Needles 101: A Guide To The Tools Used For Cosmetic Injectables

It’s estimated that around 20 percent of the population has some degree of needle phobia. Known medically as trypanophobia, fear of needles comes in different forms — ranging from a fear of the pointy object itself to anxiety around being injected. For people with trypanophobia, the prospect of getting Botox® or fillers or even considering a surgery that involves intravenous (IV) medication can be overwhelming. But this doesn’t make the results of these procedures any less attractive, so finding ways to make the thought of treatment less stressful may be helpful.

Uncertainty around what kind of needles are used, how painful a procedure will be, and what to expect during the injection process can all increase anxiety levels for any patient but especially for those with needle phobias. Here at AEDIT, we know that knowledge is power, and we’ve consulted with plastic surgeons and patients alike to better understand the different needles used in aesthetic medicine and how to manage fears.

Injectable Needles 101

When you’re looking into having a cosmetic surgery or treatment, you will come across a lot of procedure-specific medical jargon. As it relates to needles, ‘injectables’ is an umbrella term that refers to procedures that inject a product into the skin or body (think: neurotoxins, filler, Kybella®, Qwo™, etc.). “There are different types of needles used for cosmetic injectables, and there are different brands, too,” says Kian Karimi, MD, a double board certified facial plastic and reconstructive surgeon in Los Angeles. Below, a quick vocabulary lesson:

• Needle: A hollow, slender, sharply pointed instrument used for injection.
• Gauge: A needle’s gauge refers to the size of its opening. The higher the gauge, the smaller the diameter.
• Syringe: The syringe is the plastic pump that is attached to a needle to perform an injection. In the case of dermal filler, syringes often come pre-filled and your practitioner will choose which gauge of needle to use depending on your specific needs.
• Cannula: A cannula is a thin, flexible tube that is inserted via needle to administer medication or product. When a cannula is placed, the needle used to insert it is removed.

As Dr. Karimi explains, injectables come with needles in an array of sizes (usually ranging from 27-gauge to 30-gauge), and he says some providers will further customize treatment. “Some injectors like to transfer filler into even smaller syringes with 31- or even 32-gauge needles,” he notes. “But it really comes down to the thickness of the filler to determine which needle would be most appropriate.”

Neuromodulators like Botox®, for example, can often be injected with some of the tiniest needles on the market (a 31- or 32-gauge), which minimizes discomfort. Thicker and more viscous fillers (think: Juvéderm® and Restylane®), meanwhile, may require a larger 30-gauge or 27-gauge needle. As such, dermal filler injections are generally considered to be a bit more uncomfortable than neurotoxins.

Needle Alternatives

As defined above, cannulas can serve as an alternative to needles. “Using a microcannula is different from using a needle,” says Dr. Karimi, who specializes in using DermaSculpt microcannulas. “The difference between a needle and a microcannula is that only one poke is made through the skin with a needle, then the blunt-tip microcannula is used to artistically place the filler in different tissue layers.”

He has been teaching microcannula use for some 10 years now and estimates he has educated thousands of providers. “Overall, there are many advantages to using the microcannula,” he notes. They include less bruising (a typical side effect of facial fillers) and less chance of injecting into a blood vessel, which can cause serious complications. “Although using a microcannula to inject fillers does not eliminate the risk of complication, it does decrease it to a very significant degree,” Dr. Karimi says. They also allow for a more “artistic” result, he adds.

Overcoming a Fear of Needles

“Fear of needles is completely normal, although in some cases it can be quite extreme,” Dr. Karimi admits. To combat it, he and his team employ a variety of calming tactics — beginning the moment someone enters the practice — to make patients more comfortable. “We use great customer service, hearing the patient’s fears and anxieties, nice music, and friendly injectors,” Dr. Karimi shares. He’s also developed his own line of CBD wellness products, HealMD, which he says has “significantly reduced anxiety in our patients before the procedure.”

Once it comes time for treatment, Dr. Karimi has a few go-to distraction techniques. “We often recommend patients not look at the needle or think about something else while the injections are being performed,” he says. What’s more? “We use distraction methods such as having an assistant tap the shoulder of our patients while the injections are being performed or other vibration mechanisms that can help distract from the discomfort,” he adds.

In the case of more invasive procedures (think: combining filler with a thread lift or laser treatment), minimal sedation may be offered. “When we are performing more significant combination therapies, we offer nitrous oxide gas inhalation during the procedure, which is a 50-50 mix of nitrous oxide and oxygen,” Dr. Karimi explains. “[It] can really help the patient get through the procedure without any lasting intoxicating effects as the gas wears off in just a few minutes.”

Patient Perspective

Jessica conquered her needle phobia and now has regular appointments to top-off her fillers and Botox®. She tells us how hypnotherapy and exposure therapy helped her to overcome her fear of needles and improved her life for the better.

The Takeaway

It’s perfectly normal to feel some nerves prior to a cosmetic procedure, but, if you have a fear of needles, this can be exacerbated. Depending on your level of concern, methods ranging from meditation and therapy (talking and/or exposure) to even anxiety medication may be recommended to help manage your fears. Another tact? Consult with your aesthetic provider — they are often equipped with tips and tools to both educate and empower patients. “All in all, we assess each patient to see what level of anxiety they have about the procedure or procedures and discuss all the options with them,” Dr. Karimi shares.