Paul Nassif, M.D., F.A.C.S., a facial plastic and reconstructive surgeon who practices in Beverly Hills, Calif., and one of the featured doctors on the TV show Botched on E!, has seen it all. Patients have come to his practice and appeared on the show with severe complications from filling gone wrong. Some have been injected with fillers that aren’t FDA approved, including liquid cement and cooking oil. Some have suffered infections that have progressed to gangrene, limb loss and disability. In addition, there have been reports of serious complications, including blindness from filling the temple area, he says.
To warn colleagues and offer words of wisdom about how to achieve great results, safely, Dr. Nassif presented “Pearls and Pitfalls Using Blunt Cannulas with Fillers,” yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.
Dr. Nassif says his go-to filler approach involves using blunt cannulas.
“I’ve been using blunt cannulas for about 7 years,” he says. “While complications can occur with blunt cannulas or sharp needles, I find we have a lower risk of injecting into a vessel with the blunt cannulas.”
To avoid horrible complications, such as blindness that results from filling the temples, Dr. Nassif says surgeons need experience and a keen knowledge of anatomy to inject into the region of the deep temporalis fascia.
“It’s technique dependent, and injectors tend to stay out of trouble if they know what they’re doing,” he says.
Other reasons Dr. Nassif prefers blunt cannulas for filling:
“I can use one stick, or poke, in the cheek, for example. It may hurt a little more because the blunt cannula causes some trauma and pressure. But it doesn’t break any blood vessels, and I don’t get bruising with it,” he says. “With the long cannula, which is an inch and a half long, you can inject the lower eyelids, the cheeks, the nasolabial fold — all of those through one small stick.”
The facial plastic and reconstructive surgeon says the blunt cannula is easy to use and dependable.
“I like passing it through the lips. I can go pretty deep into the temples. I use it all across the face —especially, in the lower eyelids,” Dr. Nassif says. “I have patients in my practice who will be on TV that night, I can’t bruise them.”
Injectors can use any approved fillers in blunt cannulas. Dr. Nassif says he often mixes in a little lidocaine, especially when treating the temples or lower eyelids, to reduce patient discomfort.
Finally, to prevent infection, Dr. Nassif wipes the area to be treated with alcohol, then cleans it thoroughly using liquid chlorhexidine (Hibiclens, Mölnlycke Health Care).
“With this approach, the blunt cannula technique for filling is just fantastic,” Dr. Nassif says.
Dr. Nassif reports no relevant disclosures.
