title: Cannula Versus Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study.
abstract: BACKGROUND
  Soft-tissue fillers have become important products for facial rejuvenation. Deep fat compartments and facial bones lose volume during the natural aging process. For the most natural-looking results, deep volumetric injections at strategic sites are therefore preferred. Supraperiosteal placement is performed with a sharp needle or a non-traumatic cannula.
  
  
  OBJECTIVE
  The primary objective was to determine whether there is a difference in precision between supraperiosteal placement with a sharp needle compared with a non-traumatic cannula in cadaver specimens. A secondary objective was to analyze the safety profiles of both injection techniques.
  
  
  METHODS
  Cadaver heads were injected with dye material and soft-tissue fillers at multiple aesthetic facial sites on the supraperiosteum and subsequently dissected for observation of dye and filler placement.
  
  
  RESULTS
  The non-traumatic cannula technique resulted in product being confined to the deep anatomic layers. In contrast, with the sharp needle technique, material was placed in multiple anatomic layers, from the periosteum to more superficial skin layers. For both techniques results were consistent for all facial sites.
  
  
  CONCLUSIONS
  Although direct extrapolation from cadavers to the in vivo situation cannot be made, cannulae showed more precision in placement of product. With the sharp needle, the material was injected on the periosteum, and then migrated in a retrograde direction along the trajectory of the needle path, ending up in multiple anatomic layers. The sharp needle technique also showed a higher complication risk with intra-arterial injection occurring, even though the needle tip was positioned on the periosteum and the product was injected with the needle in constant contact with the periosteum.
authors.affiliation: Private practice, Amsterdam, Netherlands.
authors.forename: Jani A J
authors.initials: JAJ
authors.lastname: van Loghem
authors.affiliation: West Midlands Hospital, Halesowen, West Midlands, United Kingdom.
authors.forename: Dalvi
authors.initials: D
authors.lastname: Humzah
authors.affiliation: Department of Chemistry, University of Hamburg, Hamburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Kerscher
mesh_terms: D000369:Aged, 80 and over; D002102:Cadaver; D000072601:Cannula; D003357:Cosmetic Techniques / Q000295:instrumentation*; D000067548:Dermal Fillers / Q000008:administration & dosage*; D005145:Face; D005260:Female; D006801:Humans; D007267:Injections / Q000295:instrumentation; D008297:Male; D009339:Needles
chemical_list: D000067548:Dermal Fillers