Clearly, the microcannula technique is rapidly becoming a very popular delivery method in the U.S. for dermal fillers. However, as we all know, complications such as bruising, edema, and vascular occlusion can occur with ANY injection technique. Nevertheless, the risk of vascular occlusion and necrosis is far less with the use of microcannulas.
A few years ago when the microcannula approach was just making its way into the industry, I tried learning the blunt tip cannula technique for the nasolabial fold area and let me tell you, it was a purely awful experience! In fact, I bent four microcannulas on one patient and the results were only equal to that of the traditional injection approach! Additionally, my patients would continually complain that the cannula hurt a million times more than the standard sharp needle. You can bet I quickly concluded that the cannula practice was for the birds! However, as the technique increasingly became the topic of professional conversations and education, I knew I simply had to learn the cannula technique if I wanted to remain relevant in the injectable education world.
So, I buckled down and ordered a Dermasculpt 27g 1 1/2 inch blunt tip cannula and went to work. With my first few attempts, I used Juvederm Ultra Plus (27g cannula) for the mid-face as Voluma was not yet FDA approved in the U.S. Although I was deliberately cautious in tackling the microcannula challenge, I did feel the need to swear a few times! But I was also determined. So, a few trials and errors later, I finally threaded the cannula through a 26 gauge puncture site. And yes, I let out a huge “whoot-whoot” over my success!
Now my go-to cannula of choice is the Dermasculpt 25g 1 1/2 inch. This gauge allows most any filler to extrude effortlessly through the cannula. No need to push and dismember your thumb as the puncture site is a mere 23g. Can I get a hallelujah from all exhausted thumbs!!
Simply put, I have been in YOUR shoes. I can readily appreciate your learning curve and frustration with the microcannula. But get 10 procedures under your belt, and, as coined by Dr. Seuss: “oh, the places you will go!”
My top 5 areas to treat with cannulas and why:
- Temporal hollow and lateral brow: The superficial temporal artery, branch of the facial nerve and reticular vessel of the lateral brow are intimidating areas to treat with a sharp needle.
- Zygomaticomalar and submalar region: If you create the puncture right in front of the tragus and fan the product upward along the zygoma and down into the submalar region, you will see a seamless and beautiful result.
- Anteriomedial malar region: The angular artery and infraorbital nerve bundle are primary areas of concern with a sharp approach. If using Voluma in this region, dive deep along the periosteum with your microcannula and you can create soft and beautiful volume in this area without the trauma of edema and bruising.
- Prejowl sulcus: Creating a puncture posterior to the sulcus along the jawline, allows threading of the microcannula towards the tip of the chin where one can lay down boluses or a long, thick linear thread of fillers. The result is a nice, smooth jawline without edema or ecchymosis.
- Lips: I tend to agree with – You can’t create a shapely lip with cannula. I love using Juvederm Ultra Plus XC with a 30g 1/2 inch needle along the vermilion border just inferior to the border; one can create an immediate and beautiful white roll. Sharp needles are quick and easy in the lips. But using a cannula will provide overall volume in the vermilion border without edema or ecchymosis.
Now, you have my top five list and tips for cannula use! I also have one quick trick to pass along…At the onset of the puncture, twist the cannula and create a very patent puncture before exiting the skin with the needle.
Question – what tips would YOU like to share?
Click here for my favorite cannula: http://cosmofrance.net/shop/dermasculpt-microcannulas.html?cannula_gauge=13