Placement of Dermal Fillers and injection technique

Placement of dermal filler to maximise the effect on lines is relatively simple – deep lines caused by volume loss are corrected best 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

• 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’s face.
• Take aim by lining up the end of the needle with the point on the skin 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 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 (see later in booklet).
• 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.

Injection Techniques

When is it useful and Technique

1.   Serial Puncture

Fine lines or superficial creases on top of deep lines. 30 degree entry, superficial (just deeper than the bevel) 0.025 to 0.05ml dose.

2.   Retrograde Linear Threading

Can be used for medium lines and volume loss.

Deeper lines require a 45 degree angle of entry to ~1/3 of the needle, then stop and change angle to 0 degrees and advance to desired depth. Can be placed at 90 degrees or parallel and directly under the line.

3.   Anterograde

Advanced technique useful if you wish to keep needle tips away from important structures. Limited control of flow of filler. 

Insert needle at 45 degrees, when needle point is in desired location check flash back and then inject slowly, closely monitoring direction of filler flow.

4.   Fanning

Reduces pain, as only one initial hole is made in the skin. Useful for the top of the NLF and the marionette line- for volume replacement which is in a more even plane. Inject at 45 degrees, until 1/3 of the needle is in the skin, then change to being parallel (0 degrees) with the skin and advance, flashback and then retrograde linear thread in each direction you want to fill.

5.   Cross-hatching (grid pattern)

For stubborn widely spread fine lines. For lines under continuous pressure from tissues resting from above (like deeper nasolabial folds)This technique is superficial, 30 degree angle of entry usually starting with an injection directly under the line that makes little improvement. Further injections are placed at 90 degrees to the line, in rows.     

Bruising is more likely as so many injections are required.

Before every procedure we do on every client we always complete the disclaimer information and consent forms. We also will make a plan on our facial planner which will be kept with the patient’s records. This was taught to you as a beginner starting your career and should be instilled in you now as a n aesthetic practitioner.