Precision in Midfacial Volumization Using Ultrasound-Assisted Cannula Injections

Background: Soft tissue filler injections performed with a cannula are perceived to be less precise due to the length of the instrument and due to the blunt tip, which can deviate in any direction. Midfacial needle injections are favored despite the increased risk for intra-arterial product placement. Objectives: The objective of this study is to demonstrate that ultrasound-assisted cannula injections of the midface result in precise, safe and effective volumization procedures. Methods: Midfacial injections with a 22 G cannula were performed in 188 midfaces of 94 healthy volunteers, (86 females; 53.05 (9.9) years; 23.63 (2.1) kg/m2) under ultrasound-assisted guidance. Precision ̶ the administration of product in the same plane as the location of the cannula tip, safety ̶ the rate of adverse events ̶ and aesthetic outcome ‒ rated by the patient and the treating physician ‒ were assessed. Results: In 100% of the cases, the product was applied into the desired deep midfacial fat compartment and the product did not migrate into more superficial layers during the injection process or at any follow-up visit. There was a statistically significantly (p<0.001) improvement in midfacial volume loss and the aesthetic outcome was rated as very much improved. No adverse events were reported throughout the follow-up of the study. Conclusion: Real-time imaging allows for visual feedback during cannula advancement and injection procedures in the midface and can help practitioners achieve safer aesthetic outcomes. It is hoped that practitioners decide to use a cannula more frequently for midfacial volumization based on the results presented herein.