Cannula vs. Needle for RESTYLANE® Application : Which is Better?

As the demand for quick and non-invasive procedures that deliver instant results increases, dermal fillers like RESTYLANE® have become a popular choice for facial rejuvenation. While the procedure is generally safe, the method of administration can greatly influence the treatment outcome.

In this article, we will explore the different techniques used to apply RESTYLANE® and how they affect the final results.

RESTYLANE®: Enhancing Looks without Surgery

RESTYLANE® is a non-animal stabilized hyaluronic acid (NASHA)-based dermal filler derived from Streptococcus bacteria. It effectively corrects wrinkles, deep nasolabial folds, and marionette lines.

Unlike Botox, RESTYLANE® fillers smooth moderate wrinkles and restore skin volume through two mechanisms: blending with surrounding dermal tissue to improve volume and binding to water molecules to replenish skin hydration, giving a youthful and natural look.

Two RESTYLANE® products approved by the FDA for cannula use are RESTYLANE® LYFT for midface enhancement and RESTYLANE® SILK for lip augmentation.

Needles & Cannulas: Tools of the Trade

In dermal filler procedures, the injection device is crucial. While RESTYLANE® fillers typically come with needles, cannulas are becoming the preferred method among cosmetic specialists.

• Needles: Sharp with a pointed tip and usually short, needles are ideal for transecting deeper skin tissue and delivering precise aesthetic results.
• Cannulas: Flexible and long with a blunt tip, cannulas offer excellent tactile control and a less invasive approach. They are especially useful for contouring and volumizing procedures, such as cheek or jawline augmentation.

Therapeutic Aspects of RESTYLANE® Application

Regardless of the application method, the procedure for applying RESTYLANE® follows standard preparation protocols, including cleaning the injection area with antiseptics.

• Preparation: Clean the injection area and surrounding skin with antiseptics.
• Injection Site and Depth: Precise site selection and depth accuracy are crucial for optimal outcomes.
• Anesthesia: Use ice application, topical EMLA cream, or regional nerve blocks (submucosal, maxillary, mental, or infraorbital) to ensure patient comfort.
• Patient Comfort: Massage and soothing conversation can help distract and relax patients during the procedure.
• Injection Technique: Depends on factors such as the intended use, location, filler substance, needle or cannula size, and operator expertise.

Needle and Cannula Techniques for RESTYLANE® Application

Needle Techniques

Several techniques can be used when applying RESTYLANE® with a needle:

1. Linear Threading: Insert the needle to the desired depth and deposit the filler while retracting the needle.
2. Serial Puncture: Multiple small injections to address wrinkles and volume loss.
3. Fanning: Change the needle angle from a single entry point to deposit filler radially.
4. Cross-Hatching: Create a grid-like pattern with parallel and perpendicular lines of filler.
5. Depot: Advance the needle to the fat pads or periosteum and deposit a filler bolus.
6. Layering: Inject filler at various depths for volume build-up.

These methods can also be used with a cannula, alongside advanced techniques for specific needs.

Safety Considerations for Needles

• Gradual injections with 0.05-0.2 cm³ of filler per pass.
• Use a sharp needle or blunt cannula (25-32 gauge) to reduce trauma.
• Aspirate for at least 5 seconds before each injection to prevent intravascular injections.
• Stop immediately if blanching occurs and treat accordingly.

Cannula Techniques

The cannula method often requires a needle to create a pilot hole before insertion:

1. Preparation: Ensure appropriate cannula size and filler are ready.
2. Create the Pilot Hole: Use a needle to puncture the dermis, creating an entry point.
3. Insert the Cannula: Navigate the cannula into the dermis, using gentle tapping and lubrication if needed.
4. Navigating Through the Dermis: Position the cannula in the hypodermic fat layer, adjusting the angle as necessary.
5. Overcoming Tissue Blockages: Reposition the cannula or lift the skin to find a new path.
6. Injecting Filler: Lay down the filler with retrograde or antegrade injections as needed.

Safety Considerations for Cannulas

• Follow the path of minimal resistance during insertion.
• Avoid cannula insertion into a bleeding entry point.
• Monitor the injection site for proper filler spread.
• Aspirate before injecting, regardless of the tool used.
• Apply gentle pressure to vessels in high-risk areas to reduce complications.

By understanding the techniques and safety considerations, dermal fillers can be a safe and effective way to enhance appearance.

Cannula or Needle for RESTYLANE®: A Comparison

Feature	Needle Technique	Cannula Technique
Gauge	27-30	22-30
Filler Volume	Lesser volume per injection	More volume per injection
Results	Immediate	Immediate
Stability	Can unintentionally enter different facial planes	Blunt tip helps stay in the designated plane
Bruising	Higher risk	Lower risk
Safety	Riskier in sensitive areas	Safer in sensitive areas
Entry Points	Multiple required	Fewer required
Filler Distribution	Uneven distribution possible	Even distribution
Pain	More discomfort	More comfortable
Post-procedure Downtime	Increased	Decreased
Risk of Neurovascular Damage	Higher	Lower
Versatility	Best for fine lines, wrinkles, tear troughs, vermilion border, Cupid’s bow, columella	Best for pre zygomatic space, jawline, temples, mid-face, nasolabial folds, corners of the mouth

Possible Complications

Minor Adverse Events:

• Swelling
• Redness (erythema)
• Pain
• Bruising

Severe Adverse Events:

• Vascular occlusion
• Infections
• Tyndall effect (bluish discoloration)
• Asymmetry
• Over/under-correction
• Lumps
• Dermatitis
• Migration
• Granuloma formation
• Skin necrosis
• Pulmonary embolization
• Stroke
• Blindness

Needle vs. Cannula: Key Considerations

• Study Insights: Needles are associated with a higher frequency of vascular events, while cannulas reduce these events by 77%.
• Expert Opinion: Dr. Tim Pearce suggests that the severity of complications with cannulas may be harder to manage due to their length and the volume of filler used.
• Skill Matters: The clinician’s expertise is crucial for safe procedures with minimal adverse events.

Conclusion

Dermal fillers like RESTYLANE® play a vital role in facial rejuvenation, but they should be part of a comprehensive approach. Cannulas offer a safer alternative to needles, particularly in sensitive areas, though even thin-gauge cannulas can function similarly to needles. Clinicians must follow strict safety protocols and be prepared to manage complications promptly to ensure long-term, aesthetically pleasing results.