Placement of Dermal Fillers Copy
Placement of Dermal Fillers
Placement of dermal filler to maximise the effect on lines is relatively simple – deep lines caused by volume loss are best corrected with deeper injections in the lower dermis. Fine creases are corrected best with a shallower injection in the mid dermis. Injections in fat may not have as much impact, and injections in the papillary dermis (very superficial) will discolour the skin.
The steps to a perfect dermal injection – this is a theoretical guide only. Injection technique is better observed during your practical training day.
- Hold the needle correctly, wrist above, thumb on the plunger. This position enables greatest flexibility and means you don’t have to change the position while the needle is in the patient skin.
- Line up the end of the needle & before injection visualise where the end point will reach, this is where you want the needle to terminate. Choose your position of entry so the needle tip will reach this point.
- Use the correct angle of entry- 45 degrees for deeper lines and volume loss, 30 degrees for superficial creases.
- Insert the needle at the chosen angle until around 1/3 of the need has penetrated. Then STOP. Your needle tip should now be at the correct depth.
- Slowly change the angle until your needle is parallel with the surface of the skin. Now when you advance your depth will be maintained at the correct level.
- Advanced the needle to the desired position, then stop.
- Do a depth check. Once you are at the correct depth, check for a flashback (aspirate) by pulling back on the syringe. If there is any blood, do not inject and repeat the process.
- If no flashback, proceed to inject as per area-specific guides, explained further on during this training
- Withdraw and massage to be smooth, check capillary refill present.
How to do a depth check:
Too shallow: If the skin is blanched without lifting, DO NOT INJECT- you are too superficial, and filler will be visible.
Fine lines: If you lift the needle and can clearly see the shape of the needle as a defined line (which may blanch- but only on lifting) you are in the right depth for a low viscosity filler to treat a fine line.
Deep lines: If you lift and see a rough shape of the needle but it very defined you are about right for a deeper line or volume replacement.
Too deep: If all you see is the skin lifting generally, you are likely deep in subcutaneous fat which is not optimal.