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In a recent study conducted by The People's Republic of China, multiple doctors tested various types of microcannulas to measure their differences and effectiveness. Let's dive into what the study talked about and how they came to the conclusions that they did.

Why A Study On Microcannulas?

Soft-tissue augmentation is a mainstay of cosmetic enhancement for the face and has grown immensely in popularity. The American Society for Aesthetic Plastic Surgery has a long list of used filler types. They are calcium hydroxyapatite, collagen, fat, hyaluronic acid, polylactic acid, and polymethylmethacrylate microspheres. That's a long list of choices, but of all these unique types of fillers, hyaluronic acid is used the most.

Why? Because of its hygroscopic properties, biocompatibility, and reversibility, hyaluronic acid is viewed as the most common dermal filler with which to restore volume loss.

Hyaluronic acid injection complications are local injection-related side effects that manifest as edema, pain, bruising, erythema, itching, and ecchymosis; the most concerning difficulty is vascular occlusion. It doesn't sound too appealing at first. However, blunt-tipped can provide some reassurance. 

Hyaluronic acid gels can be injected using sharp needles or blunt microcannulas. Studies have shown that the blunt microcannula with a side port presented improvements in mitigating pain and adverse effects, which has a degree of correction similar to a needle.

Some scholars state that the use of the microcannula is ideal for deeper nasolabial fold and lip augmentation and in areas requiring a larger filler volume, such as the mid-face and jowl regions.

The Differences Between Microcannulas

It's clear that micro cannulas have superior results compared to sharp-tipped needles, but which microcannulas work the best?

Microcannulas' use is limited by the injection area and the physician's choice, but the differences between microcannulas constructed by different manufacturers have not been carefully investigated. 

This study was designed to compare the microstructures and properties of different microcannulas by several trials and provide guidance for clinical application.

Materials 

The study chose nine types of microcannulas that are widely used internationally. These microcannulas are available in gauges ranging from 18 to 30; the 23-, 25-, and 27-gauge. All microcannulas have a blunt tip with a precision laser-cut lateral side port for filler extrusion and a plastic pedestal that fits on any Luer lock syringe. 

Microcannula

The physician may choose a different gauge or length because of the requirements of injection, including the technique being used and the area being filled. 

In this study, all microcannulas are 25-gauge. 

Methods

Scanning Electron Microscopic Images of the Microcannulas.

The microcannulas were sectioned and mounted onto a stub. A scanning electron microscope was used to obtain a high-definition image of the blunt tip, side injection port, and inner surface through each microcannula's side port. For each microcannula, three new microcannula tips were measured.

The Results

The microcannulas had various tip shapes. The microcannula's hole was oval (microcannulas 1, 3, 4, 5, 6, and 7), pointed rounded (microcannulas 8 and 9), or a unique form (similar to the rounded trapezoidal structure) (microcannula 2). 

The ports of the Microcannulas were mainly oval, but the lengths were different, and some ports were three times larger than the others. There were two port edge forms; some (microcannulas 1, 2, 3, 4, 5, 6, and 7) were smooth, and others (microcannulas 3, 8, and 9) were rough. The edge form depends mainly on the technical process, and the laser cutting generally results in a smooth shape.10 For the inner surface, most microcannulas (1, 2, 3, 4, 5, 6, 7, and 8) had inner surfaces with a cord-like structure; only microcannula 9 had an oval structure inner surface, and the difference demonstrated that they had different surface processes. 

Material

The inner surfaces of some microcannulas (2 and 8) had visible impurity, and the exterior of microcannula 7 had a stripe-like structure.

Only microcannulas 1 and 9 met the requirement concerning carbon composition; the other microcannulas had a higher composition with a significant difference. For other elements, all microcannulas met the American Society for Testing and Materials requirement; microcannula 9 was the only one that fits the American Society for Testing and Materials composition standards for all elements.

Elasticity

The elastic moduli of microcannulas 2 and 7 are smaller than those of other microcannulas. The yield strength was analyzed; the yield strength of microcannula 9 was the highest. There was a significant difference in the mechanical properties among the microcannulas.

Injection Speed

Microcannula 1 had the highest speed compared with other microcannulas, and microcannula 9 was the slowest one in the test. The difference in the time spent between microcannula two and microcannula 9 was more than 7-fold.

The result of the injection force test showed that some microcannulas could easily puncture the aorta with a higher force; it was difficult for microcannula 4 to puncture the aorta.

What Does This Mean For Microcannulas?

Compared with the traditional sharp needle, there is a definite advantage for blunt microcannulas to reduce patient discomfort, bleeding, and bruising, attributable to its rounded tip. 

In the electron microscopy results, there are nine types of microcannulas, which are mainly oval, pointed, or rounded, and microcannula 2 exhibits a unique form. From the point of stress, it is microcannulas 2, and 7 show significant differences with others.

It was more comfortable for the sharper microcannulas to penetrate the tissue, and the patient may feel more comfortable. By contrast, when blunt microcannulas meet dense tissue, such as ligaments and fascia, there will be a certain degree of discomfort from the tissue shift caused by the resistance. However, a blunter microcannula has a lower probability of piercing the vessels and is therefore safer. 

This issue is further investigated in the vessel piercing test. The results show that the tips of microcannulas 2, 8, and 9 are sharper, and the others are blunter.

For microcannulas 2 and 8, the carbon content is higher than the American Society for Testing and Materials standard level, and the carburizing treatment of the microcannula surface is mainly considered. Carburizing treatment is a chemical heat treatment process in which the steel is put into the carburizing medium to be heated and preserved, making the carbon atoms enter the surface. 

Generally, the surface carbon content increases with increases in the carbon atmosphere concentration, diffusion time, and diffusion temperature, whereas the internal carbon content is less affected. As the carbon content increases, the hardness and wear resistance of the material is often higher, as is the brittleness. The plasticity and toughness are worse, which may lead to a fracture in bending and stretching deformation. Microcannula 9 is the only one that fully conforms to American Society for Testing and Materials standards.

Importance for Doctors

It is essential for physicians to feel the injection during the operation; therefore, the study designed an injection speed experiment that was aimed at determining the time of each microcannula injection, and the volume of hyaluronic acid under constant pressure indirectly reflected the smoothness of the operative process. Smoothness is related to the inner diameter and the smoothness of the inner wall.

From a fluid mechanics standpoint, all other things being equal, the time spent for the liquid to pass through a microcannula depends on the larger area of the inner section and the side port section. When the inner part is larger than the side port section, the outflow of liquid is restricted by the side port, and the inner diameter makes no difference and vice versa.

For microcannulas 1, 2, 3, 5, 7, 8, and 9, the inner section is larger than the side port section, and, along with the reason for differences in smoothness, the result of injection speed can be explained. When changing between different microcannulas, physicians should be fully aware of the smoothness of different microcannulas. They should first adapt to the actual injection handle and then inject to avoid making the injection volume too large or too small. Although injection technology of hyaluronic acid has become increasingly mature, complications are frequent. 

One of the most serious is the microcannula piercing the blood vessels, which can lead to vascular embolization. There have been many cases of embolism reported in the literature that have resulted in skin necrosis and blindness. A competent physician must, as much as possible, reduce the risk of vascular embolism to zero. On the one hand, we should be familiar with the anatomical structure of different injection areas to avoid blood vessels during the injection. 

On the other hand, it is also imperative to choose a suitable injection tool. A few studies have shown that the microcannula with a blunt tip is better for avoiding punctured blood vessels than a sharp tip. The results showed that microcannula 4 struggled the most to penetrate the blood vessels, and the relative safety was high.

If you're a doctor who wants to purchase microcannulas, then explore FACE Medical Supply's store for all our available microcannulas. We carry multiple sizes to suit whatever your needs are.  

Reference for Summary

Comparison of Microstructure and Properties of  Different Microcannulas for Hyaluronic Acid Injection. Kelun Wu et al. Plast Reconstr Surg. .

Why Do Physicians love Microcannulas?

Simply put? The clinical benefits. Benefits from blunt microcannulas include elimination or near elimination of the risks of accidental intravascular injection. An intravascular injection is an injury to vital neurovascular structures within the areas of injection. Many researchers agree that a blunt microcannula of 27 gauge or above is unlikely to puncture blood vessels or nerves if it is used with proper technique. A Microcannula will push tissue aside as it traverses the path of least resistance through the tissue. So what other benefits do Microcannulas have?

Vascular Compression 

Technique matters for avoiding vascular compression, but blunt tips make the chances of it happen far less likely. To prevent excessive extrusion force when injecting fillers through blunt microcannulas that are invariably longer than the typical 13 mm to 19 mm sharp needles, a larger gauge is selected.

In general, a microcannula of 27-gauge or larger diameter is used in place of a 30-gauge sharp needle, and a microcannula of 25 gauge or larger diameter in place of a 27-gauge sharp needle. The decreased extrusion force facilitates the increased flow of filler products that can cause the deposition of inappropriately large filler boluses if the injector is unused to the small volume micro-threading technique that is best suited to microcannulas. 

Ecchymosis 

The decreased or eliminated the risk of piercing a blood vessel with an appropriately used blunt microcannula compared to sharp needles results in a significantly reduced risk of ecchymosis, which may be particularly noted in regions such as the nasojugal fold, the upper eyelid, and the pre-jowl sulcus. In the researcher's experience, ecchymosis with blunt microcannulas is minimal and, for many patients, nonexistent.

If ecchymosis does occur, it may be at the insertion site of the sharp pilot needle, or in areas of increased tissue resistance if the microcannula is applied with inappropriate force. Increased tissue resistance may be due to fibrosis, in patients who have previously had face-lifting surgery or multiple injection sessions with collagen-stimulating volumizers such as PLLA. These situations may be considered relative contraindications to the use of blunt microcannulas.

Tolerability 

According to researchers, the tolerability of blunt microcannulas is equal to or greater than that of sharp needles. Patient discomfort is reduced to the level where topical anesthesia alone consistently suffices even for injection of the lips, and local nerve blocks are not necessary. There may be some discomfort during the injection, especially if a microcannula is passed multiple times through a zone of tissue fibrosis. Some patients dislike the noise of a blunt microcannula passing through tissue, and we recommend forewarning patients of this and playing music to provide auditory distraction during the injection procedure. 

Collagenesis 

It has been suggested that the back-and-forth passage of a blunt microcannula multiple times through an area may stimulate collagenesis. This theory is persuasive by extrapolation from the collagenesis observed with repeated back-and-forth passage of cannulas during liposculpture. However, the researchers note that collagenesis induced by liposculpture typically results from a much larger number of "tunneling" passes through the tissue than would be performed when injecting alloplastic fillers with microcannulas. 

If you're a doctor who wants to purchase microcannulas, then stop by FACEMed's Store for all our available microcannulas. We carry multiple sizes to suit whatever your needs are.  

Regardless of what the Doctor is using the utmost care should always be taken to ensure safety for the patient. 

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For decades dermal fillers have been delivered to the face through a hypodermic needle. Nevertheless, aesthetic cannulas have become more popular over recent years, particularly for more extensive regions of the face. 

When many dermal kits come with both a sharp and blunt tip needle, how do practitioners choose between the two methods when treating a patient? Let's explain the main advantages and disadvantages of sharp needles and cannulas while highlighting the differences between the two.

Relatively recently, the use of Microcannula (or micro-cannula) has been introduced as a preferred method for the injection of fillers. This innovative method has been quickly gaining popularity among leading cosmetic clinics and doctors. Unlike traditional needles that are stiff and have a sharp tip to penetrate the skin, Microcannulas are flexible and have a blunt tip. Instead of piercing through the tissues, the cannula opens up its path between the anatomic structures of the skin.

Advantages of Microcannulas

Using Microcannula for filler injection offers several advantages over conventional needles, such as:

  1. Precision: When a Doctor uses a blunt-tipped cannula, they can shoot filler more accurately to achieve the results the patients desire.
  2. Minimum downtime: Sharp needles tend to cause bruising and swelling, which is hard to avoid. The blunt-tipped cannula technique decreases the chance of swelling and bruising, requiring minimum downtime.
  3. More dependable technique: A blunt-tipped cannula cannot enter an artery. This guarantees that it is a much safer option for any augmentation treatments.
  4. Tremendous Flexibility: With just one injection site, a large area can be treated or filled, giving the Doctor much more flexibility. 
  5. Minimized risk of bleeding and bruising: Sharp needles can puncture veins and arteries below the skin, a blunt cannula will push them aside.
  6. Less discomfort: Having many shots with sharp needles around the lips can feel painful and sore. Many people describe needle injections as bothersome, while patients who are injected through using a cannula describe the feeling as "pressure."

At the beginning of the filler injection using Microcannula, your Doctor creates a small entry point in your skin using a fine sharp needle. This is a vital step since the Microcannula has a blunt tip and is incapable to penetrate into the skin by itself. The entry point is very small and superficial and does not cause substantial pain or bleeding. Then the Doctor delicately inserts the Microcannula into the small opening and glides it under your skin to reach the sections of filler injection. The Microcannula slides through the spaces present between the tissues, it can be moved under the skin without creating any injuries to the tissues, and the patients usually do not feel any pain as the Doctor guides it under their skin.

Sharp Needle VS Blunt Microcannula

Probably the most apparent distinction is that a traditional needle has a sharp tip while the microcannula is blunt. The main issue when using a needle to deliver dermal filler is the possibility of inflammation and bruising post-treatment. After inserting the needle, there is a likelihood that it will penetrate the blood vessels underneath the skin, ending in a bruise. While practitioners can take several measures and use their expertise of facial anatomy to minimize the risk of bruising, even the most experienced practitioners can't ensure that a patient won't bruise. 

In contrast, a cannula, thanks to its blunt tip, does not present a threat. A small-bore needle is used to make the first entry point for the cannula to enter. Once the cannula enters under the skin, it is far less likely to pierce and pass through the blood vessels. Instead, it merely pushes past the vessels, causing less trauma beneath the skin and, consequently, less likelihood of bruising post-treatment.

Less risk, fewer Injections, Less Pain With Microcannula

A risk worth mentioning concerning the sharp needle is not just penetrating the blood vessel but shooting the filler into it, leading to vascular occlusion. That can result in much more severe complications. Again, there are specific standards that practitioners take to ensure that this doesn't happen; however, it is something that must be acknowledged when using a needle.

The risk of vascular occlusion alone is reason enough why many doctors prefer to use a cannula in higher-risk regions such as around the eye. A cannula won't tear any blood vessels in the region, which makes it less likely to cause any severe complications.

Another significant distinction between needles and cannulas is that a cannula is generally significantly longer than a needle, and is extra flexible. The length and flexibility of a cannula allow for smoother, consecutive delivery of filler, in areas such as the jawline. It can also be a desirable solution for patients who are apprehensive about needles since there's only one injection site.

A cannula will generally only require a modest number of insertion points as it can stretch a lot further under the skin, which makes the overall treatment less painful. A sharp-tipped needle is much shorter and will need to pierce the skin several times to deliver the filler across the entire treatment area.

Why Would Doctors Use A Microcannula?

Practitioners see the flexibility/length of a cannula as one of its significant advantages. Some, however, see it as a disadvantage. A small needle allows for more control and accuracy, particularly in areas that require a great deal of precision. 

Ultimately, there are advantages to both methods, depending on the area being treated and the patient. Sometimes it will come down to individual preference for practitioners. Many practitioners may feel extremely confident carrying out the bulk of their dermal filler procedures using just a needle, or just a cannula. In contrast, others may be happy to switch between the two depending on the individual case. Some might not want to learn a new method. Most doctors will agree that cannula is a valuable skill, even if it is not something they use very often. 

If you're a doctor who wants to purchase microcannulas, then stop by FACEMed's Store for all our available microcannulas. We carry multiple sizes to suit whatever your needs are.  

Regardless of what the Doctor is using the utmost care should always be taken to ensure safety for the patient. 

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