Aspen, Colorado – Learning to inject more advanced areas such as the tear troughs helps core aesthetic physicians stand out from less skilled injectors, said Kenneth Beer, M.D., at The Cosmetic Bootcamp.
When injecting the tear trough, Dr. Beer says, it’s crucial to avoid the confluence of vessels and other subcutaneous structures. “I use a small insulin syringe to inject hyaluronic acid (HA) right on the bone. When injecting, I use my nondominant hand to press the product where it’s needed. With 2 or 3 sticks, I can fill most of the tear trough. My patients get very little if any bruising because I’m making very few pokes into the dermal layer.”
A recent study of HA in the tear trough suggests that if the distance from the skin’s surface to the bone is 0.5 cm or greater, one should use the bolus technique rather than serial punctures (El-Garem YF. Dermatol Surg. 2015;41(1):94-101.). This author’s bolus technique involves 2 needle sticks total, versus 3 for the serial puncture technique. Dr. Beer considers the difference between 2 and 3 sticks here inconsequential. “But Dr. El Garem is one of the few people who uses the depth from skin to bone as a rational basis for how to inject this area. I’ve also seen injectors use one stick with a cannula,” which also can produce highly satisfactory results safely.
Dr. Beer is a CBC cofounder, an associate clinical professor of dermatology at the University of Miami Miller School of Medicine, a consulting associate with Duke University and a clinical associate in dermatology, University of Pennsylvania Perelman School of Medicine.
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