Local infiltration of tumescent fluid and saline is required in various surgical procedures such as liposuction and hair transplant surgery. The use of small-caliber needles requires more time and power for injection, especially in the superficial planes of the skin.1 The use of large-caliber needles has a few drawbacks. These include painful infiltration and lack of control of the volume injected. Moreover, there are high chances of needle injections into the vessels, and intravascular injections may occasionally result. Various techniques have been developed to avoid the complication. One technique is to use blunt needles or cannulas or short needles. Another is to bend the needle and keep the full length of the needle parallel to the skin to avoid injuring deeper structures (Fig. 1).Fig. 1.: Single-bent (above) and double-bent (below) needles.We have developed a new technique in which large-caliber needles can be used to inject larger volumes without any fear of injuring deeper structures or risking intravascular injections, as described below. [See Video 1 (online), which demonstrates how to make a double-bent needle.] {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"Method for making a double-bent needle.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_elkyvaex"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Hold the needle in the needle holder at about 3 to 4 mm from the tip, with the eye of needle facing up. Bend the needle at a right angle in a counterclockwise direction to create the first bend (point A) (Fig. 1, above). Hold the needle at about 2 to 3 mm proximal to point A and bend in a clockwise position at a right angle to create the second bend (point B) (Fig. 1, below). The direction of the distal part can be adjusted as well (Fig. 1, below). The use of a bent needle is not new in the medical literature. The bent needle is used in dentistry for intraoral nerve blocks and for supraclavicular regional blocks.2,3 The bent needle with broken tip is also used in plastic surgical procedures for irrigation. Similarly, the double-bent needle has been used in intraocular injections as well.4 We have developed this new technique to inject large amounts of fluid without any fear of intravascular injection, especially in the subcutaneous plane. In order to maximize safety, the eye at the bevel is faced upward. [See Video 2 (online), which shows application of the double-bent needle.] The bending of the needle at two points also decreases the lumen of the needle, which decreases the flow rate as well. The part between the two bend serves as depth control. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"Clinical application of double-bent needle.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_8mnc7h8g"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Avoid a second attempt to bend or twist the needle, as that may weaken the needle and it may break and can cause needle tip impaction. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.
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