Why I prefer to use a blunt tip cannula to inject dermal fillers.

Dermal fillers are by far one of the most popular treatments I perform at Claire’s Aesthetics. Dermal fillers yield amazing results however, they do come with certain risks. These risks are always explained to my clients before we proceed to treatment, and I spend the time making sure my clients understand what may go wrong, what I do during treatment to minimise that risk, and what I will do should something go wrong to ensure they remain safe and healthy.

Perhaps the biggest complication of dermal filler treatments, and the one most commonly publicised is the risk of a vascular occlusion. A vascular occlusion can happen in several ways; either a direct injection of dermal filler into a blood vessel, too much filler being placed around a blood vessel which compresses it, or post-treatment swelling impairing blood supply by compressing vessels. I’ll focus on what happens if a vessel is injected directly or compressed with dermal filler surrounding it. Both can result in either a full blockage, or partial blockage of that vessel, which reduces the amount of blood supply reaching the tissues in that area. Once blood supply is blocked or obstructed, the tissue begins to become ischaemic and eventually, if left untreated, will form a particularly nasty wound which can lead to permanent scarring or disfigurement. Swelling induced vascular occlusion is an aged differently than the treatments I will explore shortly.

I appreciate reading that last paragraph probably scares you, and that’s normal. However, what’s important to remember is that choosing me as your Aesthetics Practitioner (a registered nurse) means you are safe hands to be effectively treated should a vascular occlusion happen.

So as mentioned above, there are things I can do to make sure your treatment remains as safe as possible, in addition to a comprehensive aftercare and follow-up plan. Despite following best practice and doing everything correctly, it’s not impossible to say that a vascular occlusion won’t happen. Sone times it’s as simple as ‘bad luck’ or unusual anatomy, because let’s face it, we are all different in sometimes unique ways.

Safety During Treatment

Thinking logically, a needle increases the risk of a vascular occlusion, they are sharp inflexible tools that will penetrate any vessel they come into contact with. For this reason I prefer to use a cannula, widely-recognised as being a considerably safer technique to inject dermal fillers (Beleznay at al, 2014; Lazzeri et al, 2012; Van Loghem et al, 2018; Beer et al, 2012). A cannula is a blunt-tipped flexible needle-shaped device, but instead of piercing vessels it glides past/over/under them, minimising trauma whilst maximising safety and comfort. A needle is used to create a ‘pilot hole’ for the cannula to slide into the tissue being treated, but no dermal filler is placed when this needle enters the skin, avoiding the risk of vascular compromise.

Practitioners exclusively using needle will argue that their treatments are more precise, and they reduce the risk of vascular occlusion by aspirating their syringe when in the the tissue (Aesthetics Journal 2019). Aspirating the syringe means to pull back on the plunger and see if any blood enters the syringe, thereby indicating the needle is in a vessel before the practitioner injects, they can then remove the needle and re-position. Yes in theory this works, however several studies have found as many as 50% false-negative aspiration results in trials, meaning that 50% of the time they aspirated no blood into the syringe, they were in fact in a vessel (Casabona et al, 2015; Van Loghem et al, 2018). This can be explained by the viscosity of certain filler products. Sometimes the pressure in the syringe will be greater than the pressure in the vessel meaning no blood will make it back despite a firm aspiration attempt...would you take a 50% chance? I wouldn’t, and so I don’t expose my clients to that risk either.

Using a cannula is recognised as safer, there is no escaping this certainty. It disappoints me when I hear other practitioners say a needle is more precise, I have to say, I disagree with this based on my own experiences of injecting fillers (over 80 filler clients) and some recent research on cadavers. I find cannula tend to find their own depth and filler stays where I leave it using cannula. I see many young women, lip treatments in particular, where the filler product has ‘migrated’ out of the lip tissue and creates unsightly bulging in the perioral area. I am pleased to report that I have never had a case of migration. This is why i can confidently say cannula are precise.

Additionally, research on cadavers in 2017 (Pavicic et al 2017) demonstrated that in a group of treatments, 60% of injections using a needle had resulted in the filler product migrating from the original injection point, there were no instances in this study where this happened after cannula technique.

A further reason why I prefer to use the cannula is that it creates less punctures in the skin, minimising bruising, reducing recovery time, reducing risk of infection post-treatment.

One final note, there are phases where different ‘styles’ of techniques are introduced to treat lips in particular, and often they are quite terrifying when you have an understanding of facial anatomy. Google this; ‘inferior and superior labial arteries’ and ‘lip tenting technqiue’ and watch how this technique involves skirting a needle across the area where these arteries lie injecting filler as they are withdrawn, this technique is not routinely aspirated because it takes too long. So consider how much risk you are exposing yourself to when your appointment booking is only 20 minutes...my consultations take longer than that.

#lipbossessex #cannulatechnique #dermalfiller #safetyfirst #takenochances