Until recently, facial fillers have been injected primarily through sharp needles. Many practitioners who offer these products continue to use them, at a disservice to their patients. The cannula is the right tool for facial injections, not the needle.
“One of the most important aspects with how we do injectables now, as opposed to in the past, is that we use blunt tipped instruments, as opposed to needles,” shares board certified plastic surgeon Dr. Peter B. Fodor.
Cannulas and Needles
Cannulas look like needles. The major difference is the end is blunt, rather than sharp. This is an extremely important distinction, as the sharp ended needle is much more likely to cause unwanted tissue damage when performing routine injections.
A great analogy involves a knife and a baseball bat. If you were to poke someone with a knife, there will be tissue damage depending on how hard you poked. Either way, you would puncture that person and cause damage. If you tried the same with a baseball bat, you wouldn’t be able to penetrate. The pointed knife is built to pierce, while the blunted bat end is not, just like needles and cannulas.
In his Los Angeles practice, Dr. Fodor begins his dermal injections by making one small needle prick near the area to be treated. He then uses the point of needle entry to introduce a blunt tipped cannula. The cannula is somewhat similar in shape and size to the needle. It is a small metal tube, but it is slightly longer, more flexible and has a dull, rounded point instead of a sharp tip. The cannula has a small hole, either at the tip or near the tip, through which the filler is delivered into the tissue.
“The beauty of it being blunted at the end, is it will spread the blood vessels and nerves and the lymphatics out of its way by very gently progressing in,” explains Fodor.
Needle vs. Cannula
- Sharp vs. Blunt
- Short vs. Long
- Stiff vs. Flexible
Once the cannula has been inserted, the rounded tip presses gently through the structures hidden beneath the skin. It pushes blood vessels and tiny veins out of the way, instead of piercing through them as a needle would. When Dr. Fodor feels resistance against the blunt tip of the cannula, he is able to maneuver the cannula around in order to find a clear path for injection.
When a needle enters the face, the blood vessels it encounters are pierced by the needle’s sharp point. If a blood vessel is pierced, blood leaks into surrounding tissue, causing a visible bruise. While bruises can be covered up with makeup, everyone would prefer to avoid them altogether. By using a cannula instead of a needle, surgeons are able to reduce the likelihood of a bruise occurring.
Fillers injected through cannulas also have the added benefit of being less painful. “I used to do nerve blocks for injectables,” shares Dr. Fodor. “Just like going to a dentist, I became pretty good at anesthetizing the whole face by just using specific approaches to each important nerve. But with these cannulas, you don’t need it.”
Lips, in particular, are known for being extra sensitive.When fillers are injected into the lips with needles, the process can be very painful. Since switching to cannulas instead of needles, Fodor no longer needs to numb even the lips prior to injecting. “Because of cannulas, the pain, the discomfort has been significantly minimized, as has been the bruising and the swelling afterwards,” he explains.
Less Needle Pokes
Injecting fillers through needles is a process that requires many entry points. Each prick of the skin only allows the needle to deliver filler to a very specific area. The needle is then removed and another prick of the skin is necessary to continue injecting other regions.
Cannulas, on the other hand, can travel more freely within the face without causing damage or cutting tissue. From a single entry point, the cannula can reach in any direction for the full length of the cannula. This means that from one small needle prick near the corner of the mouth, Dr. Fodor can inject filler into the lips, the nasolabial folds and even along the chin or jawline if desired. Similarly, one small prick in the upper cheek serves as an entry point to deliver filler to the tear troughs below the eyes, as well as the cheeks. With a needle, many needle entry points would be necessary to treat the lips, nasolabial folds, tear troughs or cheeks.
The Anatomy of Injectables
While injectables provide immediate results with very little downtime, it is also important to be aware of the extremely rare but potentially significant risks that are involved. Choosing a qualified and knowledgeable injector is the key to safety.
“You have to know the anatomy when you inject,” emphasizes Dr. Fodor. “There can be risks associated with injections from occlusion of blood vessels. There are many, many ways to protect from that happening, including the use of cannulas.”
In the case of an occlusion, the injected filler blocks the flow of blood within a blood vessel. As a result, tissues that would normally be supplied by the blocked vessel may die.
When filler is unintentionally injected into a blood vessel, other serious side effects can also happen. These include the loss of vision and even stroke. In fact, the FDA put out a warning about these risks back in 2015.
To ensure safety, it is very important that the person doing the injecting has an in-depth knowledge of the anatomy of the face. Board certified plastic surgeons who routinely do facelifts, rhinoplasties, forehead and eyelid surgeries are intimately familiar with the muscles, nerves and structures present beneath the skin. This allows for the safe and efficient injection of facial fillers and Botox, qualities that determine patient satisfaction, results, and the ability to bounce back to life after the appointment.