Quantifying Depth of Injection of Hyaluronic Acid in the Dermis: Data from Clinical, Laboratory, and Ultrasound Settings

April 2016 | Volume 15 | Issue 4 | Original Article | 483 | Copyright © April 2016


Patrick Micheels MD,a Stéphanie Besse MD,b Didier Sarazin MD,c Anne Grand Vincent MD,d
Natalia Portnova MD,e Marva Safa Diana MDf

a Private practice, Geneva, Switzerland
b Private radiographic imaging, Institut MedImage, Geneva, Switzerland
c Laboratoire Viollier-Weintraub, Geneva, Switzerland
d Private practice, Paris, France
e Private practice, Riga, Latvia
f Private practice, Neuchâtel, Switzerland

DISCUSSION

What seems clear to us is that the mathematical formula for 30° and 45° injection we had used, ie, sin (angle) x length of insertion of need= depth of penetration, will invariably lead us to implant too deeply, especially if we fully implant the needle as we have done in retrograde injection. To inject at the correct depth, the angle of insertion must be changed from 30° to 7°-9° for insertion into the superficial reticular dermis and from 45° to 9°-12° for insertion into the mid reticular dermis. Even a change of a few degrees, we believe, will result in improper placement. For example, using the mathematical formula and the conventional 10° to 12° acute angle, placement will still be in the superficial dermis, ie, 0.2 mm to 0.3 mm. Insertion depth length of implanted needle is equally critical: 1.1 mm to 1.5 mm for superficial reticular injection and 6.0 mm to 8.00 mm for mid reticular injection.

CONCLUSION

Heretofore conventional angle of injection has not proved sufficient for entry into the superficial and/or mid reticular dermis. More acute angles on entry and precise measurement of the length of the needle inserted under the skin are essential to proper placement in the superficial and/or mid reticular dermis.

ACKNOWLEDGMENTS

We warmly thank Mr. Basste Hadjab for his help with the mathematics formula; Mr. Karl Malouines, from Studio Recor for his excellent pictures; and Dr. David Howell for medical writing assistance.

DISCLOSURES

The authors have no commercial interests to disclose for this manuscript. Merz North America, Inc. provided funding to David J. Howell, PhD, a self-employed medical writer, for his assistance in editorial development of the manuscript.

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AUTHOR CORRESPONDENCE

Patrick Micheels MD…….............. patrickscab@vtxnet.ch
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