Restylane Lyft Archives | The Aesthetic Clinique

Why are Blunt Microcannulas the Obvious Choice for Dermal Fillers?

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:

Fewer dermal penetrations – cannulas are introduced through only a small number of pilot holes.
Less discomfort – the dermis contains more pain fibers than the deeper tissues. The injections with cannulas are below the dermis, so discomfort is less.
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.
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)
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

The Latest Trend “Prejuvenation” – Preventative Rejuvenation

It’s been touted for years by the aesthetic physicians – “Prejuvenation” – starting maintenance treatments in one’s late teens or early twenties. The Kardashians have popularized these minor cosmetic tweaks to stay youthful and refreshed with visits to their Beverly Hills physician, documented regularly on “Keeping Up with the Kardashians”. There is increasing pressure to get that perfect selfie for Instagram or to look cool and attractive on a “Snap”. Unfortunately filters don’t work well with videos unless you want to look like a cute puppy. Doctors are in agreement (for any disease process) that it is much easier to treat problems in their early stages than to reverse them after they have spiraled out of control. Small preventative treatments early on, can maintain and even enhance one’s looks for many years and avoid invasive surgical procedures in the future. The question is, which procedures should be considered for Prejuevenation?

Neuromodulators: These wrinkle improving injections take less than 5 minutes and have no downtime. Millions of these procedures are done each year and it is the most popular cosmetic procedure performed worldwide. Most often these are used in the younger population in the frown lines (glabella), forehead lines, and crows feet. Treating these areas before the lines set in at rest, known as “etched in” lines, is one of the fundamental concepts of Prejuvenation. (Suggestions: Dysport, Botox)

Dermal Fillers: Dermal fillers made from hyaluronic acid (HA) are used to improve the minor volume loss which occurs with age. In the more athletic patients, fat loss can be appreciated in the face as well as throughout the body. Supple enhancements can be added to the mid cheek and around the eye to stave off this premature volume loss. HA fillers are also used to plump up the lips to create a youthful appearance. (Suggestions: Restylane Refyne, Restylane L, Restylane Lyft, Sculptra)

Chemical Peels: To keep the skin in top notch shape and to reverse early sun damage, chemical peels can exfoliate the superficial layers of skin. This renews the texture and pigmentation and leaves a youthful and glowing quality to the skin. (Suggestions: Illuminize, Vitalize, ZO 3 Step Peel)

Skin care: Great skin care is the basis for good looking skin. Most would agree that some type of Retin A or Retinol is essential for maintaining youthful skin. These products lead to increased turnover of the skin cells, improve dyspigmentation (pigmentation problems), thicken the skin, and create a more hydrated skin. Sun protection with an SPF should be part of one’s daily regime. It is also highly recommended to apply growth factors to the skin to reverse the aging process. (Suggestions: ZO Skin Health, Lifeline Stem Cell Skincare)

Prejuvenation is a trend that is here to stay. Preventative maintenance will prolong the need for more aggressive corrections in the later years. With short, no downtime procedures such as neuromodulators, chemical peels, fillers, and a good skin care regime, youthful, natural appearances will persist for years. Stay ahead of the curve with Prejuvenation.

Dr. Steven F. Weiner’s 6 year Experience with Blunt Cannulas for Dermal Fillers

The value of volume replacement in the aging face is now universally recognized as one of the most beneficial procedures to restore youthfulness. The combination of sun exposure, aging, and genetics leads to collagen, fat, muscle, and bone loss. Reinflating the cheeks, lips, and tear troughs are routinely done by physicians across the world on a daily basis. Most of these patients will have a week or more of downtime – swelling, bruising, discomfort – but that doesn’t have to be. Blunt cannulas can minimize most of these side effects associated with filler injections and has become standard practice for Dr. Weiner for the past 6 years.

The benefits of blunt cannlas are:

There is only one insertion point to treat multiple areas. This equates to less intrusions through the skin and therefore a more comfortable procedure.
The tip is rounded and blunted. This very fact accounts for less bruising/swelling. When a blood vessel is encountered with the end of the cannula, the vessel is more likely to be gently displaced rather than punctured.
There is increased safety. A phenomenon termed “vascular occlusion” occurs when a filler is injected into a blood vessel. The filler then blocks the blood flow and can lead to necrosis (death of skin) or even blindness. It is much less likely to occur with blunt cannulas, particularly larger cannulas (23 or 25 guage), because they don’t enter blood vessels as easy as needles do.
Allows treatment in areas otherwise not easily accessible. Due to the safety of the cannulas, there are now areas of the face which are more easily treated. The superficial temporal area, supraorbital, forehead, piriform, periocular and lower eyelid are now routinely treated with cannulas whereas with needles, these areas were very precarious to inject.
Downtime is minimize. As a result of all the benefits listed above, most patients have significantly less healing time and are much happier after receiving their filler treatments with blunt “safety” cannulas.

If blunt cannulas have so much benefits, why are only 5% of the providers using them for dermal fillers? The art of using cannulas is not an easy one. Patience is required because directing the tip to the exact spot it is needed is not always easy. Remember, when the tip encounters an obstruction (vessel, ligament, collagen), it will need to traverse around it and not pierce it (as needles would do). This can be frustrating and lead to longer and less satisfactory results for the inexperienced cannula injector.

Dr. Weiner is one of the leading authorities on cannula injections of dermal fillers and has used them for over 6 years for nearly all of his injections. The cannulas provide a safe, comfortable, minimal downtime technique for volumizing the aging face, even with multiple syringes being used simultaneously.

The Cheek Challenge Results – Voluma Vs Restylane Lyft

There are currently 2 dermal fillers FDA approved for enhancing the cheeks – Voluma and Restylane Lyft. These are both HA (Hyaluronic acid) fillers which are injected into the deeper tissues of the cheek to volumize and lift the cheeks. By lifting the cheeks, the entire lower face is lifted as well, including the jowl area, nasolabial folds, and jawline. It is well known that for an aging face with volume loss, the mainstay of treatment starts with the cheek area.

There are 2 main distinctions between Voluma and Lyft. The first is G prime, which is a measure of resistance of a fluid to flow. What this translates into when injected into the body is it’s “lifting ability”. There is huge difference between the 2 with Lyft at 531 and Voluma at almost 1/2 of Lyft at 274. Although this is not important according to Allergan, the makers of Voluma, this was found to be significant in our challenge. The other factor is cohesivity. This has only been popularized since Voluma was introduced and it the pressure needed to “flatten” the filler. What this translate in the body is the amount of spreading of the filler in the body. Voluma is higher in this category (less spreading) when compared to Lyft, but it’s importance is not known.

When Voluma was introduced to the market, there was significant marketing on it’s “2 year duration”. What wasn’t discussed was how this FDA designation was obtained. Most people in the study were injected at 2 different times. Also, the average amount of filler injected was over 6 syringes. Lastly, only a minority of subjects had evidence of some correction at the end of 2 years. These important details are left out of most discussions with physicians, and certainly not what the public understands about Voluma. In addition, Voluma’s pricing is much higher than all the other fillers on the market, but justifies these prices due to it’s longer duration.

The “Cheek Challenge” was performed by Dr. Weiner to try to vet out whether there are significant differences between Restylane Lyft and Voluma. To try to keep the study similar to the FDA study, a total of 6cc was injected, 3 of Lyft on the right cheek, and 3 of Voluma on the left cheek. Follow ups and photos were taken at 1-2 month intervals for 1 year. There was no secondary injections because this is what most closely represents a real patient’s experience. Keep in mind this is only one patient but Dr. Weiner did challenge other physicians to do the same, similar to the “Ice Bucket Challenge”. There were about 4-5 other physicians which have also done the “Cheek Challenge”. Their findings have been similar per private discussions with them.

The Results:

Duration of improvement was the same. AT 12 MONTHS, THERE WAS NO DIFFERENCE BETWEEN THE RESTYLANE LYFT AND VOLUMA TREATED SIDES AND THE BASELINE PRE PROCEDURE PICTURES.
During the year, the patient noted that the Restylane Lyft cheek felt higher than the Voluma side.
During the year, the patient felt that the Voluma cheek dropped slighted.
During the first 1-2 weeks, more swelling was noted on the Lyft side.
There was no difference in pain between the 2 sides.
Noted improvements were seen in jowls, jawline, NLF, cheeks, and periocular area on both sides of face.

Although this is only a single patient, these results support multiple clinicians findings that Voluma’s duration is very similar to other HA products. Even with the use of 6 syringes, which is rarely used in a single patient, the duration did not exceed 12 months. Patients need to be counseled that 12 months is what can be expected for Voluma’s longevity. Less expensive and higher G prime filler, Restylane Lyft, seems to be a better choice for volumizing the cheek complex.

Video of patient at end of 1 year with discussion and pictures.

Why are Blunt Microcannulas the Obvious Choice for Dermal Fillers?

The Latest Trend “Prejuvenation” – Preventative Rejuvenation

Dr. Steven F. Weiner’s 6 year Experience with Blunt Cannulas for Dermal Fillers

The Cheek Challenge Results – Voluma Vs Restylane Lyft

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