Date of Award

Summer 8-1-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Dr. Joseph F. Burkard DNSc, CRNA


Abstract Title: Decreasing Adverse Events by Implementing Blunt Tip Cannula in the Administration of Dermal Fillers Intra and Post Treatment

Background: Dermal filler administration has become one of the most popular cosmetic procedures since dermal fillers were FDA approved in 1981. Although decreasing adverse events in dermal filler administration is a primary concern, aesthetic providers strive to provide patients with the most comfortable treatment experience possible without compromising aesthetic outcomes. Evidence has suggested that blunt tip cannulas provide a more comfortable delivery of dermal fillers and a lower risk of adverse events when compared with the standard practice of using a hypodermic needle. However, there is little clinical data comparing intra-procedure and post-procedure adverse events of the two techniques.

Purpose: The primary purpose of this evidence-based project is to compare adverse events when using either a blunt tip cannula, or the standard procedure of a hypodermic needle for the administration of dermal filler. Facial injections of dermal filler using a blunt tip cannula were compared to patients that were previously injected using a hypodermic needle. Pain/discomfort and the overall desired aesthetic effect of the two techniques were evaluated for statistical significance and best practice application.

Methods: 73 total patients, including both male and female adults, ages 24-77 years old, seeking facial augmentation using hyaluronic acid dermal fillers were included in the evidence-based project. Individuals who were pregnant, lactating or had received dermal fillers within the past 24 months were excluded. Once the participants were consented for the treatment and a photo release was obtained, participants were prepared for administration of dermal fillers via a blunt tip cannula. Each injection site was cleaned using Isopropyl Alcohol and 4% Chlorhexidine Gluconate. Topical anesthesia was provided by applying a topical cream consisting of Benzocaine, Tetracaine and Lidocaine, 15 minutes prior to beginning the procedure. As part of the standard procedure for cannula insertion, a 20-gauge hypodermic needle was used to make an entry point for insertion of the cannula into the correct dermal plane. Administration of hyaluronic acid into the anterior and lateral mid-face was then performed using a retrograde injection technique. The treatment area was then compared to the data sets of patients previously injected with the standard practice hypodermic needle for pain, and aesthetic outcome. Patients were evaluated intra-procedure, immediately post-procedure procedure and then again 14 days after the treatment. Pain was assessed and recorded using the Wong Baker FACES pain scale whereas 0 is no pain, 1 is the least amount of pain and then increases to 10, with 10 as the most pain possible. Aesthetic outcome was measured by utilization of the Global Aesthetic Improvement Scale (GAIN). The GAIN measuring tool is a 5-point scale rating and measuring the aesthetic improvement in appearance. The degree and description are as follows; 5 is very much improved with an excellent corrective result, 4 is much improved with a marked improvement of the overall appearance but not completely optimal, 3 is an improvement compared to the initial condition, but an additional treatment may be needed, 2 is unchanged and the appearance remains the same compared with the original condition and 1 is a worsened where the appearance has worsened compared to the original condition.

Results: 14 days post treatment, all patients who were injected with dermal fillers by the blunt tip cannula overall had less pain and discomfort compared to the data set of patients that were treated by the hypodermic needle. In addition, all 73 patients scored a 5 on the GAIN improvement scale reporting a significant increase in overall aesthetic effect and outcome.

Conclusion: When compared to the standard procedure of dermal filler administration by hypodermic needle, blunt tip cannula administration results in less pain and bruising with no decrease in aesthetic outcome. The addition of the blunt tip cannula to the clinical setting should be considered by providers who seek to provide their patients with techniques that offer less pain and bruising without compromising aesthetic outcome.

Included in

Nursing Commons