The Future of Injectables: Advanced Techniques for Aesthetic Physicians
In the world of aesthetic medicine, precision and safety in injection techniques are becoming increasingly important. In a recent conversation between experts Raj Acquilla and Jani Van Loghem, key topics were discussed regarding the future of injectables, the choice between needle and cannula, critical anatomy, and the risks professionals must consider to avoid serious complications such as vascular occlusion or blindness.
Risk Zones and Injection Strategy
The specialists emphasized that there are no completely safe zones—particularly in areas like the forehead. A solid understanding of arterial anatomy, such as the supraorbital and supratrochlear arteries, is crucial to avoid intravascular injection.
- When injecting in these zones, it's advisable to use minimal amounts of product (0.025–0.05 ml per retro-injection).
- Cannulas offer greater safety in high-risk areas, while needles can be used at bony support points with a controlled technique.
Needle vs. Cannula: Which One to Choose?
The choice depends on the physician’s experience and the treatment area:
- Needles, when used in contact with bone and with the bevel facing down, minimize the risk of arterial penetration. However, they require a steady hand and no sudden movements.
- Cannulas allow for safer work in subgaleal or subcutaneous planes, especially in regions with multiple arterial anastomoses (e.g., nasal or forehead regions).
Raj Acquilla, although originally a strong advocate for the cannula, acknowledges that in certain treatments—like lip contouring or specific projection points—the needle can offer more precision.
The Importance of Microdosing and Slow Injections
One of the key takeaways is the importance of injecting slowly and using microdoses to reduce risks. According to cadaver studies, as little as 0.04 ml of product could be enough to occlude the retinal artery and cause blindness.
The experts recommend:
- Retro-injections with less than 0.025 ml of product.
- Avoid rushing through procedures in high-risk zones, as fast injections increase the chance of complications.
Dilution and Product Type
There's ongoing debate about whether lower-viscosity hyaluronic acid reduces risk. While the texture can influence how the product behaves in a blood vessel, the most important factors are placement technique and volume control. Less viscous products may spread more easily but won’t prevent occlusion if injected into the wrong location.
Advances in Facial and Lip Contouring
For facial contouring, experts recommend using reference lines like Steiner’s line, which connects the nasal ala, lips, and chin to achieve a natural facial harmony.
For lips:
- More defined products are preferred for the vermilion border, while more voluminous products are ideal for the mucosa.
- A combined use of needle and cannula allows for projection without deforming the lip or inverting its natural curvature.
The Future of Injectables
The future of injectables is moving toward more personalized and safer techniques:
- Facial ultrasound mapping to locate arteries before injecting.
- Specialized training in microdosing and advanced anatomy.
- A fusion of art and science, recognizing that each face requires a unique approach.
Conclusion
Mastering advanced injection techniques requires deep anatomical knowledge, technical control, and continuous education.
At CIME Academy, we teach doctors how to work with safe protocols, respect anatomical structures, and achieve natural-looking results.
Contact us now and secure your spot in the next hyaluronic acid filler course.
Location: Calle Entenza Nº 144, 08929 Barcelona – Clínica CIME Barcelona
WhatsApp: +34 690 864 816
E-Mail: secretaria@cimeacademy.com
