Achieve a Radiant Smile with the Happy Face Treatment

In this episode of Anti-Aging Insights, Dr. Teri Fisher delves into the essential tools used in aesthetic medicine, focusing on the fundamental role of needles, syringes, and cannulas in achieving natural and precise treatment outcomes. Dr. Fisher likens these tools to different paintbrushes, crucial for accuracy, comfort, and safety in aesthetic procedures. He provides a detailed explanation of why the choice of tool matters, emphasizing that tools aren’t just about functionality but also about technique.

Dr. Fisher explains that needles are the cornerstone of aesthetic procedures due to their precision. They are primarily used for treatments requiring accuracy, such as neuromodulator injections like Botox, Dysport, and Xeomin. These needles, typically around 30 gauge, are akin to those used for insulin injections and offer control over the depth and placement of products, making them ideal for treating targeted areas like fine lines and wrinkles. However, needles can cause more bruising and are not suited for large volume treatments.

Syringes, the companions to needles, vary in size to match the product being injected and the treatment area. The smaller the syringe, the more control a practitioner has over the precise volume injected.

Cannulas are introduced as the gentler alternative to needles, equipped with a blunt end designed to slide through tissue and minimize trauma, reducing the risk of bruising. They are ideal for treating larger areas and for applications where minimizing blood vessel trauma is critical.

Dr. Fisher underscores the importance of his choice between needles and cannulas, which relies on several factors including treatment area, patient comfort, and, above all, safety. He emphasizes the importance of choosing a provider with expertise to ensure safe and effective results, thereby building trust with patients and empowering them to make informed decisions about their treatments.

Key Insights

• In aesthetic medicine, tools such as needles, syringes, and cannulas play a crucial role in achieving precise, comfortable, and safe treatment outcomes.
• Needles are ideal for precise treatments like Botox due to their ability to target specific spots, but they can cause more bruising and are less suitable for large volume treatments.
• Syringes work in conjunction with needles and come in various sizes, allowing for controlled and precise delivery of treatments like neuromodulators.
• Cannulas, with their blunt tips, are used for treating larger areas, minimize bruising, and reduce trauma by sliding through tissue rather than piercing it, but they require more expertise for accurate filler placement.
• The choice between needles and cannulas depends on the treatment area, patient comfort, and most importantly, safety, emphasizing the need for skilled and experienced providers.

Episode Transcript

Dr. Teri Fisher: Hey there and welcome back to Anti Aging Insights where, as you know, we dive into the world of aesthetic medicine with practical tips, and today we are getting a little bit technical. But don’t worry, we’ll keep it very approachable as well. We’re talking about tools of the trade. All those things like needles, syringes, cannulas, all the tools that help to create those natural sculpted results that everybody is going for.

And I want to take a few moments today to break it down to you, to let you know a little bit about what these tools are, why we might use one or the other at a particular time, and just help you understand what are the things that you may see or encounter when you come in for a treatment.

Why do the tools matter? Well, you can think of them almost like the different types of paintbrushes in aesthetic medicine. The right tool is what we use to make sure that we can be very precise, that the treatments can be as comfortable as possible and of course, so that they can be as safe as possible as well. It’s not just about what we use, but how we use it. And so, just a quick example right off the bat here, is a needle for Botox is not the same as a cannula for fillers. They have completely different functions. They’re used completely different in those two different scenarios, and they each have pros and cons as well.

So let’s start with the most valuable player, if you will, of aesthetic medicine, the needle. Needles come in all shapes and sizes, well, mostly sizes. Most needles do have a similar shape with a pointed end, and that is the key. They do have a pointed end, which is one of the big differences from a cannula, and we’ll get to that in a few moments.

In medicine, we measure needles by the gauge and the length. The gauge tells us how thick the needle is. And the length, well, that one’s pretty self explanatory. The higher the number in the gauge, the smaller the diameter. So a 30 gauge needle is thinner than a 27 gauge needle. And to give you an idea, oftentimes when we’re doing a neuromodulator injection like Botox, we are using something that is like a 30 gauge needle. It’s very, very small. It’s a similar needle to what people with diabetes use when they have to inject insulin.

The length of these needles can range anywhere from very, very short needles, only about four millimeters in length. And those are great for really superficial injections, like things that need to be injected close to the surface of the skin. And of course, needles can be quite a bit longer than that as well for deeper treatments. Why do we use needles? Well, they are really precise. They are great for targeted treatments and they’re in fact the gold standard for neuromodulator treatments like Botox, Dysport, Nuceiva, Xeomin. What’s really nice about the needle is that we are injecting the point of that needle directly down to where we want that medication or that neuromodulator to go. It is really valuable then for treating things like fine lines, wrinkles, and small areas where we want to be as precise as we possibly can. It’s easier to control the depth and placement because we know where we are placing that tip of that needle. The cons to using needles is that they can cause a little bit more bruising than cannulas because if they hit a blood vessel they can pierce that blood vessel and what happens then is you get a little bit of bleeding around that area and that can lead to some bruising. The other thing is that they’re not ideal for large volume treatments, because if you want to have some type of substance deposited in a large area, you would have to use multiple needle pokes to do that, which becomes a little bit impractical and can become a little bit more uncomfortable as well.

So the ideal situation for using needles is when we want to do Botox injections. Again, we typically use a very fine, short needle, usually 30 gauge. It’s less painful for people because they are so small and it gives me as the clinician very precise control about where I need to inject those particular muscles.

Just to give you an idea too, a 30 gauge needle is so tiny, it’s really not much bigger than like a mosquito bite. That kind of gives you an idea of how small we are talking about when we’re talking about a 30 gauge needle. .

Now, when we talk about syringes, the syringes are the partner in crime to the needles. The syringes are the actual devices that hold the substance that is being injected. These are the delivery systems for the treatments, and they come in different sizes. Oftentimes, we can have very small syringes, one milliliter syringes, all the way up to three, five, ten milliliter syringes. We have syringes that are even smaller than that, which will hold, when completely full, only three tenths of a milliliter of solution. And those are typically the ones that we use, again, for Botox, for neuromodulator treatments, because the units that we’re dealing with when it comes to Botox are so small that we want to have these very small needles because it allows for precise measuring of the volume.

You can imagine that if we had a massive syringe, a 10 milliliter syringe, and we were only injecting one or 0.2 milliliters at a time, it would be very hard to control that in a massive 10 milliliter syringe. But when you have a very small syringe that only holds up to 0.3 milliliters of solution, then when you inject it, you have much more control over how much you are depositing.

So the key is to match the syringe to the product and to the treatment area. And using a one milliliter syringe, for example, for dermal filler is a great size syringe because oftentimes we are injecting half or one milliliter of filler at a time and these syringes are made perfectly for that.

Now when it comes to cannulas, cannulas are kind of the needle’s gentler cousin, if you will. Instead of a sharp tip on the end, a cannula has a blunt end with a hole just a few millimeters back from that blunt end. What that means is that once you insert that cannula into the tissue, and by the way, you do need to use a needle to make a little hole for the cannula to get into, because the cannula doesn’t have a sharp tip. But once you do have that hole, then you can put the cannula in that hole and now the cannula is designed to slide through tissue rather than pierce it. And this is really critical because this now allows for treatment of larger areas. We can actually slide that cannula while we are injecting in a fan like orientation, and that’s just one example of a technique, but that allows us to spread things like fillers in a larger area using one little hole and then the cannula slides into various regions.

What does that mean? It means that there is lower risk of bruising because it’s less likely to hit or go through a blood vessel. If you have a needle coming up against a blood vessel, remember that needle has a sharp tip and it tends to puncture that vessel. But, if you have a cannula that comes up to the vessel, remember the cannula has a blunt tip and what tends to happen is it goes around the vessel, or it kind of pushes that vessel out of the way.

Now there is some variability in that depending on the size of the cannula because again, the size of the cannula is measured in the gauge. And again, the larger the number of the gauge cannula, the smaller the diameter. So when you get to very, very high gauge cannulas, which again means a small diameter cannula, that just by the nature of the size of it, can have a tendency to puncture blood vessels, which is why when we are using a cannula, the safest cannulas are actually those cannulas that have a little bit bigger diameter, or those with a lower gauge. In that way, we have a very safe device, and it slides through the tissues. If it bumps into a vessel, it sort of pushes it out of the way, and we’re able to deposit filler to a larger area. The con is that it is a little bit less precise than using a needle, because again, with a needle, we inject directly into the spot that we want to have that deposition occur, and we inject it right there. With the cannula we are sliding it under the tissue and we are using our knowledge of anatomy and the texture of the tissue to figure out where that cannula is and deposit the filler in the right place. Because of this, it is a little bit trickier to navigate and it requires more expertise.

So having said all that, I hope that gives you an idea that there are lots of things that go into deciding between which type of tool to use. How do I decide whether to use a needle or a cannula? Well, there are lots of variables that I think about. It’s all about the area that I’m treating and it’s all about being safe. And so in general, needles are good for small, precise areas and cannulas are better for larger areas, and also in particular for areas where I want to minimize any trauma to any underlying blood vessels.

It’s also about comfort and knowing which areas tend to be more comfortable for patients is also a key factor to consider.

Probably the most important factor though, again, is the safety. Whatever I choose to do, safety is my number one priority. Whatever I choose to do, that is at the forefront of what I’m thinking about in terms of making a decision between cannula and needle. Obviously every device that I use is sterile, single use, and we use proper technique and hygiene to prevent any possible complications like infections or vascular occlusions or the things that you may have heard about.

And this again is where experience comes in. Tools are only as good as the hands using them. And that’s why it’s so important to choose a provider with the training and the expertise.

And so if you are a patient, why does this all matter? Well, understanding the tools helps you to ask better questions and feel more confident about your treatments. It’s all about building trust and making sure that you’re getting safe, customized care.

And if you are a provider, then hopefully this has been a review for you about what to use when and how, and I hope that you will feel free to contact me with any questions at all.

So that’s a wrap on today’s episode of Anti Aging Insights. Hopefully you now have a better understanding of the tools that we use in aesthetic medicine and why they matter.

So if you’ve got questions or suggestions for future episodes, feel free to get in touch with me on Instagram at DrTeriFisher. Thanks for tuning in. Until next time, stay curious, and I’ll talk to you again really soon.