Injectable fillers in the face have surged in popularity over the last 15 years (Juvederm, Restylane, Volbella, Vollure, Voluma, Radiesse, Bellafill, etc…). This is due to several factors:
- There has been increased awareness on the part of physicians and patients of the effects of facial volume loss as part of the aging process. Volume restoration is key to treating the facial deflation that occurs over time. Hollow cheeks and temples, deep folds around the mouth, and sunken troughs under the eyes are examples of what can be improved with these in-office treatments.
- With the active lifestyle that today’s cosmetic patients maintain, low down time is often a priority. Injectable fillers are quick, can be done awake with or without topical anesthetic cream, and bruising and swelling is limited and can be covered up easily.
- The cost of injectable fillers is manageable, depending on how much is used.
- In case the patient does not like the results (which is extremely rare), most of the hyaluronic acid fillers can be dissolved.
- Many fillers are made of materials that are naturally found in the human body, such as hyaluronic acid or calcium hydroxyapatite.
Lately, there has been discussion and debate about the use of cannulas vs. needles to inject these fillers into the face. Let’s look at the pros and cons:
- Needles are undoubtedly more precise. Their sharp tip enables the physician to easily penetrate the tissue planes to precisely deliver the filler where it needs to be. Fillers must be injected in the proper tissue planes not only to deliver the desired result, but to maximize how long they last and prevent any visible bumps or lumps. The needles that accompany today’s fillers are often smaller in width than the width of injectable cannulas.
- Cannulas are blunt tipped instruments that are inserted through a small skin opening made with a needle, but their blunt tips cause less pain and less bruising because of less potential trauma to blood vessels under the skin. They require more force to insert them because the blunt tip has to push through tissues. While not immune from causing bruising, the risk of bruising is generally less.
The Bottom Line:
- When shaping the lips or treating superficial wrinkles and folds, needles work best.
- When treating broad areas such as the temples, cheeks, or jawline, cannulas are often beneficial. However, if the patient has scar tissue created by multiple prior injectable filler treatments or prior facial surgery, needles are able to penetrate through this tough tissue and deliver the product more accurately.
- There are many patients on whom I use a combination of needles and cannulas. I find that having versatility and dexterity with both techniques works well to deliver outstanding results with minimal swelling, bruising, and pain.
By Dr. Anurag Agarwal, M.D., F.A.C.S. (Double Board Certified Facial Plastic Surgeon)