Fillers: 6 ways to reduce severe vascular occlusion with cannulas

Are you still struggling with the needle versus cannula debate and worried about the risk of using a cannula for dermal filler treatments?

In this blog, Dr Tim Pearce will share his six top tips for reducing the risk and severity of vascular occlusions when using a cannula to deliver dermal fillers for facial aesthetics.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

How to reduce the risk of vascular occlusion when using cannulas with dermal filler?

Often it seems to be a very black and white decision – cannula or needle – when it comes to what to use when injecting dermal fillers. But Dr Tim notes that there are many factors that we can control as injectors that can reduce any risk of cannula use.

Be gentle

When you are using a cannula, remember that force over area is pressure. If you apply less force, you are going to be putting less pressure on the vessels, and you are far less likely to penetrate the lumen of an artery. Find the path of least resistance instead of pushing through with force.

Do not insert into a bleeding entry hole

Never insert a cannula into a bleeding hole and use your instrument to tamponade the bleeding. Dr Tim has seen this practice on stage at educational events when injectors quickly put the cannula into the bleeding hole to try and stop it and then complete the procedure; he believes this is not good practice. In certain areas of the face, this is highly risky because the bleeding could be coming straight from an artery that you then go on to insert your cannula straight into.

Assess the mobility of your cannula

Before injecting, check that the cannula moves easily. Dr Tim explains that he has explored this on a cadaver study where you place the cannula into a vessel and can feel that it is different. When placed correctly, the fat gives way to the cannula, and it moves much more easily than if it is placed in a vessel. If you routinely check before you start injecting, it is one more test that may help you detect when your cannula has gone into the wrong place and reduce your risk of inadvertent vascular injury or compromise.

Look for a raise in the tissue

Another way to ensure that the cannula is in the right place is by observing for a small raise in the tissue when you start injecting. Dr Tim likes to sense that the filler is expanding outwards because he knows that if you are in a vessel, it travels down the lumen.

He explains that you will sometimes see this when you are injecting botulinum toxin into the forehead – as you inject, it almost disappears, you do not see the usual bleb and it is sometimes associated with a flash of white. This does not matter with botulinum toxin, but it can make a significant difference if you are injecting dermal filler and you do not see the skin raise up where it should. At this point, you should stop injecting immediately and make sure that you are not in a vessel.

Aspiration works with cannulas

Dr Tim admits that he assumed many years ago that there would be no point aspirating when using a cannula but is happy to be proved wrong after his colleague Dr Amy Clark decided to test it. She discovered, when using her coffee one day, that cannulas aspirate perfectly well with the hyaluronic acid-based dermal filler products that we commonly use in practice, not with all products, but particularly the Juvéderm® Vycross range works with most cannulas. It will be useful everywhere when treating, but particularly if you are in a tight space and there is not much ability to do your other tests, for mobility etc., thus aspiration may be one more thing that reduces the risk of being in a vessel.

Decrease severity not just frequency of vascular occlusions

If you are injecting in a high-risk area, remember that decreasing the severity of any potential vascular occlusion is one of your goals, and not just reducing the frequency of causing this complication.

Dr Tim recommends compressing any vessels that are leading towards the eye when you are injecting in a high-risk area. He admits that he has no idea whether this is going to work, but it makes sense if you compress, for example, the supratrochlear notch as you are injecting near the nose because then there is less room for filler to make its way into the eye area where we least want it to go. It is a simple extra step that is easy to add to mitigate risk.

Check out this blog on how to reduce risk and avoid vascular occlusion with dermal fillers for more understanding on the balance between frequency and severity of vascular occlusions.

For more in-depth advice on the needle versus cannula debate, read Dr Tim’s full blog on is needle or cannula safer for dermal fillers?

If you have any top tips for using cannulas with dermal fillers or further questions, why not drop him a comment on social media, you can find Dr Tim Pearce on Instagram.

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Aesthetics Mastery Show

6 Steps to reduce severe cannula VOs

In this episode, Dr Tim explains that although cannulas cause fewer vascular occlusions in general, their severity can be worse. Tim details the 6 simple steps you can take to reduce the risk. Watch the full Aesthetics Mastery Show here.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.