Vascular occlusion could also be much less most probably with fillers by means of cannulas vs. needles

January 05, 2021

1 min read


Alam M, et al. JAMA Dermatol. 2020;doi:10.1001/jamadermatol.2020.5102.

The authors report no relevant financial disclosures.

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Skin fillers delivered by cannulas may cause less intravascular occlusion than fillers delivered by needles, but both methods are safe, according to a study.

“Soft-tissue augmentation using prepackaged injectable skin fillers is an increasingly commonly performed procedure for correction of acne scars, traumatic injuries, HIV-associated lipoatrophy, age-related volume loss and rhytids, and other indications,” Murad Alam, MD, MSCI, MBA, of the department of dermatology, Feinberg School of Medicine, Northwestern University, and colleagues wrote.

Fillers such as hyaluronic acid derivatives, calcium hydroxylapatite, polymethylmethacrylate microspheres and poly-L-lactic acid are delivered through a needle or a disposable microcannula into the dermal-subcutaneous junction. Vascular occlusion events may occur in some patients who receive fillers.

The retrospective cohort study evaluated injection practices, injection volumes and prior intravascular occlusion events among 370 dermatologists, totaling 1.7 million injections.

One occlusion occurred per 6,410 injections via needles compared with one occlusion per 40,882 injections via cannulas (P < .001).

Cannula injections had 77.1% lower odds of occlusion compared with needle injections, and dermatologists with more than 5 years of experience had 70.7% lower odds of occlusion.

No significant association was found between filler type and vascular occlusion in cannulas. In needles, multivariate analysis found poly-L-lactic acid had 72.5% lower odds of occlusion than hyaluronic acid. In addition, one additional needle injection per week decreased the odds of occlusion by 3%, while additional cannula injections did not show a significant association.

“Cannulas appear to be less likely to be associated with occlusions than needles,” the authors wrote. “But based on the data analyzed, it appears both types of instruments are safe, with occlusions occurring in, on average, fewer than one per 5,000 syringes when injections are performed by dermatologists.”

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