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article | TreATIng The lIps |


Figure 6 Before treatment with botulinum toxin A


less paralysed. In these cases, the next step was to administer a second toxin infiltration in the amount of 0.5 U Vistabex in two points, according to the asymmetry determined in the less paralysed lip. The patients treated with Azzalure were never retreated. Most patients were re-evaluated 30 days after the initial infiltration.


Session three In the second session, it is also decided whether to treat patients with hyaluronic acid or not: 15 days later, if retouched with botulinum toxin in this session, otherwise immediately. In this study, 106 patients (58.8%) were additionally treated with hyaluronic acid as lip fullness was still reduced. All patients signed a further informed consent form for


Figure 7 After treatment with botulinum toxin A


the injection of hyaluronic acid. The classic ‘paris lip’ technique was performed in most cases, while only a minor volume improving technique was performed in only a few cases. The author did not use a truncal anaesthetic block as it tends to significantly change local conditions, altering the precision of the technique. rather, the author prefers to use a local anaesthetic cream (eMlA) for 30 minutes before treatment. Also, the use of a 27 g blunt cannula significantly reduces pain on injection. When possible, products with lidocaine were used4


, but


when the anaesthesia was not included in the vial, Carbocaine 3% was added (Table 1). In these instances, the following were used: ■ The hyaluronic acid syringe provided by the company ■ A sterile two-way connector ■ A sterile 2 ml syringe ■ 0.2/0.3 ml of Carbocaine 3% without adrenaline. The syringes were joined with the two-way connector


relaxation of the superficial fibres of the orbicularis, is


also visible, creating the pleasant effect of fuller lips. In Figure 6 it is possible to see a patient before treatment, and in Figure 7 the same patient 15 days post-treatment. Ten patients (6%) in the Vistabex cohort declared a scarce result and were retreated with a single dose of 0.5 U for each lip, always intradermally. Three patients (1.8%) in the Vistabex group had an asymmetric response with aesthetic improvement only on one side of the lip — in this case the patient was asked to contract the muscle (the classic kissing movement), and it was possible to notice more movement of the lip that was


and, using a back-and-forth movement, the mixing is completed in a short time (Figure 8). The author injected the edge of the lip using a 27 g


Figure 8 The syringes were joined with the two-way connector and, using a back-and-forth movement, the mixing is completed


cannula, which makes the lip treatment possible in just a single injection (resulting in greater homogeneity and a much lower risk of haematoma). The technique is very simple: a little anaesthesia with 0.1 ml Carbocaine 3% is injected near the lip commissure with a 25 g needle (Figure 9), and the cannula is inserted (Figure 10) until the tip of the lip (Figure 11). no further anaesthesia is required. The same process is followed in the inferior lip (Figure 12). The central ‘V’, under the philtrum, and the philtrum columns were treated with a 27 g needle at the end of the session as the anaesthesia provided was well induced. If


Table 1 Hyaluronic Acid used Product X-HA3 Juvederm ULTRA


Company Patients treated (n=106)


Filorga 38 (35.8%) Allergan 20 (18.8%)


Juvederm ULTRA SMILE Allergan 5 (4.7%) Regenyal Idea Restylane


Teosyal kiss 36 ❚ October 2011 | prime-journal.com


Kaliderm 16 (15%) Q-Med


18 (16.8%) Teoxane 9 (8.4%)


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