What Are the Advatages of Injecting Fillers with a Blunt Tip Cannula Vs. a Needle?

Dear Lisa,

I have been using the blunt cannula for almost all fillers to all areas using Restylane, Juvederm, Radiesse, Perlane, and Belotero.  The cannulas are highly advantageous in that they are safer, more accurate, cause virtually no bruising when performed correctly, and do not require any kind of injected anesthesia or blocks in most cases.  Using one port, I commonly augment the cheeks, tear troughs and nasolabial folds with no bruising, minimal swelling, and minimal discomfort for the patient.  My patients who used to get fillers with the traditional method have sworn they will never go back.  

The blunt cannula allows blood vessels to be ‘pushed aside’ as the cannula traverses the tissue under the skin instead of piercing the blood vessels as with traditional needles used by most practitioners. This has truly decreased bruising in my practice by 90% especially when using filler under eyes or in the lips.In addition, the blunt cannula technique has allowed me to use the traditional fillers for wrinkles in the nose as part of his nonsurgical rhinoplasty that is also performed only by a few. The fear of using fillers around the eyes and in the nose has always centered around penetrating vessels with the filler material and ‘clogging’ the vessel causing a lack of blood flow to the area that can cause skin death or even blindness. Though this can still happen, gentle movement of a blunt cannula through the tissue in these areas minimize such concerns.

These days there is much media attention to the use of blunt-tipped cannulas. They are touted to reduce the number of sticks, to be less uncomfortable and to minimize bruising when injecting volumizing agents, like Perlane and Radiesse.

I began using cannulas for volumizers a couple of years back, in my office abroad, since they were available there, as with so many other agents, long before receiving approval from the FDA.

Unfortunately, it wasn't long before I discovered that patients could in fact experience bruising, particularly at the entry puncture site where a needle of a diameter slightly larger than the cannula itself must be used to create an opening through which the cannula can be inserted. 

Since the cannula must be inserted from a site far distant from the treatment site, some patients complained of an uncomfortable feeling as the cannula "slithered" and made a cruncy sound under their skin. I also found that treating something from afar gave me somewhat less precision in material placement. They are also not recommended for superficial treatment of finer wrinkles.

Today, both in my foreign and Upper East Side New York City offices, I have gone back to using needles, however, with a different technique known as the "Tower Technique." At each location I instill the material in an amount that places the most material at the base and a tapering amount closer to the surface--creating a shape that looks much like a cone under the skin. Each "tower" acts as a support buttress to the skin and only a few cones are required to give the needed support--reducing the number of sticks needed.

In addition, with this technique I can precisely place my material exactly where I need to in order to elevate depressions or to contour the skin.  To minimize bruising I include a little epinephrine in every syringe to constrict blood vessels and I inject very slowly using a "push forward" technique in which I  entered the skin and the inject the material forward of the needle so that the material itself, rather than the needle, dissects its way to the appropriate location. Each syringe also contains lidocaine to reduce discomfort. In this manner, I can achieve overall precise placement and little bruising or discomfort.