Dermal fillers are becoming increasingly popular worldwide. Contouring of the face, restoring volume loss, enhancing features such as lip plumping can all be obtained with very little downtime. Just 15 years ago, surgery was the only way these enhancements could be performed. There are some minor complications associated with fillers such as pain, bruising, swelling which are fairly common (>70%) and some major risks such as vascular occlusion, blindness, and stroke which are much less common.

The most common method to administer fillers is using the needle which is packaged with the product. While needles are very easy to use, in the author’s opinion, they are more risky and lead to more downtime versus the blunt microcannula technique. Microcannulas were introduced to the United States about 8 years ago from Europe. These were a smaller version of the already widely cannulas which were used for fat transfer. When compared with a needle, cannulas are more flexible, longer, and their tip is more rounded. The following advantages are found with cannulas:

  1. Fewer dermal penetrations – cannulas are introduced through only a small number of pilot holes.
  2. Less discomfort – the dermis contains more pain fibers  than the deeper tissues. The injections with cannulas are below the dermis, so discomfort is less.
  3. Less trauma to tissues/less bruising – because of the rounded tip, the cannula is less likely to nick blood vessels leading to less bruising and swelling.
  4. Faster procedure times – With an experienced cannula user, placement of filler is done very quickly and efficiently. (Cheek/tear troughs <5 minutes per side, lips <5 minutes)
  5. Less vascular occlusion risks – While cannulas aren’t 100% safe, the risks of injecting into a blood vessel are less because entering a vessel is more difficult with the rounded tip and flexible shaft. This is true for the larger gauge cannulas such as 22, 23, and 25. Recent studies by Dr. Pavicic and Cotofana have shown the 27g cannulas have the same force needed to enter a vessel as a 27g needle and therefore should not be used.

Galderma recognized the advantages of microcannulas and became the first company to get FDA approval for their use with Restylane Silk in lips in 2017, and for Restylane Lyft for the cheeks in 2018. While less than 10% of providers use cannulas in the US, there is a push by the top injectors to encourage their widespread use.

Dr. Weiner has been using microcannulas since 2012 and is one of the most experienced cannulas injectors in the US. He is one of the leading trainers for Galderma, particularly for their cannula trainings. He is available for private trainings in off label use of fillers – face/body. There are shadowing opportunities as well as week long internships opportunties. For inquires, please email: info@theclinique.net or steve@stevenfweiner.com

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