Lip correction with hyaluronic acid: getting a natural result

Plump lips have always been considered synonymous with beauty and youth. At the same time, the process of creating "perfect lips" depends not so much on compliance with clearly fixed criteria, but on the skills of the practitioner and the expectations of the patient.

It is important to understand that in order to form aesthetically attractive lips, it is necessary to correctly plan the strategy for the procedure, which is impossible without a clear understanding of the anatomical features of this zone.

Estet-portal.com found out aspects of lip correction with fillers based on hyaluronic acid.

• Hyaluronic acid lip correction: important anatomical features
• Vessels and nerves located in the area of ​​the lips
• How can I get a natural result with lip correction with hyaluronic acid
• Why hyaluronic acid fillers are used for lip correction
• Choice of HA injection technique for lip correction
• Possible complications after lip correction with hyaluronic acid and their minimization

Important anatomical features for lip correction with hyaluronic acid

The skin in the perioral region is represented by stratified squamous epithelium, consists of the epidermis, dermis and hypodermis, contains hair follicles, sebaceous and sweat glands, and is separated from the anatomical structures underlying it by connective tissue and muscles.

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The inner side of the lips is covered with a mucous membrane, which contains a large number of salivary glands.

When correcting lips with hyaluronic acid, it is important to consider:

• disposition of muscles in the perioral region;
• location of nerves and vessels in the lips.

The main muscles located in the perioral region

1. M. orbicularis oris – the main muscle responsible for lip movements, which consists of two parts. The peripheral part of the circular muscle of the mouth is responsible for contracting and pushing the lips forward. The deep part of the muscle allows you to tightly compress and wrap your lips inward. The orbicularis oculi connects to the drooping angle of the mouth and smile muscles at the ganglion near the corner of the mouth.

The upper lip has the shape of a flattened letter M in the area of ​​the outer contour of the red border– the so-called arc of Cupid. Vermilion, or the red border of the lips consists of "dry" and "wet" parts. The area of ​​​​junction of the skin and mucous parts of the lip is characterized by the presence of a "white roller", which is formed as a result of light reflection.

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The color of the mucosa is due to the absence of keratin and close to the surface vascular plexuses. Vessels and nerves located in the area of ​​the lips

The motor innervation of the lips is provided by the facial nerve, and the sensitive – maxillary (V2) and mandibular (V3) branches of the trigeminal nerve.

The blood supply to both lips is provided by the superior and inferior labial branches of the facial artery. The superior labial branch arises from the facial artery directly above the labial commissure. It runs at a depth of 4.5 mm along the upper lip between the mucosa and the orbicularis oris muscle, just above the junction of the vermilion and the lip mucosa, and anastomoses with the opposite artery.

The inferior labial branch branches off the trunk of the facial artery at the point where it enters the vestibule of the mouth. The main arterial trunk runs along the border of the alveolar process in the plane between the circular muscle of the mouth and the depressor muscles of the lips. The lower labial branch of the facial artery departs from the arterial trunk, which passes along with the mental nerve to the lower lip.

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Beauty and youthfulness of the face with non-injection carboxytherapy Despite the fact that the location of the vessels in the lip area varies from patient to patient and in most cases the arteries are not symmetrical, understanding the general pattern of their location helps to avoid complications when correcting the lips with hyaluronic acid.

Fig. 2 Nerves, vessels and muscles located in the perioral region

In the region of the upper lip, at the junction of the red border and the mucous membrane, there are many arteries passing under the muscles. Superficial injection of the drug to a depth of no more than 3 mm directly under the red border can be considered safe in order to increase the projection of the lip.

Most of the labial branches of the facial artery enter the vermilion perpendicularly, so the red border of the lips is a safe area for superficial fillers.

 

The blood supply to the lower lip is provided by the facial artery and its three branches. The first artery runs along the border of the lower lip and is therefore called the "inferior labial branch"; the second horizontally crosses the area between the lower lip and chin – "horizontal labial branch"; the third passes vertically through the area between the lower lip and chin – "vertical

labial branch". How can I get a natural result with lip correction with hyaluronic acid

Symmetry and proportion play an important role in determining the degree of attractiveness and youthful appearance of the face. As you know, the face is conditionally divided into three horizontal thirds:

upper third – from hairline to between the eyebrows;

• middle third – from between the eyebrows to the base of the nose;
• lower third – from the base of the nose to the tip of the chin.
The aesthetic appeal of the lips is most often defined as the ratio of the upper lip to the lower lip of 1:1.618. This ratio is relevant mainly for Europeans and Caucasians, and in the east it can even be 1:1.

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In addition, the lateral projection of the upper lip should be 1-2 mm larger than the lower one. To date, the described proportions are the standard that practitioners are guided by when drawing up a plan for lip correction, including hyaluronic acid.

Fig. 3 (A) before and (B) after injection of 0.25 ml of filler into the outer border of the red border of the lips, as well as two boluses of 1 ml into Cupid's bow

The optimal ratio of the upper and lower lips – 1:1.618, and the lateral projection of the upper lip should be 1–2 mm larger

than the lower one.   Why hyaluronic acid fillers are used for lip correction

Dermal fillers are by far the most common method for enhancing and creating aesthetically pleasing lips.

The ideal product for this purpose is a biocompatible, biodegradable filler that integrates easily into the patient's tissues and provides a natural result. Fillers based on hyaluronic acid (HA) meet all the above requirements.

The hygroscopic properties of HA make it an excellent lip correction material as it is able to absorb large amounts of water, thereby hydrating and volumizing the lips.

Fig. 4 (A) before and (B) after injecting 0.2 ml of filler into the junction and outer border of the red border of the lips, and 2 boluses of 0.1 ml into the upper lip to elevate the Cupid's bow

Another huge benefit of HA is its ability to cross-link to create gels of varying densities. Fillers with high cohesiveness and lower viscosity are softer and therefore used for lip augmentation. The photo shows the results before and after lip correction with Juvederm Ultra XC hyaluronic acid filler (Allergan, Irvine,

CA). Choice of HA injection technique for lip correction

For successful lip correction with hyaluronic acid, the doctor must have certain experience and skills. In addition, the features of the insertion surface vary depending on the individual anatomy of the patients, so it is not possible to use only one technique in all cases.

Point bolus technique (or depot creation), linear injection and sequential puncture technique are used to increase the volume of deep tissues of the lips. Such techniques are used to reshape or increase the volume of the upper or lower lip, while vertical line insertion is used to correct the filtrum and Cupid's bow.

Fig. 5 (A) before and (B) after intradermal injection of 2 units of botulinum toxin type A 1 cm lateral and 1 cm below the labial commissure, followed by the injection of 0.4 ml of filler along the outer border of the red border of the lips and the "white roller"; and retrograde intradermal injection of 0.1 ml of the filler into the Cupid's bow.

The aim of each technique is to achieve the most natural results with the minimum amount of material introduced and the minimum risk of complications. The optimal effect is achieved by combining

the indicated techniques. Possible complications after lip correction with hyaluronic acid and their minimization

The most common side effect of lip correction with hyaluronic acid fillers is injection site reactions, which occur to some extent in most patients. These reactions resolved in less than 7 days.

Immediate and early complications after soft tissue augmentation are usually temporary and resolve within a few days after filler injection. These include:

erythema;

• swelling;
• sensitivity;
• discoloration;
• bruises;
• pain;
• hypersensitivity reactions.
Local erythema is a consequence of a local inflammatory reaction, therefore, patients are advised, if possible, not to take drugs or vitamin supplements that lead to dilatation of blood vessels, to cool the injection site; if necessary, prescribe intratissue corticosteroids.

Fig. 6 (A) before and (B) after two injections of 0.35 ml HA 20 mg/ml along the outer border of the red border of the upper lip 

Introduction technique – a very important point to minimize side effects. If during the injection of the drug there is blanching of a significant area of ​​the skin, it is necessary to immediately stop the introduction of the filler. In case of lip blanching, it is recommended to use

hyaluronidase

to destroy the injected material. Repeated entry at the same injection site increases the risk of bruising, and nitroglycerin paste and possibly heparin injections are recommended to increase vasodilation to prevent bruising. In terms of delayed complications, the most common are:

inflammatory nodules;

• granulomas;
• sterile abscesses;
• chronic inflammatory reaction around the insertion site caused by bacterial colonization of the implant.
It is also possible that lumps may appear, which can be eliminated within the first 24 hours after injection.

With slow and non-superficial administration of hyaluronic acid, complications are quite rare.

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Lip contouring: how to avoid hypercorrection Because the perioral area is highly vascularized, aspiration should be performed prior to drug administration to rule out intravascular injection of the product. To avoid bruising, it is necessary to inject small amounts of filler and do it slowly.

The author also believes that when correcting the lips with fillers based on hyaluronic acid, it is necessary to remember the hydrophobic nature of this substance, therefore, in this case, it is important not to overdo it with the amount of the drug in order to avoid hypercorrection.

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