| INJECTABLES | PEER-REVIEW
basic fan technique whereby a single point of entry is made at the base of the nasolabial fold and aimed the microcannula superiorly and medially into the nasolabial fold, injecting retrograde back to the point of entry — without removing the tip of the microcannula. Then, the fan was repeated above and below this baseline to span the entire nasolabial fold. However, desiring a cross-hatching effect for a more
natural appearance, the author bisected the nasolabial fold at right angles and repeated the process whereby the two fans would intersect with the addition of only one other pilot hole, creating ‘the long microcannula double cross-hatched fan technique (LeeXX)’. This same technique is adoptable to many other areas which he uses almost exclusively in the nasolabial folds, the marionette lines, the submalar areas, and many body applications.
Wiggle progression technique Traditionally, needles plunge blindly ahead regardless of obstruction, shearing tiny blood vessels which creates ‘the oozing which causes the bruising.’ Extravascular blood degrades and discolours over time to create unsightly ecchymosis, which can be more disconcerting to the patient than the treatment itself. Penetration of other soft tissues such as nerves, tendons, ligaments, and muscle invariably leads to swelling and pain. The microcannula advantage is that—with a little experience — the blunt tip makes it possible to almost touch sensitive tissue without actual penetration. The author’s ‘wiggle progression’ is simply to insert the
microcannula through the pilot hole and progress very slowly and gently — constantly prompting the patient to voice any significant pain — which is an indication of directly abutting the tissue we wish to bypass. With any report of pain, simply ‘wiggle’ back a bit and redirect the tip of the microcannula one or two millimetres in another direction or plane until no obstruction is felt, and then continue insertion. The author estimates a greater than 70% reduction in bruising using microcannula with the ‘wiggle.’
Lip technique In the upper lip, enter at the lateral aspect of the vermillion border, follow the vermillion border to Cupid’s Bow, then fan inferiorly into the body of the upper lip as
Figure 5 (A) Juvederm Ultra Plus XC Injection into upper Lip with TSK by Air-Tite microcannula. (B) Before and (C) after lips and nasolabial folds injected with microcannula—without bruising
needed. One may also enhance Cupid’s Bow and the philtrum. In the lower lip, enter at the lateral aspect of each side of the lip, insert to just past mid-line, then fan inferiorly into the body of the lower lip as needed. This is so atraumatic that the author invariably uses only topical numbing cream instead of the inferior orbital and mental nerve dental blocks that were so necessary using hypodermic needles. Moreover, since there is so little trauma, it is far easier to create symmetric lips without swelling from multiple injections, which can distort lip anatomy.
Advanced microcannula techniques Hand technique Often, it is the hands that give away one’s age but now it is possible to inject cosmetic fillers such as Radiesse to
Figure 6 (A) Radiesse injection, with TSK by Air-Tite microcannula,
glides over vein. (B) Left hand immediately after Radiesse injection using TSK by Air-Tite microcannula
prime-journal.com | January/February 2015
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