What is the best way to inject dermal fillers? Through a needle or using a cannula?

The world of aesthetics and anti aging is divided in opinion over this question. Doctors at many conferences discuss the pros and cons of a needle, and that of a cannula. Patients are sometimes confused as they get different information from different doctors. So what is best? What do I advise? Here is my definitive answer.

As always in my blogs, I like to be honest, and I like to inform my patients as well as I can. On this topic I have absolutely no doubt, that the NEEDLE is the best, most accurate and most comfortable way for patients to have hyaluronic acid fillers injected. Let me explain…

When 25 year ago, Canadian occuloplastic surgeon Jean Carruthers made the accidental discovery that botox wipes away wrinkles, aesthetic medicine was born. Then, when Bengt Agerup first invented the first hyaluronic acid dermal filler, Restylane, now over 15 years ago, anti aging aesthetic medicine was placed firmly on the map of the world of medicine, indeed as a proper medical speciality of its own.

For the last 10 years, I have been a big part of this wonderful and truly magical world of anti aging medicine, treating over 20,000 botox and dermal filler patients successfully, and with my light handed approach, painlessly through the needle.

Safetly in injectable aesthetic medicine is paramount to all good aesthetic doctors.  We are always striving for new injection techniques and new instruments. In the last 3-4 years, blunt long cannulas have arrived on the scene, and there are many names for these including flexible cannulas, pixel cannulas, micro cannulas, as it is a growing industry driven list. Distributers of fillers such as Juvederm, Restylane and Teosyal are “pushing” these new ways of injecting fillers, and many doctors of great repute are happy with this new method, but I must say that I am very sceptical indeed!

The main reason for my scepticism of injecting dermal fillers through a blunt cannula is that it is a very inaccurate way of injecting. A very long  and “bendy” cannula is used, which is often inserted below the skin about 10 cm away from the actual area being treated! Indeed, the injector will often enter the skin, for instance somewhere near the cheekbone behind the eye, and will then actually inject the filler from that same spot into many areas including lips, naso labial lines, cheeks and tear troughs, in what is in my opinion paramount to “remote control” injecting. With a cannula, it is impossible to inject the right amount of filler  into the correct areas every time, as it is with a short accurate needle, as with a cannula you are so far away and the cannula is too big. With a needle, we can accurately, safely and with a close control over dose, inject directly into the target area. With a cannula, the chances of hard lumps and swellings are much bigger. With a needle, yes we inject many more times, but painlessly, and this way, as I often say we build a measured and careful patchwork of filler and achieve a much better result and more natural result.

The second reason why I do not like cannulas is that the procedure becomes a much “bigger procedure” and less of a lunchtime one. To explain, with a cannula, firstly a very large bore needle is used to make the entry point into the skin, and then this bendy needle is awkwardly pushed and prodded along under the skin to a distant target, all of which patient always say actually hurts more and is more uncomfortable, and in my opinion uneccessary. Surgeons , who are used to much bigger operations and procedures, unsurprisingly often prefer the cannula.

Finally, some professionals will say that cannulas are safer and give less bruises, and even this assumption is not supported by numbers, as just as many complications such as large bruises, infections and even necrosis occur with cannulas as they do with needles (in any case, with these safe procedures, the listed side effects are very very rare).  Also, if you remember, an even larger needle has to be used to make an entry point first, before you can use the cannula!

To conclude, those doctors who like cannulas, that is their opinion and so be it, but if anyone ever offers you a cannula treatment into my favourite tear trough area, in my opinion it is time to panic! For an accurate and natural result without hard lumps under the eyes, a special multiple puncture technique through a needle is necessary.

Not everything new is better, and sometimes tried and trusted things in life are a much better option my dear bloggers!

21, January, 2015Dr Milo Blogs