ArtiCle | fACiAlAeSTHeTiCS | and vessels away from the cannula’s path through
the tissue, rather than incise them as a needle does. The result is decreased trauma. Clinical experience shows that cannulae decrease the incidence of haematoma, increase patient comfort, and speed up recovery time. These micro-cannulae are available from 18 gauge
to 30 gauge. Currently, 25 or 27 gauge thin-walled flexible cannulae with a precision lasered side outlet, such as the TSK or Magic Needle cannulae, are becoming popular with practitioners. The cannula comes in a range of lengths, including 1 inch and 1.5 inch in the 27 gauge, and 1.5 inch and 2 inch in the 25 gauge. flexible cannulae have proven especially useful when there is a need to slide a long cannula over a curved surface; for example the zygomatic arch to malar region. Consequently, it is sometimes possible that both areas may be treated with a single insertion point. As a rough guide, the 25 gauge cannula is often used for supraperiosteal onlay injections, and 27 gauge cannulae are good for injections in the sub-dermal plane. experienced physicians will, of course, suit the cannula gauge to his/her own experience and technique. There are a few exceptions to these general guides for
cannula use. Patients with scarred fibrotic skin, and some men with no specific skin problem but who may have thicker skin, are often more easily treated
Figure 2 Identification of safe injection zones (courtesy of Merz Aesthetics). 1, infraorbital rim; 2, infraorbital foramen; 3, medial canthal line (parallel to nasolabial fold); 4, alar–tragal line; 5, zygomatic arch
with 25 gauge or lower subdermally. As a rule, the shorter the cannula is, the stronger it will be. Therefore, if there is difficulty passing the cannula along the sub-dermis, choose a shorter cannula, with a smaller gauge if necessary. Techniques for using cannulae at both the
supraperiosteal and subdermal level are discussed below. Clinical experience shows that the use of cannulae at the subdermal level provides the most significant advantages, dramatically reducing bruising, pain and downtime. Vectoring often involves depositing product over a reasonably wide surface area of the face at a subdermal level. The incidence of bruising in particular is noticeably lower when using cannulae. Patient feedback suggests that there is no difference in discomfort experienced between 27 and 25 gauge cannulae used subdermally. Patient discomfort is at an extremely low level for either gauge. As with all new techniques, some practitioners may adopt cannulae to the exclusion of traditional needle techniques. Others may view cannulae as a useful addition to their practice and combine them with needles for a patient-specific approach.
28 ❚
Facial mapping Before beginning vectoring treatment, a careful map is made of the patient’s face, in order to clearly identify the safe injection zones, to plan the augmentation, and to maintain orientation of safe and aesthetically optimal product placement during the procedure. in Figure 2, a number of marks are seen which indicate the border of these safe zones. The infraorbital rim is clearly shown. Palpate bilaterally and draw the marks on both sides at the level of the lowest orbital rim. The product should never be placed above this line, and the borders should also be avoided. The medial canthal line may also be seen; this mark runs from the medial
September 2011 |
prime-journal.com
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