| INJECTABLES | PEER-REVIEW


ANTI-BRUISING COSMETIC FILLER TECHNIQUES


ADVANCED


Garry R. Lee describes his techniques to reduce bruising, pain, and swelling using microcannula instead of needles


COVER STORY


ABSTRACT Often, patients are more traumatised by the bruising and swelling resulting from the injection of cosmetic fillers than the treatment itself. Increasingly, physicians are replacing the conventional hypodermic needle for the blunt-tip microcannula to increase injection safety and to decrease bruising, swelling, and pain. To date, there is no general consensus on the best microcannula injection techniques. The author describes microcannula techniques he originated and teaches in the USA.


hypodermic needles was the golden standard for cosmetic filler injections as technological innovations focused only upon improvements in the nature and duration of action of the fillers themselves. Unfortunately, bruising1,2


W


HAT IF THERE WAS A SAFER way to inject cosmetic fillers with less bruising, less swelling, and less pain? Well, now we can inject wrinkles without needles. Traditionally, the use of


described herein are the author’s techniques; are not definitive in nature; and are not a substitute for the experience of hands-on, personalised instruction.


What is an aesthetic microcannula? A cannula5


is ‘a small tube for insertion into a body cavity,


duct, or vessel’, which originated circa 1684, derived from the Latin for ‘reed’. Now commonly called microcannula, reflecting the size, aesthetic medicine usage is perhaps more precisely defined6


as a ‘small tube with an edge that


is not sharp, designed for atraumatic intradermal injections … that can be used for the injection of fillers, like hyaluronic acid, collagen, poly-L-lactic acid, CaHA, etc.’ Appearing much like the needle it replaces, the aesthetic microcannula markedly differs in that filler extrusion is only through a tiny opening, or port, near the blunt-end tip.


and swelling were often expected and it was


not uncommon for patients to have as much apprehension for the sequelae as the treatment itself. Indeed, Glogau and Kane observed bruising in up to 24% of their Restylane® and Perlane® patients3


; and Tzikas


recorded 68% bruising in a small sample of patients injected with Radiesse®4


. Consequently, it was revolutionary when attention


abruptly shifted from product improvement to improving product delivery — from the sharp-tipped needle to the blunt-tipped microcannula. The challenge today is to discover the best ways to use microcannula as we progress from revolution to evolution. The following microcannula cosmetic filler injection techniques


Less pain, swelling, and bruising Publications are scarce, but slowly accumulating, supporting the use7


traditional hypodermic needle. Niamtu8


of aesthetic microcannula over the in 2009, reported


less injection pain, less oedema, and less bruising using fat injection cannula for cosmetic filler injections. Fulton et al9 also noted less bruising, less ecchymosis, and less pain, which was quantified as 3 (mild) for injections with microcannula, increasing to 6 (moderate) with the hypodermic needle. They found no significant differences in a comparison of cosmetic filler results using the Global Aesthetic Improvements Scale Score between the hypodermic needle and the microcannula. In 2012, Hexel et al10


performed a double-blind, randomised, controlled clinical trial to compare safety and efficacy


GARRY R. LEE MD, is a lecturer and published author in the US teaching for Allergan, Medicis, and Eclipse Aesthetics. He is the Air-Tite National Director of USA Microcannula Instruction.


email: drlee@lookyoungermd.com


KEYWORDS Microcannula, cosmetic filler, bruising, ecchymosis, hyaluronic acid


prime-journal.com | January/February 2015 ❚ 25


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