When having filler injected to the cheeks and under eye area, is a cannula syringe a better option?
Doctor Answers 13
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.
Dermal fillers for eyes
Fillers in the face can be placed using both cannulas and needles, it depends on the filler, location and personal choice
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Cannula Versus Needle For Fillers
Cannulas or needles
Microcannulas are better for microsculpting. Needles are good for threading fine lines and wrinkles.
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!
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Using the Cannula technique for injectables
It depends on your doctor.
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