van Loghem Jani A J, Humzah Dalvi, Kerscher Martina
Private practice, Amsterdam, Netherlands.
West Midlands Hospital, Halesowen, West Midlands, United Kingdom.
Aesthet Surg J. 2017 Dec 13;38(1):73-88. doi: 10.1093/asj/sjw220.
Soft-tissue fillers have become important products for facial rejuvenation. Deep fat compartments and facial bones lose volume during the natural aging process. For the most natural-looking results, deep volumetric injections at strategic sites are therefore preferred. Supraperiosteal placement is performed with a sharp needle or a non-traumatic cannula.
The primary objective was to determine whether there is a difference in precision between supraperiosteal placement with a sharp needle compared with a non-traumatic cannula in cadaver specimens. A secondary objective was to analyze the safety profiles of both injection techniques.
Cadaver heads were injected with dye material and soft-tissue fillers at multiple aesthetic facial sites on the supraperiosteum and subsequently dissected for observation of dye and filler placement.
The non-traumatic cannula technique resulted in product being confined to the deep anatomic layers. In contrast, with the sharp needle technique, material was placed in multiple anatomic layers, from the periosteum to more superficial skin layers. For both techniques results were consistent for all facial sites.
Although direct extrapolation from cadavers to the in vivo situation cannot be made, cannulae showed more precision in placement of product. With the sharp needle, the material was injected on the periosteum, and then migrated in a retrograde direction along the trajectory of the needle path, ending up in multiple anatomic layers. The sharp needle technique also showed a higher complication risk with intra-arterial injection occurring, even though the needle tip was positioned on the periosteum and the product was injected with the needle in constant contact with the periosteum.
软组织填充剂已成为面部年轻化的重要产品。在自然衰老过程中，深层脂肪隔和面部骨骼会失去体积。因此，为了获得最自然的效果，首选在关键部位进行深层容积注射。骨膜上注射可使用锐针或无创套管进行。
主要目的是确定在尸体标本中，使用锐针进行骨膜上注射与使用无创套管相比，在精准度上是否存在差异。次要目的是分析两种注射技术的安全性。
在尸体头部的多个美学面部部位的骨膜上注射染料材料和软组织填充剂，随后进行解剖以观察染料和填充剂的分布情况。
无创套管技术使产品局限于深层解剖层面。相比之下，使用锐针技术时，材料分布在从骨膜到更浅表皮肤层的多个解剖层面。两种技术在所有面部部位的结果均一致。
尽管不能直接将尸体情况外推至体内情况，但套管在产品注射位置上显示出更高的精准度。使用锐针时，材料先注射在骨膜上，然后沿针道轨迹逆行迁移，最终分布在多个解剖层面。锐针技术还显示出更高的并发症风险，即使针尖位于骨膜上且注射时针始终与骨膜接触，仍会发生动脉内注射。
