Expert Tips for Mastering Your Injection Techniques: Beginners to Advanced
Learning to use neurotoxins and fillers is not easy. There is little to no cosmetic or hands-on training in most traditional residency programs. Access to patients willing to be used as Guinea pigs is limited. And the risks for errors and complications: from irritation and headaches to bruising and weakness/paralysis – are prohibitive. Even once you have had a chance to learn the basics, how do you then set about improving your technique and setting yourself apart as a seriously-skilled injector? Learning to master these skills is incredibly challenging because what separates ‘good’ work from ‘great’ is subtlety and artistry that are hard to define – much less learn.
On the road to mastery, everyone who has ever learned to inject can agree that there are some basic essentials such as attending reputable instructional courses and reading to stay on top of the latest products and trends. But how does one learn to really become a master injector? We offer a few tips both for the novice with aspirations and for the more experienced looking to take their skills to the next level.
In the Beginning:
In Richmond, VA, Dr. Joe Niamtu has his very own Top 10 for novice injectors.
Niamtu’s Top Ten Tips for Injection Success
- Study relevant anatomy
- Study relevant anatomy (really, it is that important)
- Know danger zones and emergency treatment for intravascular injection
- Find a mentor and watch them inject
- Walk before you run: Start with smaller easier cases and work your way up – a nasolabial fold is much easier than a tear trough
- Begin with patients you can follow on a daily basis. Injecting staff or family allows the novice injector a chance to observe the natural course of injection effect, recovery and complications
- Novice injectors should only inject reversible fillers
- Have a supply of hyaluronidase available
- Take pictures on all patients – they serve to teach and can serve as before and after marketing and legal record
- Have fun
Down the Road:
For those who are more experienced injectors, it can be challenging to figure out those little ‘somethings’ that take your skills to the next level.
One technique employed by Dr. S. Manjula Jegasothy of Coral Gables, FL is one used by many types of professionals – athletes and artists, in particular are known for using the concept to hone their craft. “At all times while I’m injecting, I visualize mentally exactly where in the skin or subcutaneous tissue the tip of my needle is. The Zen way of putting it is, “BE the tip of the needle”, she says with a smile. “This may seem a little esoteric and “out there”, but it sharpens my focus while injecting and helps me with precision.”
Dr. Vivian Bucay
of San Antonio, TX focuses on continuing to be an avid student. “The best advice is to keep training on new injection techniques. And [continue developing] in-depth knowledge of anatomy. Understanding of the interdependency of muscles, soft tissues, and bony remodeling in the aging process, is a must… and a willingness to take calculated risks.”
In complete agreeance, Dr. Hema Sundaram of Washington, D.C. spoke in greater depth about the significance of understanding facial anatomy. “To understand the nuances of facial analysis, and to treat the underlying cause of what we see, rather than the secondary effects. The key to injecting at an advanced level is to appreciate how skin, muscles, subcutaneous fat and bone interact with each other, both in repose and animation. As new FDA approvals occur, the number of injectable products available to us is increasing rapidly. We are gaining access to new products with the ability to truly restore aging tissues, rather than merely being injected as boluses over the bone in an attempt to fill the gaps left by lost tissue.”
Dr. Sundaram went on to say, “Holistic facial analysis, tissue-integrating products, and advanced techniques such as layered cannula dispersal allow us to advance to 3-dimensional thinking – truly supporting tissue rather than “lifting” it, which is an older, 2-dimensional idea. I would also make a plea for safety: Every injector should attend cadaver dissection courses regularly to gain an in-depth knowledge of facial anatomy; preferably, courses where the dissection is performed in a manner that specifically teaches injectables safety.”
In Niagara Falls, Ontario, Dr. Kevin Smith also suggests that a significant part of the mastery is in the tools you choose to use. “For [neurotoxins], learn how to minimize discomfort, by using BD-II 0.3 ml syringes with 31 ga needles. For fillers, learn to use long cannulas. I use the TSK UTW 22 ga x 70 mm for most work and the TSK UTW 27 ga x 50 mm for lips.” He also had one other little pearl learned after many years of practice, which is to “stroke the skin before and after each shot” as it also helps to reduce any discomfort for the patient.
And finally, one must set aside their ego and be willing to ask for help. Dr. Suneel Chilukuri of Houston, TX says, “I do not hesitate to reach out to colleagues and experts to learn more about a product or discuss a complication.”
Dr. Renato Saltz of Salt Lake City, UT sums it all up in a few short words. “[Have] full knowledge of the facial anatomy, and then keep training, training, and training.”
What are the pearls of advice you’ve received? What have you learned along the way that has made a significant impact on your technique? Leave us a comment and let us know!