The Aesthetic Contrarian Weekly Recap - Cannula and Being Liked

Welcome to your no-holds-barred, zero-BS briefing for aesthetic disruptors.

This week, I’m going in hard on the industry’s favourite safety blanket,
getting brutally honest about the emotional price of people-pleasing and
handing you five ruthless fixes to stop botching filler with your beloved blunt
stick.

Here’s what’s inside:

THE EVIDENCE CHECK

“Cannula vs Needle: The Real Safety Debate They’re All Botching”
The industry says cannulas are safer. The evidence says maybe. Reality? Depends who’s holding it. I break down the stats, the lies and the lethal complacency behind the cannula cult—and show you why your technique, not your tool, is what keeps patients alive.

HARRY’S HONEST HOUR

“I Want to Be Liked (But Complaints Break Me)”
Confession time. I don’t fear complications—I fear complaints. In this raw breakdown, I open up about the deep-rooted people-pleasing that made me overdeliver, undercharge and nearly burn out trying to be everyone’s favourite injector. If you dread refunds more than revisions, read this.

ACTION POINTS

To my fellow contrarians, disruptors, and practitioners who’ve had enough of recycled CPD slides, Instagram KOL worship, and “certified” trainers with more selfies than clinical sense—this is for you.
“Use It Right, or Don’t Use It At All”
If you’re going to worship the cannula, at least learn how to wield it like a surgeon, not a kebab vendor. Five ruthless, evidence-backed tactics to stop overfilling, avoid occlusions and master the blunt tool without blunting your brain.

Section 1: The Evidence Check

“Cannula vs Needle: The Real Safety Debate They’re All Botching”
Are cannulas actually safer—or just the industry’s favourite myth?

MYTH Spotlight

“Cannulas are categorically safer than needles for dermal fillers.”
That’s the go-to gospel, right? Spouted by KOLs in recycled Instagram reels, parroted in Level 7 courses written by marketers not medics, and clung to by anxious new injectors as if the cannula’s blunt tip is some kind of magical force field.
You’ve heard the lines:
  • “Cannulas don’t enter blood vessels.”
  • “Cannulas don’t cause occlusions.”
  • “Cannulas are more comfortable and safer for patients.”
Yeah? Well, here’s the problem: most of that is half-true horsesh*t.
Because what’s really going on here is the classic lazy binary—the industry’s desperate attempt to simplify a nuanced clinical debate into a TikTok soundbite. Let’s unpick it properly.

Understanding The Tools: What’s Actually Different?

Before we rip the safety claims apart, let’s get clear on design and function:
  • Needles are sharp-tipped. They puncture vessels and tissue. Great for precision, depth control, and periosteal contact.
  • Cannulas are blunt-tipped, side-port delivery tubes. They require a sharp needle to first create an entry hole (so... irony alert).

Now here’s where the cannula cheerleaders start gushing about how their blunt ends “slide past vessels” like some ballet dancer in a bloodless wonderland. But here’s reality:

  • Displacement immunity. Cannulas can enter vessels. And when they do, they stay there longer.
  • The safety profile is also about what happens after a mistake—not just how likely the mistake is.

Let’s Talk Complications: The Data That Actually Matters

Most of the cannula-humping begins and ends with one flashy stat: In a large cohort study involving 370 dermatologists and 1.7 million  syringes, occlusion rates were:
  • 1 in 6,410 with needles
  • 1 in 40,882 with cannulas
  • Source: JAMA Dermatology (2021)
Now look, I’ll be fair—this is good data. Large numbers. Multi-centre. Real world. And yes, the occlusion rate with cannulas was six times lower. But what no one tells you: this doesn’t account for the severity of outcomes. And it doesn’t override anatomical common sense.

Frequency Vs Severity: The Nuance Everyone Ignores

Let’s say it louder: Less frequent ≠ less dangerous.
Here’s why cannulas might cause worse damage when they do mess up:
  • Length = Range of disaster.A 50mm cannula inside a vessel = more filler potentially distributed intravascularly = more territory necrosed.
  • Blunt = Lodged. Sharp needles often enter and exit fast. Blunt cannulas can pierce a vessel wall and stay in the lumen, silently delivering product.
  • Volume = High-stakes injection. Because cannulas are used to treat larger zones through one port, more product is often injected per bolus. If that goes wrong? More filler. More fallout.
We’ve seen full-lip necrosis from one cannula pass. Retinal artery occlusion. No technique is immune when used improperly.

Cadaver Studies Don’t Lie (But They Do Surprise)

Everyone says needles are “more precise.” But… are they?

In a cadaver study by Daines et al. (2016), injectors placed filler using both tools. The cannulas showed better placement in the intended plane. Why? Because sharp needles pierced straight to the bone and then back-tracked filler along the insertion track. The product migrated.

Cannulas? They glided through the fascia, respecting anatomical planes, with more uniform distribution.

So no—blunt ≠ blunt instrument. When done right, cannulas are surgical. The problem is most of you are using them like BBQ skewers.

What About Bruising, Pain, And Recovery?

Alright, here’s where cannulas win and deserve credit:

Lower with cannulas. The blunt tip avoids nerve endings and causes less microtrauma.

Far lower incidence due to reduced vessel puncture.

Faster recovery. Patients often walk out looking presentable (instead of like they lost a bar fight).

RCTs consistently show these benefits. But again, they’re marginal if your technique is trash. Cannulas reduce trauma, not eliminate it.

So Why Do Newbies Default To Cannulas?

Training someone on cannulas before they’ve learned needle basics is like teaching someone to fly a plane before they’ve ridden a bicycle. Good luck.

The Uncomfortable Truth: Practitioner > Product

They’re told:

  • “It’s safer for beginners.”
  • “Less chance of complications.”
  • “Easier to master.”

 

Total bollocks.

  • Force modulation. You need feel. You don’t get tactile feedback the way you do with needles.
  • Anatomical skill. You can’t rely on depth—because you’re not piercing tissue, you’re navigating it.
  • Patience. You must work with resistance, not against it. Most newbies are far too aggressive.
One of the strongest findings in the JAMA Dermatology paper? This: Injectors with more than 5 years’ experience had 70.7% lower odds of vascular occlusion. Let that land. Experience mattered more than whether you used a cannula or needle.

So while the industry flogs tools, tech and gimmicks, you know what the best safety upgrade is?

Time. Reps. Practice.

Not a £997 cannula course with 1 live model and a certificate that looks good on LinkedIn.

Debunking The Big 3 Lies (Again):

Wrong. They do. Just less often. And when they do—it can be catastrophic.
Only if you’re doing basic bolus work. Advanced treatments? They require serious skill. Try sculpting a temple with a 25G and no plane awareness—go on, I’ll wait.
In some planes, yes. But periosteal work? Preseptal areas? Good luck getting consistent product placement without a sharp, direct instrument.

Clinical Use Cases (Because You Need Actual Context):

  • Tear troughs (reduce bruising risk)
  • Nasolabial folds (when used via lateral entry)
  • Mid-cheek volume (less trauma with larger bolus delivery)
  • Jawline sculpting (long linear threads)
  • Fine perioral lines
  • Deep periosteal anchoring (cheek apex, pyriform fossa)
  • Temples (especially in high-risk zones)
  • Lip border definition
Use the right tool for the right job. This isn’t religion. It’s clinical thinking.

So What Should You Actually Do?

If you want safety, here’s your cheat code. It’s not sexy. It’s not sponsored. But it works:

Not the diagrams. The layers. The vessels. The variants. Relearn it every month.

Cannula stuck? Don’t push. Feel your way around. No forceful plunging, FFS.

Especially in risky areas. 0.1ml can destroy a nose. Why are you doing 0.5ml per thread?!

Cannula tip won’t move? It’s probably in the fascia or tethered near a vessel.

Not just stocked—understood. Have your hyalase, your needles, your game plan. And above all:

That’s what keeps people safe. That’s what saves faces—and reputations.

Final Thought:

  • You don’t earn safety by switching to a cannula.
  • You earn it by becoming someone who knows when NOT to inject.
  • When to stop.
  • When to say, “I don’t know.”
  • When to prioritise the patient over the platform.

So here’s the final question, my friend:

Are you chasing the tool that makes you feel safer?

Or are you becoming the practitioner who is?

Choose wisely.

References

  • Goodman GJ, et al. JAMA Dermatol. 2021;157(1):55–63.
  • Beleznay K, et al. Plast Reconstr Surg. 2015;136(4 Suppl):110S–121S.
  • Daines SM, et al. Aesthet Surg J. 2016;36(5):535–543.
  • Funt D, Pavicic T. Dermatol Surg. 2013;39(2):263–272.
  • Fagien S, et al. Aesthet Surg J. 2017;37(suppl_1):S1–S24.
  • Beer K, et al. J Clin Aesthet Dermatol. 2020;13(3):E57–E63.

Section 2: Harry’s Honest Hour

“I Want to Be Liked (But Complaints Break Me)”

Let me start with something I usually wouldn’t admit to a room full of colleagues:

I want to be liked. Not just professionally respected. Not just “oh, he’s decent.”

I mean liked-liked. Admired. Celebrated. F**king adored, ideally.

It’s why I work like an absolute demon.

That’s why I reply to DMs at stupid o’clock.

It’s why I undercharge.

It’s why I can’t sleep after a refund request.

It’s why a patient’s passive-aggressive comment ruins my whole f**king week.

Sounds pathetic, right?

But let’s rewind.

Confession Corner: It Started With a Turban School. That’s where this all began.

Imagine standing out from day one. Brown kid. Turban. Quiet. Smart but not loud about it. Easy pickings. I didn’t “fit.” So naturally, they came for me.

So what did I do?

Eventually, I flipped the script.

The bullied became the bully. Classic.

I went hard, because at least that gave me control. Power.

Didn’t feel great either side, to be honest.

But that planted the seed: you either get liked, or you get f**ked.

There’s no middle ground. So I learned how to adapt, how to read a room, how to say what people wanted to hear.

Later, when I became the “aesthetic guy,” the educator, the mentor—well, it

felt bloody incredible. I wasn’t just liked. I was wanted.

Delegates hanging off every word. Students quoting me.

“Harry, you’ve changed my life.”

It’s addictive. That kind of praise?

It’s heroin for people who didn’t get hugged enough.

Let’s not dress it up—there’s ego in this too. I like being the centre of attention.

Maybe it’s the ADHD. Maybe it’s trauma rewired into performance. Maybe I just like my own voice (actually I hate the sound of my voice). Whatever. It works.

Until it doesn’t.

The Flip Side: The Complaint That Cracked Me

Let’s talk Botox.

Perfect injection.

Accurate dosing.

Crisp result.

No bruising.

Textbook f**king outcome.

And yet—

“I want a refund. I don’t think it worked.”

I went into full collapse mode.

My brain:

“She’s crazy.”

“She’s ungrateful.”

“She doesn’t realise how much I care.”

“Am I actually shit?”

“F**k. I’m a fraud. They’re going to find out. It’s over.”

All that, from one sentence.

Because here’s the truth, I don’t often say out loud:

I’m terrified of critique.

I can handle pressure.

I can handle chaos.

But criticism? Especially when I know I’ve done my best?

That wrecks me.

And I stew. Quietly.

Pretend I’m fine.

Inside, I’m mentally setting fire to everything I’ve built.

Catastrophising? 100%.

Logical? Nope.

But welcome to my head.

I Overdeliver Because I’m Terrified.

You know all those students who say, “Harry gives more value than anyone”?

Yeah. That’s because I’m f**king terrified you’ll think I’m not worth it.

I’ll run over on training days.

Answer every message.

Give more resources than you’ll use in a year.

Offer payment plans I shouldn’t.

Say yes to stuff I hate.

Why?

Because if I can’t be liked, I’ll settle for being indispensable.

But here’s the price I pay for all that “value”:
  • Missed gym sessions.
  • Missed family dinners.
  • Missed life.

Wife calls me a lodger (coming in a later edition!) Not joking. She literally said, “You live here like a tenant. Gym, clinic, dinner, bed. We never speak.” She’s not wrong. I dread conflict so much I’ve built a life where I don’t have to talk. Just give, give, give until people leave me alone.

Vulnerability? Nah, Let Me Tell Jokes Instead People say I’m raw. Honest. Unfiltered.
Here’s the kicker: I’m also incredibly emotionally shut off. Ask my wife. She’ll confirm it before you finish the question. I don’t talk about my feelings. I don’t “process” things. I just joke about them. Sarcasm’s my suit of armour. If I’m outrageous enough, you’ll laugh.

If you laugh, you won’t look too closely. If you don’t look closely, you won’t notice that I’m actually full of f**king doubt. That’s my version of vulnerability—push people away just enough to stay safe. Teaching is My Safe Space You want to know why I love teaching? It’s not just the ego. Not just the stage.

It’s control. In the clinic, patients might argue, complain, ghost, or moan about £10. But in a training room? I’m in charge. I’ve put the reps in. I know the content. I control the environment. And after getting absolute dogsh*t training myself back in the day, I made a promise: No one who trains with me will leave feeling short-changed. Ever.

Because I know what it’s like to pay a fortune and learn f**k all. To get fobbed off with a CPD certificate and no confidence. That trauma still burns. So yeah—education’s my safe space. But it’s also my redemption story. But I Hate Difficult Conversations Here’s how you’ll know when something’s bothering me: I disappear. Text unread. Email flagged.

Message seen… but not replied to. My heart jumps when I hear, “We need to talk.” My first thought? “What did I f**k up now?”
And if it’s a patient with a problem? Oh mate, I’ll go full avoidance:
  • Delay the call.
  • Reread their message 25 times.
  • Mentally rehearse a million rebuttals.
  • Then… still cave in and give the refund.
Not because they’re right.

But because I just want it gone. Conflict drains me. I’d rather lose £300 than lose sleep. You too? The High-Functioning People-Pleaser It’s weird. Outwardly, I come across as confident. Decisive. Even controversial. But inside? I’m walking a tightrope every day trying to please everyone and avoid being disliked. And the irony? It’s made me both nicer… and better.

I give a sh*t. That’s why my clients stay loyal. That’s why students rave about me. That’s why people trust me. But the cost? Mental load. Undercharging. Saying yes when I want to scream no. I’ve refunded patients I shouldn’t have. Gave freebies when I was exhausted. Bent over backwards until I was horizontal. Because being seen as generous felt safer than being respected with boundaries.

Truth Bombs and Turning Points

Here’s what I’m learning (slowly, painfully, via therapy, coaching and lots of stewing-in-my-own-s**t moments):

The more you chase it, the less you get it. People don’t respect over-givers. They expect them to bleed.
Saying no doesn’t make you a bastard. It makes you a f**king adult.

It’s not being dramatic on Instagram. It’s saying, “That refund crushed me,” and letting people in—even if they don’t fix it.

But bottling it might.
You can control how much you sell your soul to keep them happy.

Quick Win For You:

Here’s a little exercise I’m doing right now that’s helping more than I thought it would: The “I BEND TOO MUCH” LIST (that reminds me, must re-watch Bend it like Beckham):
  • Write down 5 things you only do because you’re scared people won’t like you.
  • Now, pick ONE to stop doing this week.
  • Watch your brain go into meltdown.
  • Then watch nothing bad happen.
  • Repeat.
And another:
Before replying to ANY negative message/email/review, ask: “Am I responding to fix this… or to be liked?” Answer that honestly, and you’ll know what to do.

Final Thought:

I still want to be liked. That hasn’t changed. But I’m not willing to lose myself over it anymore. Because if I’m constantly performing for love, I never really receive it.
And if I keep giving everything to be liked, one day I’ll have nothing left. So if you’re like me, trying to balance being excellent with being emotionally exhausted, this is your wake-up call.
You can’t help people from a place of burnout. You can’t teach powerfully from fear. You can’t be both respected and spineless. Pick your side. And maybe… just maybe… like yourself enough that you don’t need everyone else to.

References:

  • Gilbert, P. (2009). The Compassionate Mind. Constable & Robinson.
  • Neff, K. (2011). Self-Compassion. William Morrow.
  • Brown, B. (2012). Daring Greatly. Penguin.
  • Ellis, A. (1962). Reason and Emotion in Psychotherapy
  • Flett, G.L., Hewitt, P.L. (2002). Perfectionism: Theory, Research, and Treatment.

Section 3: Action Points

For the Overconfident Cannula Crusader Who Thinks Blunt = Bulletproof

“Use It Right, or Don’t Use It At All”

Alright. You’re in love with your cannula. It’s pink, it’s blunt, it makes you feel invincible. But here’s the cold truth—if you don’t respect the damn thing, it’ll make you look stupid. Or worse—liable.

Here’s what to actually DO if you’re serious about reducing risk, not just reposting #safetyfirst graphics for the algorithm.

Yeah, I said it. Cannulas aren’t cheat codes. They’re tools—and some of you are shoving them into deep planes like it’s a kebab skewer.

DO THIS:

  • Map the danger zones per region. Label every entry point: vessel proximity, fascia planes, tethering risks.
  • Practice plane awareness with blunt probes on cadaver or pig skin—not just hypotheticals on a printout.

 

ASK YOURSELF: Would I still inject here if I had to use a needle? If not, why am I comfortable with a cannula?

You don’t need to dump 0.5ml of filler per pass like you’re icing a cake. Overfilling through cannulas is the fastest route to tissue damage and aesthetic failure.

DO THIS:

  • Limit each linear thread to 0.1–0.2ml max in high-risk areas.
  • Pinch-and-pull technique to assess soft tissue mobility before advancing—don’t inject into stuck planes.

QUICK TIP: If your filler isn’t gliding, stop. Pull back. Reassess. Pushing = panicking.

Too many of you are relying on “feel.” No. You need visual feedback. Where’s the tip? Where’s the track?

DO THIS:

  • Watch skin displacement as you advance. Not moving? You’re deep or tethered.
  • Palpate with your non-dominant hand to guide, not just hold.

 

REALITY CHECK: You’re not sliding past vessels like Moses parting the RedSea. You’re more likely to jab into fascia blind.

You need an occlusion protocol ready before you start injecting. Not after your patient turns white and silent.

DO THIS:

  • Have your hyalase drawn up. Syringes prepped. Dosage plan rehearsed.
  • Know your injection-to-dissolve time. Every second counts.

 

ASK: Can your team describe the occlusion protocol without looking at acheat sheet? If not, train tonight.

Reading PubMed doesn’t make you competent. Repetition does.

DO THIS:

  • Practice advancing and redirecting without a product. Dry runs with cannulas build feel.
  • Use visual overlays or AR anatomy apps to correlate hand movement with internal paths.

 

EXERCISE: For 1 week, inject every cheek on dummy heads without filler. Focus solely on plane navigation. If your cannula bends or snags—good. Learn.

Reflection Challenge:

If I banned you from using cannulas tomorrow… would your results suffer? If yes, you’re not skilled—you’re dependent.

Coming in the next brutal dose of truth…

Next week, we’re going deep on three things that have been quietly bleeding your time, money  and credibility while the “Inner Circle” sips champagne in Dubai and tells you it’s all normal.

Let’s blow the doors off it:

Section 1 – The Evidence Check

“Two-Week Botox Reviews: Clinical Logic or Just Old Habits Dying Hard?” You’ve been told it’s the gold standard. It’s not. It’s lazy, fear-based, and borderline gaslighting. I’ll break down why automatic two-week top-ups are killing your margins, training your patients to expect freebies and weakening your results over time. Spoiler: NO MOVEMENT = NO MORE PRODUCT.

Section 2 – Harry’s Honest Hour

“The Inner Circle in Aesthetics: Support or Strategic Circle Jerk?” I’m done pretending the same 5 people reposting each other’s selfies is mentorship. It’s politics. It’s posturing. And it’s damaging the real injectors out there doing damn good work without clout or camera crews. I’ll tell you what happened when I realised I wasn’t being recognised—I was being recruited.

Section 3 – Action Points

“How to Detox from Botox Top-Ups & Inner Circle Syndrome – Starting This Week”

Five brutal, practical changes you can make THIS WEEK to reclaim your time, protect your clinical integrity and stop training patients to expect charity syringes. Plus: how to clean your social feed, your scripts and your own brain from the industry’s worst habits.

P.S. Got a colleague who thinks they know what they’re doing but still handing out Arnica like it’s gospel? Forward them this newsletter—IF they can handle the truth (cue Jack Nicholson voice: “YOU CAN’T HANDLE THE TRUTH!”).

If they survive it and still want more, they can subscribe over at:

Subscribe Now
Warning: no fluff, no filters, no sponsored BS. Just evidence, honesty, and the occasional ego bruising.
Scroll to Top