Aesthetic correction of hyperactive lip shapes: what specialists should remember

Every aesthetic medicine specialist who performs injection procedures for aesthetic correction should be aware that patients with hyperactive lip shapes may be encountered in his practice. Working with such patients has certain features that largely affect the outcome of the procedure. Hyperactive forms of the lips are associated with different activity of different parts of the circular muscle of the mouth. It is these patients who have the highest risk of such a delayed undesirable phenomenon as filler migration.

I highlight two hyperactive lip shapes: a seagull shape and a boat shape. They are directly related to the hyperactivity of the labial part of the orbicularis oculi muscle. This is noticeable both in statics and in facial expressions: in the first case, a sheer-sloping upper lip is observed, in the second – lip curling. At the same time, the gull-shaped upper lip is characterized by hypertonicity of the labial part of the orbicular muscle of the mouth along the entire length of the upper lip. This is especially noticeable in the facial expressions – in conversation, the upper lip is compressed. In this case, botulinum therapy of the upper lip is desirable.

It is with gull-shaped lips that the risk of filler migration after injections is highest.

If the upper lip is in the shape of a boat – there is a tucking of the lateral part of the upper lip with a harmonious activity of the medial part. Patients in this case often complain of lowered corners of the mouth. For correction, the combination of botulinum therapy of the upper lip and contour plastics is optimal.

Hyperactive lip shapes:

•    risks and difficulties of aesthetic correction of hyperactive lip shapes;•    main tasks and techniques for correcting hyperactive lip shapes;•    important features of correction of hyperactive lip shapes;
•    key points for correcting hyperactive lip shapes.

Risks and difficulties of aesthetic correction of hyperactive lip shapes

The introduction of fillers in the perioral zone is possible at several levels: intradermal, subcutaneous fat, intramuscular and submucosal. However, one should be aware of the risks: when injected intradermally, we can get contouring of the drug, when injected into the subcutaneous fat, the filler can move quite freely under conditions provoking migration, and when injected into the submucosal space, the drug can both contour and migrate. Least of all, the filler moves when it is administered intramuscularly. With hyperactive lip shapes, mainly in the form of a seagull, depending on where the drug is injected, we can get a high risk of certain adverse effects.

In particular, a filler injected subcutaneously below the white ridge may migrate to the oral fissure. A filler injected above the white ridge can migrate into the skin of the upper lip and give a cat whisker effect. A filler injected into the submucosal space in the region of the lower lip can migrate to the oral fissure, and we can get undesirable phenomena in the form of formations in the submucosal space. In addition, not only migration is of great importance, but also the violation of proportions in the correction of hyperactive lip shapes. We can get the "duck effect" with an excess of filler in the central part of the upper lip, "balcony effect"; with the upper lip hanging over the lower, as well as the "square lower lip",

The main tasks and techniques for correcting hyperactive lip shapes

When correcting hyperactive lip shapes, the doctor must solve the following tasks:

•    normalize the activity of different parts of the circular muscle of the mouth with the help of botulinum therapy;

•     make the red border of the upper lip wider without pushing it forward;

•    Improve lip proportions;

•    prevent possible adverse events, including filler migration.

Botulinum therapy of the upper lip is carried out according to the classical method: injections are performed very superficially at 4 symmetrical points above the upper lip and 2 symmetrical points under the lower lip. But it is important to remember that not all patients with hyperactive lip forms have botulinum toxin therapy in the perioral area with a 100% effect. For injection contouring of the upper lip in the shape of a seagull, I recommend performing linear injections with an injection from a white roller. It is very important not to leave the drug in a white roller, but to place it only within the red border of the lips. I recommend the intramuscular level of fillers, because, firstly, it reduces the risk of drug migration, and secondly, we reduce the activity of the labial part of the orbicularis oculi muscle, as we fix the muscle and unfold it, giving the upper lip a more harmonious look.

For upper lip correction in the shape of a boat, I allow the subcutaneous injection of the drug, with the exception of the medial part. It is necessary to perform linear fan injections within the red border of the lips, and on the upper lip – within the lateral part. In order to harmonize the proportions of the lower lip, I offer my original technique for its correction. It combines linear intramuscular vertical injections from the white ridge of the lower lip to the middle of the red border, and intradermal surface injections from the border of the red border of the lower lip at the level of the projection of the tops of the Cupid's bow of the upper lip, which converge in the center of the lower lip 1-2 mm below the white roller. In fact, I do the contouring of the drug in this area, but it is here and with such a markup that the risk of drug migration is quite low, and to stretch the lower lip,

It must be remembered that the more we turn the upper lip forward, the more we push the lower lip forward.

When correcting the lips in the shape of a boat, the fan technique gives a very good effect, but it is also important not to forget to push the lower lip forward. With the combined type, when we do not understand what kind of hyperactive form of the lips is observed in the patient, we can use both intramuscular vertical injections and subcutaneous injections of drugs, but we give preference to intramuscular injections.

Key points for correcting hyperactive lip shapes

Thus, the following key points of contouring hyperactive lip shapes can be distinguished:

•    upper lip: mainly the technique of vertical injections, intramuscularly, strictly within the red border;

•    no linear filler injections into the contour of the upper lip;

•    lower lip – fan technique and my original "Eiffel Tower" technique, do not inject the filler into the submucosal space, increase the volume of the lips due to the lower lip.

Knowing all the features of working with hyperactive lip shapes, and adhering to the above recommendations, the specialist will be able to minimize the risks of filler migration and other delayed adverse events, and get the best results of aesthetic correction of hyperactive lip shapes. estet-portal.com thanks you for your attention.

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