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Vancouver cheek filler with cannula injection close up

The best method for receiving dermal fillers is not always used; ask your doctor about cannula injections!

Editorial note: an earlier version of this post first appeared on September 17, 2012. It was updated on October 9, 2020.

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Around 2010, dermal injectors were widely introduced to the idea of avoiding needles when performing non-surgical facelifts. How? By using cannulas (technically, “cannulae”) to distribute fillers under the skin. This is, after all, the way fat grafts are traditionally done.

While this newer method is a lot more popular today, it may not be used by all practitioners who administer volumizing fillers. However, this method is not only safer for patients, it also offers better cosmetic outcomes.

So, if you’re looking for a cosmetic injector in your area, you’ll want to ask whether they use needles or cannulas. We’ll explain why below.

In case you’re wondering, our cosmetic clinic in Vancouver (Surrey), does use the cannula method for dermal filler injections!

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Needles vs. cannulas for dermal fillers: how are they different?

In medical practices, doctors and nurses can insert substances into the body with needles, or with cannulas (a.k.a. micro cannulas).

A needle has a sharp tip, so it can penetrate through the skin. A cannula has a blunt tip. This means it can not penetrate the skin. It can, however, be inserted into the skin after a needle has made a small opening for it.

When a cosmetic injector advertises “needleless injections,” they don’t mean zero needles. They mean that a cannula is being used instead of a needle when it comes to the actual distribution of filler beneath the skin.

Why not just go in all the way with needles? There are a few reasons:

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1) Cannulas avoid hitting veins and arteries during dermal filler injections, resulting in fewer side effects

Vancouver Juvederm dermal filler cannula injection for cheek lift in Surrey

Firstly, we need to remember that fillers are not meant to hit arteries or veins. They are only meant to provide lift to your skin, while leaving the rest of your face alone. If they do hit or enter an artery or vein, this can result in side effects. If filler gets inside an artery or vein, this is called intravascular injection. It is not good!

Side effects can be mild, such as creating a bruise when a vein is affected. However, they can also be very severe, such as deadening the skin (i.e. necrosis) or blindness, when an artery is injected.

Since a needle is very sharp, it can ‘slice’ through anything in its way, as it penetrates the skin’s layers. This makes it much harder for a practitioner to carefully feel their way through the skin while dispensing filler. It increases the chances of hitting a vein or artery.

A cannula, however, doesn’t slice through veins and arteries in the same way a needle can. Once it is beneath the skin, and passing through its tissues to reach a target point, it can push veins and arteries out of its way. Plus, if it gets close to a vein or artery, the practitioner can feel the resistance, and then redirect the cannula towards another pathway.

This doesn’t mean a cannula will never cut through veins and arteries. It just means it is less likely, if the practitioner is ‘tuned in’ to the process, and experienced at what they’re doing.

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2) Cannulas require fewer skin openings, resulting in less pain, bleeding, swelling and downtime

Vancouver lip filler doctor using trocar needle before Juvederm vial

When using a cannula for a dermal filler procedure, one insertion point can reach several areas underneath the skin. That one opening can also be reinserted multiple times to go in at different angles.

For example, using one insertion point, a cannula can fill an entire upper or lower lip, from one corner to the other corner. Or, with another single insertion, a cannula can fill under-eye circles, and the cheeks. The same is true when filling nasolabial folds and jaw lines. With a cannula, only two to four entry points are needed for full face injections (i.e. a non-surgical facelift). This is in comparison to 10 or 20 openings that would be needed for a needle-based facelift.

While it may at first make you feel uneasy to see such a long device moving around in your skin, it’s actually far less painful than a short needle. Patients undergoing cannula injections experience much less discomfort than during needle injections.

You see, a short, sharp needle can’t reach as far as a long cannula. In order for it to dispense dermal filler into the skin, multiple piercing are needed. With each opening, more injuries are created, each of which would need to heal. It is more common to see bleeding, swelling and bruising with multiple needle insertions, than with one. As a result, patients may need more time to heal before they are comfortable going out in public.

Plus, with each new needle insertion, there is further risk of hitting a vein or artery. Not to mention, further risk of infection.

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3) Cannulas allow for smoother face sculpting by evenly distributing dermal fillers

Vancouver lip filler procedure with doctor - cannula injection - in Surrey

Let’s demonstrate how dermal fillers can be distributed with cannulas, in comparison to needles. Imagine using a paintbrush to make strokes versus blots on a canvas. With blotting, you can ‘dab, dab, dab’ to make a line. You will get a line. But, it will be less uniform than if you stroke and glide your paint brush across your canvas. The stroke makes an even, smooth line. The pressure of your hand, and the size of the paintbrush, can determine the stroke’s thickness. This way, you can add more or less paint as you wish, to create your masterpiece.

The concept is similar with dermal fillers. A doctor or nurse could make multiple piercings with a needle to distribute filler within a ½ inch area (the typical size of needles used in this context). However, a flexible cannula can reach horizontally all the way to a certain point, then release substance slowly as it glides out. The face can be sculpted much more accurately this way.

Not only that, when a cannula can go deeper into the dermis, it can offer more natural-looking results. This is because the muscle and bone that make your face contours and expressions are located more deeply in your skin.

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Why don’t all cosmetic injectors use cannulas if it’s so much better, and safer?

Vancouver non-surgical facelift procedure using trocar needle close up - Surrey clinic

We certainly believe in using cannulas for dermal filler sessions in our practice. We can only speculate a few reasons why other clinics or practitioners would not do this. It could be because:

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1) It takes a lot more skill to use a cannula vs. a needle for dermal fillers

It’s very hard to use a cannula in this type of medical aesthetic application. In essence, a flexible cannula is a tool – it is not a failsafe, nor a ‘magic’ wand. It takes meticulous knowledge of anatomy, art form and dexterity on the part of the injector to use it correctly. Let’s explain:

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Cannulas require a sense of feeling under the skin

While a cannula passes through the skin, the injector must feel their way around, which requires great sensitivity and experience. While doing this, they can’t see under the skin, where the cannula is moving and injecting.

However, the ability to feel ligaments, dermal layers, tissues and other facial structures can help the practitioner tremendously when targeting a certain area to lift it. Of course, they should know generally where parts of a human face are. But being able to feel them with a cannula on each individual patient can provide more accurate outcomes.

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Cannulas require experience with dermal filler flow rates

There are many types of dermal fillers. The fluidity and thickness of the dermal filler, as well as the gauge of the cannula, can affect its flow rate. While not being able to visibly see what is going on under the skin, the injector must be very adept at understanding exactly how much filler is being released with each push of the plunger.

This means the injector needs to be experienced with the filler itself, and not just the tool they are using to dispense it. If they release too little, you won’t get the effects you were hoping for. If they release too much, you will get bumps and uneven sculpting of the face. Worse; you could get side effects, like those noted above.

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Cannula mistakes can be hard to reverse when it comes to injecting dermal fillers

To avoid the risk of mishaps, doctors or nurses may choose not to use a cannula. Some of these mishaps can be hard to reverse, especially when the filler is not made with hyaluronic acid. Hyaluronic acid fillers can be dissolved easily, if you don’t like the results. But the flip side is that they don’t last as long as other types of filler material. So sometimes, longer-lasting fillers are chosen by the patient. These can stay in place for a long time. It’s important to get them ‘right.’

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2) Dermal filler packages come with short-tipped needles, and their makers train injectors to use them

juvederm dermal filler syringe for beauty treatments

The other reason injectors may stick to the needle method for injecting dermal fillers, is that their pre-packaged products come with them. Companies that make dermal fillers often train their buyers to use the needle that comes with their package.

If a cosmetic injector is not versed in the principles of dermal filling, they will only be able to ‘follow the rules,’ so-to-speak. Like the point above, they may believe it is ‘safer’ to stick to the ‘user manual.’ A smart doctor or nurse, however, should have additional training and knowledge on the use of various tools to do this type of job. As we’ve seen above, it is not safer to use a needle if you know how to use a cannula – it is just easier.

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3) Purchasing additional cannulas adds cost to the procedure

While this should be a minor point, it may be that some dermal injectors want to minimize costs to their practice for this procedure. Cannulas would need to be purchased separately, apart from the filler, which is already an expensive product. Plus, a doctor or nurse may need to use both a needle and cannula, or different gauges of cannulas, for a single procedure, to do it well.

However, in our view, the cost of whether or not to use a cannula should not be a cost deterrent, especially when it comes to the betterment of patient safety. These procedures cost the patient hundreds, if not thousands of dollars. Injectors should be able to afford to keep cannulas on hand!

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Do I always need a cannula procedure for dermal fillers? Can needles work in some cases?

When the situation calls for a cannula procedure, it’s best to seek the services of a dermal injector who can handle this method. For example, if you are looking to have large facial areas volumized and sculpted, you will be better off with a cannula procedure.

However, there are some cases where a needle tip would actually be better. For example, very small face sections might be better served with a short, sharp needle. Plus, some fillers may be too thin or thick to be administered with certain tools. Certain layers of the skin, and the amount of filler needed in that layer, can also require one tool or the other.

Chin augmentation, nose and earlobe re-contouring may better served with a traditional needle. A Tri-Site Bolus technique for upper cheek enhancement is another example where needles may be more suitable. However, when it comes to marionette lines, nasolabial folds and temples, using a cannula can be very effective.

The determinant of whether to use a cannula or needle can also depend on the specifics surrounding your case, and the results you want to achieve. In general, it is best to choose a doctor or nurse who can offer both methods. This will avoid you having to guess whether or not they are using the best technique for your case. If they have the right skills, they will be able to make better judgement calls, regardless of the technique that is usually used in a certain context.

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Using cannulas vs. needles for dermal fillers is not the only qualifier to seek in an injector!

As a concluding word, we will say that while a cannula injection is certainly something to look for when seeking dermal filler services, it is not the only qualifier.

A ‘good’ practitioner of cosmetic injections will be well-versed in many other areas of this discipline.

For example, certain fillers need to be inserted at particular angles, and at particular spots on the face. Some won’t work as well as others for certain use-cases. Many require specialized training, or even optional training, which injectors may not make time for. Some fillers need to be stored a certain way, or mixed with other substances before use. Then, there is the idea of mixing fillers with wrinkle relaxers, like Botox®. There are special techniques for doing this properly.

A patient’s history and pre-existing conditions are another consideration when it comes to dermal filler procedures. For example, a doctor or nurse should be able to screen for potential side effects from allergies. Or, if a patient has already had work done, an injector who is better equipped can augment, and not interrupt, any previous efforts at facial sculpting.

There is a lot that goes into dermal filler injections. It is not the kind of thing any doctor or nurse can do, just because they know how to use a syringe.

If you live in the Vancouver area are looking for a dermal injector, we’d love to be your provider of this service. We encourage you to book a consultation at our Surrey cosmetic clinic. Our highly experienced, lead doctor or nurse will be able to take a closer look, and make recommendations for a procedure that can give you optimal results.

Be it for facial thinning, face contouring and sculpting, plumping the lips, smoothing nose bumps, reducing the appearance of wrinkles, brightening facial expressions or otherwise, our dermal filler services have been the answer for many of our existing, happy patients. They may just be what you’re looking for, too!

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