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Posted: 12:01 a.m. Sunday, June 16, 2019

By Anita Mandal, M.D.
Question: I’ve heard of a few doctors using cannulas for injection of fillers instead of needles. What are the benefits of cannulas and do they hurt more than needles?
Answer: The injection device used for certain injectable fillers is actually a micro-cannula, meaning these cannulas are very thin. There are many benefits of micro- cannulas for filler treatments.

Micro-cannulas are blunt- ended at their tips compared to needles which are sharp. The blunt tip allows micro- cannula injections to be less traumatic resulting in less pain, less bruising and less swelling compared to a sharp needle tip.

Because of these blunt tips, there is also less risk of certain side effects. With a needle, it is much easier to accidentally enter a blood vessel and inject filler into a vessel rather than in soft tissue.

Studies show that with micro-cannulas, the pressure needed to puncture a blood vessel is much higher than that needed when a needle is used for injection. This means there is lower risk with micro- cannula injections compared to needle injections. However, a micro-cannula should not be smaller in size than 25g in order to avoid blood vessel puncture.

I use micro-cannulas for most of my injectable filler treatments. While you can still get some bruising and swelling, my patients find that it is much less compared to having the same injection treatment with a needle.

The type of filler injections I use micro-cannulas for are mainly facial volumization treatments in the cheeks, temples, forehead, smile lines and mouth corners. I also use micro-cannulas when injecting deeper into the tissues. It is the deep tissue planes where the blood vessels and nerve trunks lie and micro-cannulas can be much safer in deeper facial areas.

When it comes to lip wrinkles and fine facial lines, it is difficult to get a micro- cannula into thin lines. In these cases, I inject with a thin needle. Fine facial lines are typically very superficial and you are less likely to enter a blood vessel in those superficial tissue planes.

Common fillers injected with micro-cannulas are Bellafill, the 5-year filler. Fine line fillers such as Restylane Silk are typically injected with a thin needle.

Regardless of whether an injector uses micro-cannulas or needles as their method of choice, what’s most important is that you seek an injector who is highly knowledgeable. Your injector should throughly understand facial anatomy and the location of the various nerve trunks and blood vessels to avoid injury.

It’s not enough, however, to understand the anatomy. Even more important, the injector must be aware of all the anatomical variations of the location of blood vessels and nerve trunks in the face. The one week course many injectors take these days is far from sufficient. Board certified facial plastic surgeons spend years in training, thus have a completely different level of experience.

If your face is important to you, don’t price-shop or cut corners. Seek a Board Certified Facial Plastic Surgeon who understands the complex facial anatomy of aging and is an expert injector not only in your filler of choice but also has extensive experience in the proper use of micro- cannulas.

 

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