| LIP ENHANCEMENTS | arTicle evidence
suggests that the future of filling will be shaped by research. even if the ideal filler doesn’t exist today, research is trying to attain that goal.
Figure 8 Before and after. Lip
enhancement by combination of: filling of the vermilion
border and red lip for
volume in association with a CO2 laser
resurfacing of the white lip.
Figure 7 Where to inject for vermilion border (blue).
With lips, it is not only volume, but other patient
concerns about the lips, such as the vermilion border, wrinkles, the philtrum columns definition and the area around the lips such as the nasolabial folds. Vermilion border: inject superficially at the level of
vermilion border to recover a good definition (Figure 7). At the same time, we also treat ‘lipstick bleeding’, the situation where deep wrinkles overlap both the vermilion border and the red lip (Figure 8). Philtrum columns and Cupid’s bow: flattening of
philtrum columns is not only due to atrophy but essentially due to the laxity of the extrinsic orbicularis muscle. They correspond anatomically to the insertion of their fibres (extension of depressor anguli oris and buccinator compose one part of these extrinsic muscles; we have to know that the fibres of these muscles don’t stop at the lip corner but continue in the upper lip to participate in extrinsic orbicularis). To recover the shape, the relief and provide a good definition of the philtrum columns, inject superficially, just under the dermis. Perioral wrinkles: as for wrinkles, inject superficially in
the dermis with the needle bevel up, perpendicularly or in the same orientation of the wrinkle (as you feel comfortable). A very small amount is sufficient if you want to avoid any irregularities. The use of canula can be interesting, not for product injection but to achieve tunnelling perpendicular to the wrinkles. The healing process gives a kind of fibrous tissue, a smooth scar tissue which gently rigidifies the superficial skin.
What to inject? Evidence suggests that the future of filling will be shaped by research. Even if the ideal filler doesn’t exist today, research is trying to attain that goal. Today, hyaluronic acid injections are the ‘gold standard technique’ for lip enhancement and lip rejuvenation. Cost effectiveness must also be considered. The main qualities required for a product are: ease of
administration, no migration and good incorporation into human tissues, predictable side effects, nonimmunogenic, no induction of granuloma, and to be compatible with other procedures, now and in the future. We also require a sufficient duration of cosmetic effect. For these reasons, our philosophy is to eliminate the
non-resorbable or semi-resorbable fillers. We don’t want to compromise the future by foreign body reactions, healing process and scar tissues, granuloma, migration, functional or aesthetic adverse events. Today, more than 70 brands of fillers are available in
Europe, and possibly more worldwide. It should not be forgotten that both patients and physicians demand safety and quality to give confidence to the patients and to be credible for physicians.
Declaration of interest The author is a consultant for Allergan.
References
1. Belhaouari L, Gassia V. L’art de la toxine botulique en Esthétique. Arnette Wolters Kluver France (2006) 44–57.
2. Caix P. Anatomy of the labial region. Annales de chirurgie plastique Esthétique (2002) 47:332–345.
3. Byrne P, Hilger P. Lip augmentation. Facial Plast Surg (2004) 20:31–38.
4. Weinkle S. Injection techniques for revolumization of perioral region with hyaluronic acid. Journal of Drugs in Dermatology (2010) 9:367–371.
5. Carruthers A, Carruthers J et al. A validated lip fullness grading scale. Dermatologic Surgery (2008) 34:S161–S166.
6. Nahai F. The art of Aesthetic Surgery. Quality Medical Publishing Inc USA (2005)1437–1461.
7. Zbili M. Classifi cation du vieillisement des lèvres. Lip score. 2009, DIU morphologic and antiageing Medicine, University Paris13.
8. Penna V, Ibhler N, Stark GB. Proving the effectiveness of the lip lift for treatment of the ageing lip: a morphometric evaluation. Plast Reconstr Surg (2010) 126(2):83e–4e.
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