article | TreATIng The lIps |


heavy peelings and laser resurfacing is not easily tolerated, and fillers of whichever type improve but do not completely correct the problem of mimic wrinkles. In these patients, this technique can be considered an ideal solution, a ‘gold standard’. What is important, however, is to make patients aware of all the strange feelings they will experience.


Frequent and


sometimes excessive contraction of the orbicularis oris is the greatest limitation that the aesthetic practitioner can encounter when correcting perioral rhytides using a resorbable filler.


discomfort for 1 month did not voice any complaints


with regard to this prolonged effect, and ultimately perceived an excellent result of treatment. lower, prudential doses used in our patients eliminated any eventual problem of ptosis of the lip, which did not occur in this study, and all other significant side-effects, occurred in other studies1, 8–10


. In most cases, using low doses (0.5 U Vistabex or 1 U


Azzalure per point) was still effective. There were no patients who did not respond to treatment. The use of the 30 U Becton Dickinson syringe is fundamental for the precision of the injected doses. It is interesting to note that many patients were satisfied with the toxin alone (highlighting, therefore, a new technique to be used as primary indication), and that the toxin infiltration reduces the frequency and the amount of filler injections. When used in conjunction with the toxin, the author never had to make any over-corrections — not even in those patients who complained of the durability of the filler when used alone. This technique is particularly suitable for younger


people, with increased movements, who have wrinkles mainly in the dynamic phase, and who are searching for a way to remove them. Currently, there are few techniques to treat these patients; surgery is premature,


40 ❚ October 2011 | prime-journal.com References


1. Redaelli A. Botulinum Toxin A in aesthetic medicine, for the treatment of hyperhidrosis and in odontostomatology. Basic principles and clinical practice. OEO-Firenze: Italy, 2010


2. Gordon RW. BOTOX cosmetic for lip and perioral enhancement. Dent Today 2009; 28(5): 94–7


3. Ascher B, Talarico S, Cassuto D et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit)--Part II: Wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol 2010; 24(11): 1285–95


4. Suryadevara AC. Update on perioral cosmetic enhancement. Curr Opinion Otolaryngol Head Neck Surg 2008; 16(4): 347–51


5. Weinkle SH, Bank DE, Boyd CM, Gold MH, Thomas JA, Murphy DK. A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine. J Cosmet Dermatol 2009; 8(3): 205–10


6. Weinkle S. Injection techniques for revolumization of the perioral region with hyaluronic acid. J Drugs


Dermatol 2010; 9(4): 367–71


7. Semchyshyn N, Sengelmann RD. Botulinum Toxin A treatment of perioral rhytides. Dermatol Surg 2003; 29(5): 490–5


8. Redaelli A. La Medicina Estetica. Editrice Firenze: Italia, 2009


9. Levy PM, De Boulle K, Raspaldo H. A split-face comparison of a new hyaluronic acid facial filler containing pre-incorporated lidocaine versus a standard hyaluronic acid facial filler in the treatment of naso-labial folds. J Cosmet Laser Ther 2009; 11(3): 169–73


10. Andre P. New trends in face rejuvenation by


hyaluronic acid injections. J Cosmet Dermatol 2008; 7(4):251–8


11. Ali MJ, Ende K, Maas CS. perioral rejuvenation and lip augmentation. Facial Plast Surg Clin North Am 2007; 15(4): 491–500


12. Benedetto AV. ed, Botulinum Toxins in Aesthetic


Clinical Practice. Informa Healthcare: London and New York, 2011


Conclusions Frequent and sometimes excessive contraction of the orbicularis oris is the greatest limitation that the aesthetic practitioner can encounter when correcting perioral rhytides using a resorbable filler, which reduces both the duration and the quality of the result. It is clear that the use of botulinum toxin A can help, giving more relaxed tissues. Additionally, the thinner and superficial wrinkles, which are the most difficult to correct with fillers (hypercorrection is frequent), often disappear after using only the toxin. The wrinkles that, in the author’s experience, demonstrate the best indication are those that appear only during the contraction of the orbicularis; this is the case in younger patients who are smokers. When used alone in these patients, the filler does not produce optimal results, and the duration time is unsatisfactory. The toxin has been proven to successfully obtain a good clinical result using lesser amounts of filler. If well performed, side-effects are infrequent, always


reversible, and of little concern for the patients, if well informed in advance. In the author’s opinion, the greater side-effects described in previous reports are the result of elevated doses and incorrect injection sites. Often very low doses are enough to obtain good results. In some cases, finally, botulinum toxin can be used alone as a first-line treatment.


Declaration of interest Professor Redaelli is consultant, speaker and tutor for Filorga, Galderma, Allergan, Aventis and other medical companies. This article received no funding sources and is written purely from Professor Redaelli’s experience.


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