Commentary on: Cannula vs Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study

Over the last ten years, the use of synthetic cosmetic tissue fillers has become transformative with regards to what outcomes may be accomplished. While there are many choices in fillers, most injectors utilize hyaluronic acid (HA) class fillers as their first choice for wrinkle filling or volume enhancement. Throughout this time, innovators have discovered additional tissue planes and off-label techniques for correction of areas such as the tear trough.^1,2 Reported adverse events relating to filler use can occur with virtually any location, from mild, such as the Tyndall effect, to extremely serious, like intra-arterial injections that produce local tissue slough, blindness, or stroke.^3,4 Conversely, minor-level filler-related adverse events seem to occur for unknown reasons. The good news, however, is that HA tissue fillers produce good clinical outcomes time and time again for patients. The bad news is that there are myths and wrong assumptions regarding precision of where the filler goes once it leaves the needle. When we think that we are acting in a safe, precise fashion, a new study like this one is a cause to reassess how one injects tissue fillers. Going forward, we simply cannot be attempting advanced tissue filler techniques with techniques of yesteryear and wrong techniques.