Cannula vs Needle Injection Technique & Plane‑Depth Protocol - Dermal Filler

1. Purpose

Guide safe, outcome‑focused filler technique selection using anatomy, plane and rheology; align workflow with Australian governance.¹ ² ³ ⁴

2. Scope

Applies to all injectors at Newcastle Cosmetic Doctor (Australia). Covers HA and CaHA fillers across midface, periorbital, lips, nasolabial folds, chin and jawline; includes ultrasound integration, complication pathways, and NSW Health reporting.¹⁴ ¹⁵

3. Governance & Advertising (Australia 2025)

Ahpra: non‑surgical cosmetic procedure guidelines (practice, training, advertising). ¹
TGA: no public advertising of Schedule 4 injectables; follow Cosmetic Injections FAQ. ²
RACGP/ACSQHC: apply IPC and NSQHS standards in clinic workflow. ³ ⁴
NSW Health: Incident Management (PD2020_047) and Medication Handling (PD2022_032). ¹⁴ ¹⁵
Device traceability: record ARTG; capture UDI where available (AusUDID). ¹⁶

4. Needle vs Cannula — Evidence

Vascular occlusion (VO): large cross‑sectional analysis shows significantly lower VO odds with cannulas vs needles, but absolute risk is low with both. ⁵
Aspiration is unreliable as a safety test; rely on anatomy, plane, low pressure, micro‑aliquots and motion. ⁶ ⁷
Gauge matters: 22—25 G cannulas are less likely to penetrate arteries than very small‑gauge cannulas; cannulas are safer, not safe. ⁷

5. Decision Framework (Goal → Plane → Instrument → Rheology)

Structural lift/anchor on bone → supraperiosteal → needle (or large‑gauge cannula) → high‑G′ cohesive HA or CaHA.
Smooth contour over distance → deep subcutaneous/sub‑SMAS → cannula (22—25 G) → medium‑G′ HA.
Fine surface definition/hydration → superficial dermal/submucosal → needle or short‑stroke cannula → low‑G′ soft HA.
High‑risk vascular zones (forehead/temple/periorbita/nose) → map with ultrasound before injecting.

Rationale and imaging support: ⁸ ⁹

6. Region‑by‑Region: Plane, Device, Technique, Aliquots

6.1 Tear Trough / Infraorbital

Plane: supraperiosteal or deep to orbicularis; avoid superficial threads. Start lateral support first. Ultrasound recommended.¹² ¹³ ⁹

Instrument: cannula (25 G) or needle for tiny deep boluses. Aliquots: 0.02—0.05 mL/point; stage treatments.

Notes: PHAREE/malar oedema risk; choose lower‑hydration cohesive gels.¹²

6.2 Midface / Cheek

Plane: supraperiosteal anchor points then deep subcutaneous blending.⁹

Instrument: needle for bony anchors; cannula for blending. Aliquots: 0.05—0.15 mL/point (bone), 0.05—0.1 mL/cm (threads).

6.3 Temple

Plane: deep temporal fat/periosteum; ultrasound mapping of STA/DTFA advised.⁸

Instrument: cannula (22—25 G). Aliquots: 0.05—0.1 mL/point. High‑risk: low pressure; constant motion.

6.4 Nasolabial Fold

Plane: mid‑dermis for line effacement; consider lateral support if fold is structural.

Instrument: needle for precise linear threads; cannula for longer tracks. Aliquots: 0.02—0.05 mL/line; 0.05—0.1 mL/cm.

6.5 Lips

Plane: submucosal for volume/hydration; vermilion border for definition. Ultrasound‑assisted approaches are increasingly described.⁹

Instrument: needle or cannula; short strokes and low pressure. Aliquots: 0.02—0.05 mL/line; stage.

6.6 Chin & Jawline

Plane: supraperiosteal for projection; subcutaneous border threads for straightening.¹⁰ ¹¹

Instrument: needle for bony points; cannula (22—25 G) for border threads. Aliquots: 0.05—0.15 mL/point; 0.05—0.1 mL/cm.

6.7 Nose (Advanced)

Plane: supraperiosteal micro‑aliquots; ultrasound mapping strongly recommended. Ocular emergency pathway must be ready.¹⁹

7. Rheology & Product Selection

High‑G′, cohesive HA or CaHA for bony anchors/edges (chin, jawline, malar). ¹¹
Medium‑G′ HA for contour blending (midface/jawline border).
Low‑G′ soft HA for superficial refinement (lips/lines); avoid highly hydrophilic gels in oedema‑prone zones; consider product‑line hydrophilicity and cohesivity data.¹⁸

8. Technique Safety (non‑negotiables)

Low pressure, tiny aliquots, continuous motion for threads; avoid large static bolus in risky zones. Aspiration is not a safety net.⁶ ⁷
Cannulas are safer, not safe; prefer 22—25 G when appropriate; recognise 27 G cannulas can behave like needles.⁷
Ultrasound: map vessels and confirm plane in forehead, temple, periorbita, and nose; capture screenshots in the record.⁸ ⁹

9. Complication Recognition & Escalation

Cutaneous vascular occlusion: pain/blanching/livedo; stop, massage, warm compress, high‑dose pulsed hyaluronidase flooding to reperfusion; document/report significant events.²⁰ ¹⁷
Any visual symptom: stop; call 000; urgent ophthalmology transfer per RANZCO pre‑hospital guidance (do not delay with prolonged in‑clinic maneuvers).¹⁹

10. Documentation & Audit (Australia)

Injection map (planes, volumes, device + gauge), product brand/line, ARTG, lot, expiry, UDI if applicable; ultrasound screenshots; consent and photos.¹⁶
Governance: Ahpra/TGA advertising compliance; RACGP IPC + NSQHS standards in workflow.¹ ² ³ ⁴
Adverse events: report via TGA (IRIS/MDIR) where reportable; apply NSW Health incident policy.¹⁷ ¹⁴

11. Technique Selection Cheat‑Sheet

Region	Primary plane	Instrument	Aliquots	Key cautions / refs
Tear trough	Supraperiosteal / deep to OOM	Cannula 25 G or needle	0.02–0.05 mL/point	PHAREE; pick low‑hydration gels
Midface	Bone anchors + deep SC	Needle (points) + cannula	0.05–0.15 mL points; 0.05–0.1 mL/cm	Respect fat compartments
Temple	Deep temporal fat/periosteum	Cannula 22–25 G	0.05–0.1 mL/point	US map; high‑risk
NL fold	Mid‑dermis ± lateral support	Needle/cannula	0.02–0.05 mL line; 0.05–0.1 mL/cm	Don’t ignore lateral support
Lips	Submucosal + border	Needle/cannula	0.02–0.05 mL/line	Short strokes; low pressure
Chin/Jawline	Supraperiosteal + SC border	Needle (bone) + cannula	0.05–0.15 mL points; 0.05–0.1 mL/cm	High‑G′ HA or CaHA

Sources

Ahpra (2025). Performing non‑surgical cosmetic procedures — Guidelines hub., viewed 05 November 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩
TGA (2025). Advertising health services & cosmetic injections — FAQs., viewed 05 November 2025, https://www.tga.gov.au/products/regulations-all-products/advertising/specialised-advertising-issues-and-topics/advertising-health-services-and-cosmetic-injections-frequently-asked-questions-and-answers ↩
RACGP (2024). Infection prevention & control guidelines (primary care)., viewed 05 November 2025, https://www.racgp.org.au/running-a-practice/practice-standards/racgp-infection-prevention-and-control-guidelines ↩
ACSQHC (2021, updated 2024). NSQHS Standards (2nd ed.)., viewed 05 November 2025, https://www.safetyandquality.gov.au/sites/default/files/2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_updated_may_2021.pdf ↩
Alam M, Kakar R, Dover JS, Harikumar V, Kang BY, Wan HT, Poon E, Jones DH (2021), Rates of Vascular Occlusion Associated With Using Needles vs Cannulas for Filler Injection, JAMA Dermatology, 157(2), 174–180, viewed 05 November 2025, https://pubmed.ncbi.nlm.nih.gov/33377939/ ↩
Goodman GJ (2021). Aspiration before tissue filler — an exercise in futility and risk. Aesthet Surg J. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8670299/ ↩
Goodman GJ et al. (2020). Neither positive nor negative aspiration should be relied upon. Aesthet Surg J. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7954536/ ↩
Vasconcelos‑Berg R. et al. (2024). High‑frequency ultrasound for fillers — best practices. Diagnostics (MDPI)., viewed 05 November 2025, https://www.mdpi.com/2075-4418/14/22/2544 ↩
Jung JY. et al. (2024). Recommendations on ultrasound‑guided HA injections. J Cosmet Dermatol. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11684153/ ↩
Go BC. et al. (2023). Injectable fillers for chin & jawline — technique/review. Dermatol Pract Concept. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10296042/ ↩
Moradi A. et al. (2023). CaHA jawline consensus & rationale. ASJ Open Forum. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10120162/ ↩
Karlin J. et al. (2023). Post‑HA recurrent eyelid edema (PHAREE). ASJ Open Forum. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11140515/ ↩
Schelke L. et al. (2023). Malar oedema after periocular filler — duplex/US. J Cosmet Dermatol., viewed 05 November 2025, https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocd.16012 ↩
NSW Health (2020). Incident Management Policy PD2020_047., viewed 05 November 2025, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2020_047.pdf ↩
NSW Health (2022). Medication Handling PD2022_032., viewed 05 November 2025, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2022_032.pdf ↩
TGA (2025). Unique Device Identification (UDI) — compliance guidance., viewed 05 November 2025, https://www.tga.gov.au/resources/guidance/complying-unique-device-identification-requirements-medical-devices ↩
TGA (2025). Reporting medical device adverse events (IRIS/MDIR)., viewed 05 November 2025, https://www.tga.gov.au/safety-and-shortages/adverse-events/medical-device-adverse-events/obligations-report-adverse-event-medical-devices ↩
Enright KM. et al. (2024). Hydrophilic/cohesive/physical properties of HA fillers. PRS Global Open. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10790663/ ↩
RANZCO (2024). Filler Blindness Guidelines — pre‑hospital pathway., viewed 05 November 2025, https://ranzco.edu/wp-content/uploads/2024/06/RANZCO-Filler-Blindness-Guidelines_2024.pdf ↩
Kroumpouzos G. (2024). Hyaluronidase for dermal filler complications — dosage & indications. JMIR Dermatology. (Open access), viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10836581/ ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.