With more physicians performing injections to the face in increasingly sophisticated ways, techniques must evolve accordingly. Injectables are no longer mere wrinkle fillers but true panfacial volumizers that are placed in many different planes and tissues of the face, in contrast to fillers of the past used for the dermis. This development is providing better results previously not achievable with off-the-shelf fillers. Microcannulas represent a step forward in enhancing surgeons’ ability to fill the face with less discomfort, edema, and ecchymosis, with faster recovery. Microcannulas will probably play a role in volume replacement for many years to come.
Injectables have become a mainstay of cosmetic enhancement for the face and have grown immensely in popularity. According to the American Society for Aesthetic Plastic Surgery, Americans spent roughly $10.7 billion in 2010 on 9.5 million cosmetic procedures: 8 million were minimally invasive procedures and 1.6 million were surgical procedures. The top 2 cosmetic minimally invasive procedures were botulinum toxin type A and soft tissue fillers. Fillers have evolved from early usage as wrinkle fillers to true 3-dimensional volumizers for the entire face. Our modern understanding of facial aging has taught us that “it’s not all sagging, it’s deflation as well.” Alongside this there has been a paradigm shift in the way clinicians think about injectable fillers and how they are applied. These fillers are used for temple rounding, cheek and chin augmentation, tear-trough correction, and jawline enhancement, to name just a few. This level of sophistication in filling techniques has also increased the awareness and rate of complications, the most dreaded of which is intravascular injection. Typically fillers have been applied using hypodermic needles, which have been associated with increased pain, bruising, and needle phobia in patients. Blunt-tip cannulas have made the jump from fat grafting to off-the-shelf injectable fillers as an alternative to needles. These cannulas represent a natural evolution in the way fillers are applied to volumize the face. In theory, they cause less trauma to the tissues through decreased vessel laceration, damage to subdermal tissues, and risk of intravascular injection.
Microcannulas
The concept of using cannulas for filling the face is not an entirely new one, as it has been used in fat grafting with success. Similar to fat-injection cannulas, they possess a blunt tip and a side port near the tip. In contrast to fat-injection cannulas, they are flexible, which allows a greater ability to fill the varying contours of the facial anatomy. The main advantages of these cannulas over hypodermic needles are:
- 1.
Minimized bleeding and bruising
- 2.
Less patient discomfort and needle phobia
- 3.
Faster recovery
- 4.
Decreased risk of intra-arterial injection and adverse events.
It is theorized that the cannula does not cut the tissue, but glides along the natural tissue connections with minimal damage ( Fig. 1 ). The blunt tip is thought to displace blood vessels rather than lacerate them, thus reducing bruising and edema, thus creating a more pleasant procedure with less downtime for the patient. Studies have not been performed in support of these claims as yet, but clinical experience has shown a decrease in bruising, bleeding, and patient discomfort during and after the procedure using a cannula.
The anatomy of a microcannula
Several companies have begun manufacturing disposable microcannulas. Dermasculpt ( Fig. 2 ) is made by CosmoFrance Inc (Miami Beach, FL), Pix’L cannulas are made by Thiebaud, a French company led by Dr Luc Dewandre (manufactured in partnership with Q med), and Merz cannulas ( Fig. 3 ) are manufactured by TSK Labs (Tochigi-Ken, Japan). These microcannulas are available in a gauge range from 18 to 30. At present the 27- and 25-gauge cannulas are becoming popular with aesthetic practitioners. The available lengths include 1, 1.5, and 2 in. The author prefers the 1-in cannulas for 27 gauge, and the 1.5-in for 25 gauge. The aesthetic practitioner may choose a different gauge or length as experience is gained with their usage, depending on the technique being used and area being filled.
Specific features of flexible cannulas currently available include:
- 1.
Flexibility, unlike a rigid cannula ( Fig. 4 )
Fig. 4
Demonstrating the flexibility of the microcannula.
- 2.
Blunt tip with a precision laser-cut lateral side port for product extrusion ( Fig. 5 )
Fig. 5
The blunt tip and the laser-cut side port.
- 3.
Fits on any Luer lock syringe ( Fig. 6 )
Fig. 6
Microcannula attached to Luer lock syringe.
- 4.
Made of stainless steel.
The anatomy of a microcannula
Several companies have begun manufacturing disposable microcannulas. Dermasculpt ( Fig. 2 ) is made by CosmoFrance Inc (Miami Beach, FL), Pix’L cannulas are made by Thiebaud, a French company led by Dr Luc Dewandre (manufactured in partnership with Q med), and Merz cannulas ( Fig. 3 ) are manufactured by TSK Labs (Tochigi-Ken, Japan). These microcannulas are available in a gauge range from 18 to 30. At present the 27- and 25-gauge cannulas are becoming popular with aesthetic practitioners. The available lengths include 1, 1.5, and 2 in. The author prefers the 1-in cannulas for 27 gauge, and the 1.5-in for 25 gauge. The aesthetic practitioner may choose a different gauge or length as experience is gained with their usage, depending on the technique being used and area being filled.
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