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What is the better delivery of fillers to the tear trough area, needle injection or micro cannula?

Dr. Dean Kane Q & A Q. What is the better delivery of fillers to the tear trough area, needle injection or micro cannula? I am considering having under eye hollows filled conservatively. Which method and filler (Restalyne, Restalyne Silk, Juvederm Ultra or Plus??) Also which method, needle injection or micro cannula? Looking for better results and less side effects. A. All injectibles like medicine are art and science. The science is in the product and how it will respond in where it is placed. The art is in the skill and talent of your artist, the injector. ​ ​It takes experience, knowledge and skill to perform injectibles. Considerations include:
  1. Sharp needle injection or cannula technique
  2. ​Type of filler
  3. Layer of injection
  4. ​Amount of filler
  5. ​Area to be filled
  6. ​Goals of injection: to volumize an area, fill a fold or smooth a fine line
  7. Matching the filler(s), technique(s) with the patient
  8. Potential for swelling and bruising
  9. ​And more.
Personally, I best employ the use of a cannula technique along the tear trough bone under the deep muscle, over the deep muscle, within the fat packets and under the eyelid muscle.  I try to stay away from needle injection above the eyelid muscle as it does not adequately fill the deeper trough, risks a tindel (blue effect), cobble stone effect within the skin and more potential for bruising. My nurse on the other hand is expert in micro-needle injection of lid / cheek lines with thinner fillers. ​ ​Having said that, I recommend you consult with different but Board Certified, well experienced injectors such as a Plastic Surgeon and Dermatologist to examine and review what is best for you. ​ ​I hope this is helpful. All the best!
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