Should Dark Circles Under the Eyes be Corrected Using a Cannula or Needle?

Do you have dark circles or hollows under your eyes? I use an injectable filler containing hylauronic acid, such as Restylane or Juvederm Volbella, to fill, lift, and contour the under eye area. This product hides dark circles and eye bags to give a vibrant and more youthful look. Injections have traditionally been done using sharp needles, however, the incidence of bruising, pain, and swelling has been high, especially in the eye area.

Recently, cannulas have been introduced as an alternative to needles as a way to place the filler in the eye area. A cannula is a long metal device that looks similar to a needle, but is longer, not sharp at the tip, and has a side port. When a cannula is used, an initial puncture is made in the skin to introduce the cannula to the area under the skin. Once the cannula is under the skin, the cannula is advanced carefully to the desired area and the filler is injected. The biggest advantage to this approach over a needle is that the cannula is not sharp, so the injection is painless and the chance of puncturing a blood vessel is much smaller. Also, length of the cannula allows a uniform flow of filler across a long distance with fewer injection sites, resulting in a smoother surface texture. The side port is also useful because the direction of filler flow can be controlled by rotating the cannula to subtly affect the placement of the filler to the right, left, top, or bottom of the cannula, allowing finer control.

 However, needles have several advantages over cannulas also. Needles are shorter and sharp. Direct placement of the filler using a needle is easy and precise. Needles can sometimes reach areas that would be difficult to reach using a cannula due to its size and length. The flow of the filler from the tip of the needle versus the side port can also be beneficial in certain instances, especially when injecting accurately through multiple skin layers in a vertical direction. Fine, touch-up work with the needle can be useful to help sculpt and mold the final appearance.

So, the answer to the question of whether under eye dark circles should be corrected using a cannula or needle is that most of the time both are needed to give an optimal result. I typically use the cannula to do the majority of the filling. This minimizes the potential for pain, bruising and swelling. Then, I follow with some touch-up work with the needle to address any minor imperfections. Finally, I mold the filler with my fingers to smooth the surface and the edges to achieve the finished composition. I consider every patient treatment to be a work of art. Just like with any art project, it is always helpful to have many different tools such as multiple paint brushes, palette knives, and sponges to achieve the best results.

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