 5 stars 2 reviews

Best techniques for injection of Restylane

You needn't worry about semantics and names of techniques.  What's most important is what it is that you want corrected or improved, what filler is being used, and who's injecting it. We recently made a training video for Medicis that demonstrates all the techniques for the correction of nasolabial folds and perioral lines.


Ramtin Kassir, MD, FACS  NY and NJ Facial Plastic Surgeon

Ramtin Kassir, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 106 reviews

Injection patterns for dermal fillers

Physicians who have a vast experience with dermal filler substances have already determined which technique works best for them. This is a physician specific (rather than location based) issue. Broadly, however, the fern technique is helpful when increasing lost volume is the goal.

Peter L. Kopelson, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

Restylane Injection for Lip Augmentation

Hi Central Florida 7404,

As other plastic surgeons and dermatologists have stated, there are several techniques for injecting dermal fillers such as serial puncture, linear threading, fern pattern, or fanning. The injection method is not as much of an factor, but rather the specific material (Restylane, etc), volume injected, and location placed. Each cosmetic specialist has their preferred method, and commonly uses many techniques. Speak to your cosmetic specialist to help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 68 reviews

Fern technique for injecting Restylane

There are a number of techniques for injecting fillers: linear threading, serial puncture, depot, and fanning.  They are used separately or in combination depending on the area to be filled, the filler used and the goal one is trying to accomplish.

The fern technique was developed to get a smoother result in dynamic folds, like nasolabial folds, so that the filler is not more apparent when the patient is smiling or talking.

I use a combination of techniques to achieve the desired cosmetic goals.

For the lips, linear method along the border of the vermilion to outline the lips, then adding small boluses in the four lip pillows, and linear along the philtrum work well.  Injecting filler in a K shape at the corners of the mouth buttresses the corners if they are downturned or deepening, brings the corners up.

For restoring the volume in the soft tissues around the lips, linear threading or fanning somewhat parallel to the lip border with small amounts of filler gives lift to the surronding tissue and to the lips themselves.  Filler must be done conservatively around the lips while preserving or restoring the proper proportions of upper lip to lower and the distance of nose-to-upper-lip vs lower lip-to-chin.  It's not just a matter of which injection technique to use.

The fern technique was primarily developed for the smile lines, so that the lines don't show up above or below injected filler.  This is a good technique, but again multiple techniques can be used to accomplish this goal.

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 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.