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. 

As the name suggests, the blunt cannula is blunt at the tip as apposed to a sharp point of needle.  A blunt surface is less traumatic.  Therefore the advantages of a blunt tip when injecting fillers are:

- Less bruising

- Less risk of injuring sounding important structures (eyes)

- Less pain

- Less needle sticks.  The cannula can be placed in one hole made by a needle and then moved to multiple locations in the face.

 

I use cannula for my injections for these reasons.

 

I hope this helps

The use of blunt cannulas involves fewer injection sites with less chance of bruising and more patient comfort.  Often a combination of cannulas and needles is used to achieve the best result.

Needle injections are great in more superficial areas of the lips, such as philtral columns, vermillion border, and the finer lines around the lips. When more "inflation" of an area is needed  micro-cannulas have proven to be a better choice.

The advantages of micro-cannulas include less bruising, less swelling, less pain. Micro-cannulas also allow for smoother contouring in areas such as jawline, cheeks, chin, tear troughs, brows, and even the body of the lips- any area that require deeper injections for sculpting, contouring and "lifting."

I have been using blunt cannulas since early 2011.  The pain, bruising, swelling, and length of the procedure have been significantly reduced with these cannulas.  With only one or 2 skin entries, I can fill most of 1/2 of the face, in all the areas you describe.  As other physicians have said, most of the pain occurs when you pierce the skin.  Obviously, there is much less of this with the cannulas versus the needles.  All fillers, like Radiesse, Restylane, Perlane, Juvederm can be injected this way.  I don't use the cannulas for Sculptra because the areas where Sculptra needs to placed (along the bone and in the dermis) cannot be done with the cannulas easily.  Also, using newly developed cold technology, my injections have become even less painful because the cold goes deeper than topicals can go and it works much faster too.  Please see my video demonstrating the technique on former Mrs. of the USA, Jennifer Cirone.

Blunt cannulas are less painful once it enters the skin for the resaons mentioned in other posts. However, please remember that blunt cannulas are more painful to get through the skin because more force has to be applied vs a fine needle. Most of the pain people feel is getting through the skin vs passing the needle once the skin is punctured. 

I have used many injection techniques, including cannulas, and found I still prefer needle injections for the following reasons:

Disadvantages of cannulas:
1. Bruising at the puncture site where a needle larger than the cannula itself must be used to create an opening through which the cannula is inserted.
2. An uncomfortable feeling as the cannula slides under the skin and makes a crunchy sound.
3.  Less precision in placement of fillers.
Supposed Advantages of Cannulas:
1. Fewer needle sticks.
2. Less discomfort
3. Less bruising
I prefer to use needles rather than cannulas for injection because I can precisely place my material exactly where I need it. This is important because different levels of injections are needed either to elevate depressions or to contour the face.
To minimize bruising, I mix fillers like Radiesse with lidocaine containing epinephrine just prior to the injection to both minimize discomfort and to constrict blood vessels. I also inject very slowly using a forward injection technique in which the filler is injected as I am advancing the needle so that the material itself, rather than the needle, dissects its way to the appropriate location. In this manner, I can achieve overall precise placement and little bruising or discomfort.