What is the better delivery of fillers to the tear trough area, needle injection or micro cannula?

Question

Considering having under eye hollows filled conservatively. Which method and filler (restalyne, restalyne silk, juvederm ultra or plus ?? Also which method, needle injection or micro cannula?? For better results and less side effects

Mark Berkowitz, MD · Answer

Petrinabella.  Thank you for the question.  A complete consultation is necessary to  best formulate the course of action that will work  for you.  I utilize both needles and cannulas depending upon the surrounding anatomy.  While Cannulas are attractive to use , remember a needle is necessary to make the initial entry hole.  Cannulas can also limit the area of placement.  As far as fillers are concerned, you first have to take the entire face into consideration.  Many people have significant tear troughs only because their cheeks have fallen or deflated.  if this is not first addressed the results may be less than satisfactory.  My preference is always a long term filler like Bellafill but short term like Belotero and Previlles silk  will have an advantage over Juvederm ( reducing Tyndall Effect).  I am only a hop skip and a jump from Toledo.  Call Laney at 5862547692 and come in for a complimentary consultation.

Nima Shemirani, MD · Answer

Hi @Petrinabella! Restylane and Belotero work great for the tear troughs. I prefer a cannula since there are less chances of vascular occlusion and less bruising. Best of luck, Dr. Nima!

David J. Myers, MD · Answer

For the under eye area I prefer to use Restylane or Belotero though it depends on the facial structure. This is extremely vascular (i.e. “chock-full" of blood vessel). I prefer using a microcannula, as it allows for less pain and a lesser likelihood of swelling and bruising. You should always see a board certified dermatologist or plastic surgeon for best results with your injections.

Jason Emer, MD · Answer

Cannula injections in this area limit pain, bruising and swelling.  You should go to someone with expertise in treating this area. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

Treating the under eye area is not for novice, inexperienced injectors. In the proper hands, the potential is high for achieving gratifying results when treating tear troughs, hollows and bags. What's more, injector experience and expertise trumps even which particular filler is used for this region and whether a needle or microcannula is chosen. In my Upper East Side Manhattan practice, I typically opt for Belotero Balance and in my Israel satellite facility (where the choice of regulatory agency approved fillers is much greater), I prefer Teosyal Redensity II or Volbella. Each of these has little tendency to give rise to the Tyndall Effect.As to microcannula vs needle, this is still hotly debated. I have used needles for injectable fillers for three decades and have used cannulas for several years (long before they were introduced into the U.S), since one of the major microcannula distributors is located in Israel. Frankly, I have found that much too much has been made of the benefits of microcannulas over needles. Bruising can in fact be seen with both, although theoretically microcannulas are less likely to produce them. The advantage of the needle is more precise placement and actually much less likely to evoke the sensation of "pushing and shoving" that patients often feell with cannulas.

Mehryar (Ray) Taban, MD, FACS · Answer

The best method really depends on what the injector is most comfortable with but in my hands, needle works better as it is more accurate.  The best type of filler for under eyes is either Belotero or Restylane, for many reasons.

Paul L. Leong, MD, FACS · Answer

Microcannulas have many advantages over needles to inject dermal filler. I find that using microcannulas not only produce a better cosmetic outcome but are more comfortable for my patients. The face has a large network of vessels, so using a blunt tip microcannula greatly reduces the chance of cannulating a vessel and potentially obstructing blood flow. This can lead to more serious complications. In addition to being safer, microcannulas also decrease the chance of bruising and swelling. I prefer to inject the tear trough with Restylane L but never with needles. I highly recommend scheduling a consultation with a skilled professional to make sure you are a good candidate for this procedure.

Jill C. Fichtel, MD · Answer

Using a microcannula can reduce pain and bruising associated with injection of filler. It also allows for a speedier recovery.  We use the microcannula technique quite often in my practice, and my patients have been very pleased with their results. The most important factor here is choosing a Dermatologist with lots of experience using these products to improve the cosmetic appearance of the tear troughs.As for the choice of filler, that really depends on your overall facial anatomy. That question is best answered with an in-person consultation.  Products like Restylane and Juvederm can provide great results in the tear troughs when injected by a skilled Dermatologist.

Steven Wallach, MD · Answer

I think using either a needle or a cannula is fine. It really is more important to have a good injector. Best of luck.

Dean P. Kane, MD, FACS · Answer

Dear Petrinabella:All injectibles like medicine are art and science. The science is in the product and how it will respond in where it is placed. The art is in the skill and talent of your artist, the injector.It takes experience, knowledge and skill to perform injectibles. Considerations include:type of fillersharp needle injection or cannula techniquelayer of injectionamount of fillerarea to be filledgoals of injection: to volumize an area, fill a fold or smooth a fine linematching the filler(s), technique(s) with the patientpotential for swelling and bruisingand more.Personally, I best employ the use of a cannula technique along the tear trough bone under the deep muscle, over the deep muscle, within the fat packets and under the eyelid muscle.  I try to stay away from needle injection above the eyelid muscle as it does not adequately fill the deeper trough, risks a tindel (blue effect), cobble stone effect within the skin and more potential for bruising. My nurse on the other hand is expert in micro-needle injection of lid / cheek lines with thinner fillers. Having said that, I recommend you consult with different but Board Certified, well experienced injectors such as a Plastic Surgeon and Dermatologist to examine and review what is best for you. I hope this is helpful. All the best!

What is the better delivery of fillers to the tear trough area, needle injection or micro cannula?

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