PEER-REVIEW | FACIAL AESTHETICS |
owing to the fineness of the skin at the level of the lidÐ cheek junction. Although the cannula is considered to be less
traumatic, the needle causes no extra bruising if the physician understands how to avoid the trunk of the facial artery and vein (i.e. medially). In the authorsÕ opinion, the relative risk of trauma on the small vessels and capillaries, both small branches of the facial artery and facial vein, is the same when using either device. However, the impact on larger vessels, such as the trunks of the facial artery and the facial vein, is riskier with a needle, which can pierce these large vessels, whereas a cannula will avoid them. Despite this, using a cannula requires a greater amount
Figure 3 Anatomy of the palpebromalar junction
of force, giving less control, especially in the denser and more fibrous deep malar fat. Physicians should be wary of using a flexible cannula because of its ability to bend, making it more difficult to control its route and end cannula position. Care must be taken to ensure the flexible cannula does not slide into the orbit and the ocular globe.
Bolus or fanning techniques Again, it is advised that physicians use the technique most comfortable for them, either fan or bolus. Product deposition can be placed using a fanning technique to create a fine and narrow sheet, or using a few small bolus, which can be gently moulded to remove any irregularity. A very gentle pressure can reduce the risk of bruising,
but caution needs to be observed as excessive pressure or massage can provoke a superficial spreading of the product, despite an initially correct placement.
What to inject? Even if the Ôideal fillerÕ does not exist, it is clear that hyaluronic acid is the gold standard product7
, especially
Figure 4 Orbicularis oculi muscle
caused by light diffraction. Therefore, the injection
must be deep. The following technique is proposed:
■ The injection must be deep at the level of the palpebromalar groove, in front of the bony orbital rim, and just behind the orbicularis muscle (Figure 6)
■ Inject slowly with a very gentle pressure on the plunger of the syringe to avoid uncontrolled superficial spreading of the product. Do not crack under pressure
■ Inject small quantities to avoid over-correction, which is unaesthetic and difficult to rectify correctly, even with hyaluronidase.
Even if the Ôideal
fillerÕ does not exist, it is clear that hyaluronic
recent advances in the quality of volumising products.
22 ❚
Cannula or needle? This is generally based on the personal preference of the physician, depending on the technique he/she is most comfortable using. Using a needle is certainly easier; however, a fine blunt cannula easily penetrates
January/February 2013 |
prime-journal.com
when considering the recent advances in the quality of volumising products. The authors also have experience with fat injections, with remarkable results. However, it is easier and more flexible to use hyaluronic acid as greater technical, surgical and anaesthetic requirements are necessary for fat injections. Smaller particle hyaluronic acid is even more forgiving owing to the fine anatomical structure of the treated area. The future will be shaped by further
acid is the gold standard product, especially when considering the
research. Developing less hydrophilic hyaluronic acid products, resulting in less water absorption, can have an impact on this area, and so minimise the risk of the Tyndall effect. The use of short chains of hyaluronic acid can achieve this goal. Low-molecular-weight hyaluronic acid creates a more effective
cross-linking with 4-butanediol diglycidal ether (BDDE) as attachment is easier on short strings compared with high-molecular-weight hyaluronic acid, with their long chains. With short strings, attachment is easier on the two sides of BDDE; less free chains or chains attached on
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