I turned away more lips than I care to admit, only because I didn’t have a good plan in place to address lip augmentation. The lips are formed by an internal portion, the oral mucosa (M) (comprising nonkeratinized stratified squamous epithelium, chorion rich in blood vessels, and minor or accessory salivary glands), by a transition zone, called the vermilion border (comprising keratinized stratified squamous epithelium without hair follicles, apocrine or salivary glands, and possibly with sebaceous glands), and by an external portion comprising the skin and its appendages. 1 –. However, the problem is primarily dermal, and restoring dermal integrity will yield the most natural result. I know this isn’t the exact answer you are looking for, but as you know, every patient and technique can differ! Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral-chin depression. I discard the used needle, place the sterile end-cap back on the filler and secure the syringe in an envelope we use to autoclave surgical instruments. As the ageing process continues subcutaneous fat atrophy may also be a contributing factor. Better results are obtained by injecting type A botulinum toxin to relax the OOM. Viruses such as Hep C, HPV and HSV are just a few that could potentially cross contaminate. Id like to hear your opinion on injection the tear trough area in regard to safety and the best products to use. The small syringe allows for microdroplets of product. My favorite product for tear trough injections is Voluma, placed with a 3/10cc insulin syringe. The product is applied into the dermis via retrograde injection at the edge of the vermilion border. Another tip of the trade: I always leave 0.2cc in my syringe for touch ups. A validated grading scale for marionette lines. 2. The applica tion technique takes this division into consideration, as a filler injection in each of these areas yields different results, as specified below: Lip contour: Filler injections in this area givedefinitionto the lips. Injection of the vermillion border. Your credibility in the injection industry is greatly valued. It’s a bit more temperamental! The injection should be interrupted immediately in case of sudden pain or whitening. Hairdresser Reacts To Girls Trying To Balayage Their Own Hair - … It sounds like Juvederm may be all you need and it typically runs around $600 across the country. I use this technique 80% of the time and teach it to beginners 100% of the time. Vascular occlusion and necrosis are consequences of embolization of the product in the lumen of the labial artery and can be avoided by using thicker microcannulas, greater than 25 G, when applying filler injections to the deep fat pad of the lips (DFPL). Next, inject the upper portion of the vermillion border, starting at the tip of the cupid’s bow. Sincerely, Take note with Restylane Silk, it can create moderate edema so prepare your patient for this 48 hour event. Plast Reconstr Surg 2013;132(4 Suppl 2):59S-68S. Using your 30 g needle (love this smaller gauge), measure 1/2 inch from the top of the vermillion border. This disappears gradually in 5 to 10 days. Vermilion border: Filler injections in this area give the lips anterior projection, (re)creating a convex format. I don’t like to replace the syringe in the original packaging and tape the edges, like I used to do. The characteristics of “ideal” lips have been described in the literature. A validated lip fullness grading scale. Inject a linear thread of product into the VB, creating a soft projection of the border. Haley, It very well could have been my nerves and not having expected that. The esthetic objective of labial filling is to improve the three dimensional relationship with the rest of the face, taking into consideration the ethnic origin of the patient, cultural factors, age, and gender. 3. Retrograde injection or bolus can be used. FILLER for Marionette Lines | Instant Results - Duration: 1:27. Acetylsalicylic acid, oral anticoagulants, nonsteroidal anti-inflammatory drugs, and even vitamin E and herbal supplements can cause ecchymosis. Hello, I was wondering how much filler would someone need who already has nice lips but just wants some volume and maybe on the corners of the mouth? What causes this and how can it be avoided if she chooses to try again? These injections will add slight volume to the lower lip, everting the lip a bit creating a very pretty shape. Lips lose volume with aging, meaning that they lose convexity and take on a flattened look when seen from the side. 4. This will begin to shape the lip, setting a nice support for the corners. I just can’t do it. The product is placed along the periosteum in 0.01 0.02cc aloquots, avoiding important anatomical structures such as the infraorbital nerve foramen and the branch of the facial artery. Preenchimento labial com microcânula. Share the lip love! Increasing the vertical height of the lip is achieved by placing filler at the wet dry border, and eversion can be achieved by placing the filler in the wet border in relation to the anterior surfaces of the teeth. The lips should be parallel to the imaginary line drawn between the pupils; the upper lip should be 18 to 20 mm from the nostrils and the lower lip 36 to 40 mm from the chin. SC068684) | © 2020 - Website by Gecko Agency, This site uses cookies. 1. 16.1–16.8). To restore dermal integrity we use a filler suitable for superficial placement (Belotero Balance or Belotero Lips Contour). My favorite products for lip injections are Juvederm Ultra Plus XC, Juvederm Ultra XC or Restylane Silk. It has a very smooth flow and is very easy to push and inject! A pretty lip has a “white roll” where light is reflected from the lip. Inject slowly, more superficially and try not to massage Silk. This is usually seen in the lower lateral labial fat compartments, immediately below the oral commissures. Between 0.4 and 0.8ml of filler is required in this area (Figure 2 and 3). Yikes! An M-shaped curve of the upper vermilion border is called the Cupid’s bow, and the linear prominence that originates at the two apices of the M toward the nostrils consitutes the philtrum columns. 8. Micheels P, Sarazin D, Besse S, et al. Read our, THE PMFA JOURNAL VOLUME 6 ISSUE 1 OCTOBER/NOVEMBER 2018, HOW I DO IT Approaches to lip augmentation: Perioral rejuvenation – a multi-product approach. If the procedure is performed, the upper lip would become “heavy,” below the ideal height, projecting forward, and patients’ teeth would not be visible when they smile. Class 4: Extremely long and deep folds. In Caucasian women, the ratio from the upper lip to the lower lip is 1:1.6, i.e., the lower lip is more voluminous than the upper one, and the Cupid’s bow and the philtrum are evident. If lip shaping is needed, I may stray from this 6 step approach; however, this is a great approach for the patient who has never had their lips injected with dermal filler. A small bolus can also be applied to the modiolus to help lift the commissure. The needle is replaced after each injection due to it blunting on the bone, and to ensure an unprimed needle is used during each aspiration. If someone has a thinner lip and they are timid about lip augmentation, go with Ultra but let them know that a second syringe may be needed in 2-4 weeks after the edema resolves. It is essential to warn the patient about this. Injection of type A botulinum toxin in the depressor muscle of the angle of the mouth and the platysma muscle is also helpful. Treatment of deep volume loss in the pre-jowl, pyriform and central maxilla (Figure 1). You are awesome. In order to enhance the columns of the philter, it is important to remember that they are not parallel as they have an inverted V shape that narrows as it approaches the columella (Fig. Repetitive movements of the depressor muscle of the angle of the mouth and the platysma muscle also contribute to signs of aging. Lips are my absolute favorite place to inject on the face. 1. Anyway, I am looking back at your comment about voluma on the tear trough, do you place your needle straight down (perpendicular) or go 45 degree at the tear trough? Declaration of competing interests: None declared. This should not be confused with blanching associated with vascular compromise. Yes, by “C” shape, your description is what I am referencing. One of my patients refuses filler for her lips after having a negative experience with filler at another practice. The number of punctures should be minimized, and ice should be applied after the procedure to help reduce erythema and edema. Copyright 2015 Haley Wood Aesthetics, LLC | All Rights Reserved | Marketing by, The top 3 considerations for a new practice start up. Haley, 6. Christian. Sandie. The product is applied into the dermis via retrograde injection at the edge of the vermilion border. In these cases, curvilinear resection of the excessive skin below the nostrils is recommended, using the gull-wing technique. The common “duck bill” is another undesirable effect that occurs due to excessive application of the filler agent or an inadequate filling indication.