Fern Pattern Technique of Injecting Restylane

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.

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.

 

 

 

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.
 

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

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.

Thanks for your question. The Fern pattern technique is a strategy to strenghten the skin without filling underneath enabling to eliminate wrinkles and dermal weaknesses without creating a pillow face. Excellent for wrinkles around the mouth. The Restylane will enhance the skins' collagen growth to ensure supreme longevity. I have been teaching this and other techniques for over ten years now. I will try and add the video later.. Kind regards,
Tom van Eijk 

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.

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

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.

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.