article | TreATIng The lIps | toxin and hyaluronic acid coMbining botulinuM
Managing lip rhytides
Alessio Redaelli reviews the results of a study evaluating the use of botulinum toxin and hyaluronic acid to treat perioral rhytides
ABSTRACT
Background: The treatment of upper lip wrinkles is often unsatisfactory when using fillers only for the hyperfunctional movement of the orbicularis oris muscle.
Objective: To evaluate the immediate outcome of the cosmetic use of botulinum toxin A to understand the real rate of side-effects after this part of the technique, and to evaluate the outcome together with hyaluronic acid for the correction of lip wrinkles caused by hyperfunctional movement. It is difficult to correct these wrinkles using just the ‘Paris-lip’ technique, especially in younger patients.
Materials and method: In the period from January 2008 until May 2010 the author treated 180 patients: 74 patients were treated with botulinum toxin A alone when ‘barcode’ wrinkles were the result of hyperfunctional movement of the orbicularis oris (first cohort), and 106 with botulinum toxin A and hyaluronic acid using cannulae when a loss of lip volume was evident over orbicularis oris hypercontraction (second patient cohort).
Results:
Although this is an ‘off-label’ indication for botulinum toxin use, all patients showed good results, there was not a single case of ‘real’ side-effects, and no systemic effects were noted. The subjective improvement observed by the patients themselves was also significant.
Conclusions: Botulinum toxin A is a safe and effective technique in the management of lip wrinkles and can be used as a primary indication. It can also improve the results of filler treatment with immediate and/or long-lasting results. If well performed and explained beforehand, no significant side-effects occur, and any eventual effects are accepted by patients.
30 ❚
young people as a result of the hyperfunctional movement of the orbicularis oris, as is the case in smokers1–4
F October 2011 |
prime-journal.com . in these cases, the use of normal fillers alone
is insufficient, because it is sometimes impossible to completely eliminate wrinkling during movement of the mouth and, even when possible, the long-term result appears unsatisfactory1, 2
. Of the vast range of
potentially corrective techniques for these problems (laser resurfacing, peelings, dermal abrasion, revitalisation, implants of re-absorbable and non-resorbable materials, surgical techniques), hyaluronic acid is possibly the most used substance to restore the original lip volume, or for its augmentation in cases of insufficiency5,6
. In all hyper-mimic patients, the author believes it is
possible to use botulinum toxin A with an off-label indication in the initial session. Botulinum toxin has been used for many years and is also used in the lower face, where it is proven to be very safe1–3, 7, 8
. This should
prove to be extremely useful in young patients, where the muscular component is more pronounced: in these cases, the single reduction of the muscular contractility is often enough to resolve the problem1
, and the injection of hyaluronic acid will be useful only in cases in which
KEYWORDS botulinum toxin, hyaluronic acid, barcode wrinkles, perioral region, Vistabel, Azzalure
ALESSIO REDAELLI, MD, is Professor at Milan Aesthetic School AGORA’ and ASPEM; Director of Research at SIES Italian Society; and Professor at Padova University.
contact:
mail@docredaelli.com
acial ageing is primarily the result of gravity and loss of elastic tissue support owing to subcutaneous changes in the dermis. consequently, wrinkles are usually strictly linked to age. On the contrary, lip wrinkling often appears in
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84