PEER-REVIEW | INJECTABLE TREATMENTS |
Figure 6 Single distal insertion point (SDIP) with cannula
stabilised. The use of very small, thin needles (30 G to 32 G x 1/2”), also known as mesoneedles, is recommended. This leads to the smoothening and thickening of the skin without affecting the subdermal volume very much13
.
Cannula versus needle On first sight it may appear easier, faster, and more comfortable to use a needle. However, as the only correct injection space is the underface of the skin and an injury to deeper structures must strictly be avoided, it is important to stay immediately below the skin during the whole injection procedure. For this purpose, when compared to a sharp needle, a
the wrist, using a threading technique with a sharp
needle and avoiding vessels and tendons, followed by the massage towards the direction of the fingers7
. When using multiple punctures (approximately three) a
needle or a blunt cannula is introduced from the most proximal or distal point (Figure 4) of the atrophic MC space at the appropriate depth—scraping against the skin, injecting the filler along a line in a retrograde fashion. With the fanning technique the material is injected
without withdrawing the needle or the blunt cannula, and a number of threads are injected radially (Figure 5). This may be done using most commonly one, if necessary two, single proximal insertion points (SPIP) or single distal insertion points (SDIP) located either proximally or distally at the dorsum of the hands (Figure 6). Often no or minimal massage is needed when using this injection technique as the filling material is distributed evenly already during the injection procedure (Figures 7 and 8). Multiple small injections14
or micro-droplets (minute
amounts of filler at a large number of points) are predominantly recommended for use with non-crosslinked native hyaluronic acid (HA) and intradermal injections when treating dermal elastosis13 (Figure 9). The author’s preferred product is Restylane Vital™ Light (Q-Med, a Galderma division, Uppsala, Sweden) because it is stabilised HA and with lidocaine, although most products used for this purpose are not
The only
correct injection space is the underface of the skin, and injury to deeper structures must strictly be avoided.
blunt cannula appears to be the most appropriate tool to ensure staying in the correct injection layer, thereby minimising the risk of damage to nerves and blood vessels, or even worse complications such as compartment syndrome. It is important that the blunt cannula is stiff and not too flexible (21 G to 25 G), and the length will depend on the severity of the atrophic area to be treated.
After injection Some authors recommend the application of ice packs after an injection to reduce the possibility of swelling7,12 and/or use of an anti-bruising cream7
.
, , or to keep the hands
in rest position for 2 hours and apply topical antibiotics daily for approximately 5 days5
After hand augmentation procedures patients may
return to normal activities of daily living as soon as they feel comfortable. In some cases there may be mild swelling and bruising over 1–2 weeks, especially when using a sharp needle or when injecting large amounts of filling material11
. If necessary, an additional touch-up
treatment is recommended after 4–6 weeks. Fat transfers often require multiple treatments, as they are of an uncertain duration11
. Patients should be advised to avoid
visiting a sauna, excessive sun exposure, heavy manual work, and other cosmetic procedures for around 2 weeks after hand augmentation. They should also be reminded to consult the treating physician immediately if they experience any problems, including swelling, pain, dysfuncion, or dysaesthesia.
Figure 7 (A) Before and (B) after augmentation in proximal single injection point with a blunt cannula
42 ❚ October 2013 |
prime-journal.com
Figure 8 (A) Before and (B) after augmentation in distal single injection point with a blunt cannula
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