Fillers: how cannulas changed my aesthetic practice
A decision that often leaves aesthetic clinicians in two minds is the choice between needles and cannulas when it comes to injecting dermal fillers. Both have their merits – advantages and disadvantages – thus, are you really making a choice between one and the other, or simply deciding when a cannula might be a better instrument within your tool kit?
In this blog, Dr Tim Pearce reflects on his experience with cannulas, his journey of discovery, and how they were revolutionary in his aesthetic practice.
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 do cannulas fit into aesthetic practice?
Dr Tim reflects that in his initial training in medical aesthetics, well over a decade ago, particularly that which was led by the manufacturers of the dermal filler brands he was using, the key opinion leaders and faculty mentors tended to be heavily focused on the use of needles when delivering official training. However, he believes that many of the same practitioners used cannulas a lot more in their own day-to-day clinical practice. This experience somewhat delayed how quickly Dr Tim discovered and used cannulas himself.
Becoming accustomed to using cannulas can be quite stressful, initially. You are more used to immediately inserting a needle and delivering product, retracting, and doing the same again. When using cannulas, there is an extra stage involved – making the entry hole and positioning the cannula – which can add to the nerves. Placement can seem fiddly or tricky as you learn to master the art of using cannulas, and in the early stages, you might worry about how long it takes to place your cannula, and what your patient might be thinking as you seem to be ‘messing about’. It can take a good month to get proficient, so do not be put off.
But this was a game-changer and Dr Tim quite rapidly found it more difficult to use needles where he had previously used them all the time – his practice was changing.
The first place this happened was in the melo-labial folds. Foundational skills using needles employed cross-hacking techniques in this area, which is still useful in some cases, but Dr Tim found that by moving to using cannulas in this area, the main advantage was the reduction in risk to the underlying vasculature, in particular the facial vein, which avoided haematomas and potential vascular occlusion.
Alongside the reduction in complication risk, Dr Tim reflects on the revelation that cannulas are a superb tool in the lowest part of the melo-labial fold, for creating a straight jawline. The cannula delivery allows you to line up exactly where you want to create and strengthen the jawline and fill along that line. This technique also leads to less bruising for the patient, when compared to needle delivery, making it preferable for both the patient and the practitioner on an emotional level, aligned with the desire to do no harm.
Like many things, practice makes perfect and over time you will become much quicker at using cannulas, and the treatments inherently become quicker and less traumatic when performed through the one entry hole than when using a needle to deliver the same quantity of dermal filler product through multiple entry points.
With needles, each injection requires more practical management and risks more bruising (with more time spent compressing bleeding entry points). If you are delivering larger quantities of dermal filler (multiple syringes) into the same patient for a full-face rejuvenation, for example, then cannulas are certainly a preferable tool to reduce trauma, highlights Dr Tim.
The use of cannulas, and the change for many indications, away from needles, is quite an unexpected emotional twist in practice for a clinician, but the reduced trauma for the patient is usually the driver. Although you might then become reluctant to use a needle, there are times when only a needle will do the job. One area where Dr Tim realised that needles are preferable over cannulas is in the tear trough. Having tried cannulas in this area, with the aim of reducing the potential for bruising, he discovered that the depth of injection required meant that needles were in fact the better tool.
Reflecting on his own practice, Dr Tim noted that approximately 70% of his dermal filler treatments are now done using a cannula. He still uses and teaches the use of needles, viewing them as analogous to print writing versus cursive writing, in that you must start with the basics, the skill set to inject. However, you can very likely quickly move on to using cannulas in more areas, as a safer option. It does not take long to learn the ‘knack’.
If you are considering a move to cannula, why not read more from Dr Tim; he asks, is needle or cannula safer for dermal fillers? and explains 6 ways to reduce severe vascular occlusion with cannulas.
Dr Tim also offers training courses which use both needle and cannula at his SkinViva Academy including:
If you have any further questions about using cannulas for dermal filler treatments, or wish to comment on anything you are going to reflect upon and maybe change in your practice, Dr Tim would love to hear them. Find Dr Tim Pearce on Instagram.
Aesthetics Mastery Show
Cannulas changed my aesthetics practice
In this episode, Dr Tim discusses how cannulas changed his own aesthetics practice and how he feels they have gone from optional to essential. Watch the full Aesthetics Mastery Show here.
Is your worst nightmare causing a VO?
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Dermal Filler eLearning Courses
If you want to increase your knowledge of popular injectable treatment techniques, Dr Tim Pearce offers two fabulous courses:
Both give CPD and certificates on completion and are highly rated by our delegates.
In addition, browse our FREE downloadable resources.
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.
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.