Cannulas for Facial Fillers: The Evolution of My Technique

Although I would estimate that only 1% of injectors currently use cannulas rather than standard needles to perform facial fillers, I truly believe that they have become the standard of care in my practice and I would hope the industry soon. I have been using cannulas for injecting soft-tissue fillers like Restylane, Juvéderm, Bellafill(Artefill), etc. since October 2010, before which I have affectionately called “The Dark Ages”. I have been able now to deliver better, smoother, safer, and less bruised results with cannulas than I ever could with needles.

What is a cannula? That is perhaps what many of you are wondering. A cannula differs from a needle in that it has a blunt end with a small side port hole through which product is infiltrated. The standard needle, by contrast, is sharp at the end with a hole at that sharp end, as all of you know. The true advantage of a cannula is that I can slide the cannula into areas like underneath the eye in the tear trough region and fill it without the risk of a significant bruise, especially without having what I call a “devastating bruise” that when I was using needles could rarely last 6 weeks to 3 months. With a sharp end, the cannula simply does not lacerate or tear a vessel so long-term bruising is exceedingly rare and I cannot even remember a case of it since I switched over from needles to cannulas.

Cannulas however are very hard to use for the novice injector since they are longer and bend a lot. A needle can be considerably easier but really offers such an inferior way of doing things that I cannot imagine going back to it. Further, cannulas offer unparalleled safety (in the right hands). Because the cannula does not have a sharp end, it is virtually impossible to place a cannula tip inside a vessel. Besides limiting bruising, the cannula really should not cause a “vascular compromise”. What this means is in the very rare case that a needle enters a major facial vessel, it can stop the blood flow to the point that there can be disastrous loss of skin tissue. Cannulas really make this risk almost impossible.

Are all cannulas made alike? No. I started with Dermasculpt cannulas but found them to be too fragile to push through thicker products like Bellafill and Resylane Lyft when using very small cannulas that are 27-Gauge in size. I try never to use anything larger like a 25-Gauge cannula that could otherwise cause more tissue injury but more importantly greater discomfort. I switched over last year to a Japanese company called TSK that allowed me to pass amazingly thicker product through a very thin cannula. However, the one design flaw was that the TSK cannula was so thin-walled that it would bend way to easily and make it hard for me to direct the product where I wanted it. Since June 2012, I have started using Soft-Fill cannulas that have literally blown my mind. I can use the 27G cannula to pass thicker products through it but now the cannula wall no longer bends. In fact, I can now use this improved cannula to work in the lower face like the smile lines etc., where simply put I could not venture into that area with the TSK. What that means to you is that your injection is far safer and major bruising is significantly reduced. I cannot imagine my injectable practice without cannulas.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To schedule a consultation please call 972.312.8105. To Learn more about Dr Lams’ facial filler procedures Click Here or to ask Dr Lam a question please visit his cosmetic injectable and fillers forum.