aMount Sinai Medical Center, New York, NY bAboutSkin Dermatology, Denver, CO
resulting skin necrosis, blindness, or even stroke.3 High-risk areas reported in the literature
include the glabella (from supratrochlear artery occlusion), infra-orbital region (angular artery), peri-alar and nasolabial fold (lateral nasal artery and facial artery) and
perioral region (labial arteries).5 Moreover, nerve damage from needles can result in temporary or permanent paresthesias.6
Unlike needles, cannulas have blunt tips and may offer a safer method to administer dermal fillers. A blunt
tip is much less likely to traumatize soft tissue or nerves. Less trauma may translate to less pain and bruising, and ultimately a happier patient. Moveover, without a sharp
tip, the use of a cannula carries a lower risk of perforating a blood vessel and inadvertently embolizating filler into the blood stream (Figure 2).3,7
New cannulas will likely change the techniques used for soft tissue augmentation. Cannulas with flexible
bodies have been developed with as small as a 30-gauge width. At these sizes, they can be used to administer the dermal fillers currently available on the market. The
properties of the new cannulas may allow injectors to retry the fan-like injection technique, and likely see very nice results filling an area without the increased
Cohenbruising risk associated with fanning and needles. Using cannulas, an entry point in the skin still
needs to be made using a needle that is usually slightly larger than the cannula (i.e., a 25 gauge needle is often used to penetrate the skin before a 27 gauge cannula is
inserted). The blunt-tipped, flexible cannula is then maneuvered through the newly created needle opening and into the regions that require volume replacement. These cannulas
seem to decrease the amount of bruising anticipated compared with sharp needles alone. Moreover, cannulas may make injection of high-risk areas a safer procedure. Currently,
only the DermaSculpt microcannula (CosmoFrance, Inc., marketed by Merz Aesthetics), is the sole blunt-tipped, flexible cannula approved by the FDA for use in the United
Small-gauge, blunt-tipped cannulas are currently available in the United States. Their use for the
administration of dermal fillers may change the way we treat our patients and could improve patient outcomes.
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