There are many different injection techniques used by cosmetic dermatologists for administering dermal fillers. Recently, cosmetic dermatologists Tom van Eijk and Martin Braun developed a new approach called the Fern Pattern Technique (FPT) for administering Restylane. This hyaluronic acid filler is used to smooth out fine lines and wrinkles. It is often injected into the nasolabial folds (lines between the edges of the nostrils and the corners of the mouth). These lines can be very deep and this area of tissue is highly mobile. The skin around the mouth moves a lot during smiling, talking, and eating. This makes nasolabial folds particularly challenging to treat.

The goal of this technique is to firm up the tissue slightly so that it does not crease as deeply when in motion. At the same time, it is designed to use less filler than other techniques. The developers of the FPT report that it offers optimal correction without the filler being visible either when the face is at rest or during a smile.

Technique Description

In the Fern Pattern technique, the needle tip is inserted into the nasolabial fold, but perpendicular to the direction of the fold. The needle is pushed forward into the tissue so the tip ends up a few millimeters from the fold. Then, as the needle is slowly withdrawn back toward the fold, Restylane is gently injected along the path created by the needle shaft. The depth of needle insertion is carefully judged so the majority of the filler material ends up in the mid layer of the dermis. As the needle is withdrawn from the skin completely, some of the filler may end up closer to the surface of the skin. Since the original entry point for the needle tip was in the deepest part of the fold, this just adds more filler bulk where it is most needed.

This process is repeated along the length of the nasolabial fold. The filler material is injected in short lines at a 90 degree angle to the nasolabial fold as described above. The dermatologist alternates injecting to one side of the fold line and then the other. So, if the fold represents the central stem of a fern plant, the injections represent the individual fronds on each side of the stem. This pattern is what gives the technique its name. Many cosmetic dermatologists are now learning and using this technique in their practices. Other dermatologists believe the FPT carries a higher risk of inflammation than traditional techniques due to the number of punctures required. However, so far this concern appears to be based on a very small amount of data.