NLL technique: natural lifting and lip augmentation with HA fillers

The natural result of lip correction with fillers is not as easy as it seems. To do this, the doctor must have knowledge of anatomy, a high level of skill and be creative in solving the problem. Most of the techniques for lip augmentation with fillers, to one degree or another, include injection correction of the red border of the lips – transition zones between the thin skin of the lips and the denser skin of the face. However, this leads to a distortion of the natural anatomy of the – creating a linear projection pointing up or forward. Dr. Steven Harris (Steven Harris) in the article estet-portal.com talks about the technique of non-surgical lip lifting (NLL), which provides a harmonious correction result.

• Non-Surgical Filler Lip Lift (NLL) Technique Summary
• Assessment of the patient's face before performing a lip lift
• Description of non-surgical lip lift technique with hyaluronic acid
• Change in the position of the lip cusps in the NLL technique

Non-surgical lip lift technique with fillers (NLL)

Non-Surgical Lip Lift (NLL) – creative approach to injectable lip augmentation with hyaluronic acid fillers. His goal – restore the ideal shape and rotation of the lips, respecting their natural anatomy. Depending on the insertion points, the lip ridges can be reshaped or repositioned to achieve the desired result.

Fig. 1: indirect lip beautification after chin correction

To determine the ideal location of the tubercles of the lips, the author uses H-shaped lines (Harris lines or H-planes), and to identify the most harmonious curve of the lower lip – H-shaped curves (Harris curves).

Patient assessment before lip lift 

To obtain a harmonious result of lip contouring, it is important to consider the face as a whole during the evaluation phase.

As you age:

• face skeleton is compressed in the direction of the midline, internal rotation is observed;
• Unsupported soft tissue "presses" on lips that undergo changes due to a lack of their own internal and external support.

Direct lip correction without restoring the surrounding supporting framework will inevitably lead to unnatural and unsatisfactory results.

A more balanced and natural aesthetic result can be obtained by restoring the contours of the face and areas adjacent to the mouth area. These include the dentition, as malocclusion also affects the shape of the lips.

Photo 2: (A) before and (B) after non-surgical lip lift (NLL) 0.4ml HA – lower tubercles of the lips – white circles, lip rotation – blue arrows

After working on the surrounding areas, the lips are significantly corrected by "indirect beautification". And direct lip beautification is carried out at the final stages to form a more natural, balanced and harmonious result.

Description of non-surgical lip lift technique with hyaluronic acid

Lip lifting with fillers is performed using linear and bolus techniques in compliance with the natural anatomy of the lips – their lines, curves and tubercles – for restoring the ideal shape and rotation of the lips.

All injections are made from the "labial side"; red border. As the lips rotate upwards, the filtrum columns shorten and become more distinct.

You may also be interested in: Harmony and naturalness of the lips: non-surgical lifting technique 

The classic lip lift technique with fillers consists of 10 steps. For each step, no more than 0.05 ml of filler is injected. For lip augmentation resort to:

• bolus injections into the tubercles of the lips;
• linear drug administration;
• injection of HA along curved lines.

Depending on the anatomy of the patient's lips, the sequence and number of steps may vary.

Since HA injections are not performed at the vermilion border of the lips, the risk of filler migration is eliminated. In most cases, maximum 0.5 ml of filler.

To increase the lips in the presented technique, you can use any "soft" filler (low viscosity) and injections are best done with a needle that provides control and accuracy of injection.

Photo 3: (A) before and (B) after non-surgical lip lift HA 0.3 ml

To make the procedure as safe as possible, the filler should be injected:

• very carefully;
• slow;
• superficial (no deeper than 1–2mm from the skin surface).

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Typical side effects of – swelling and hemorrhage – reduced to the absolute minimum.

Changing the position of the lip cusps using the NLL technique

In order to optimize the projection or shape of the lips in different planes, the NLL lip lift technique resorts to repositioning of the cusps:

• filler injections into medial areas of tubercles – augmentation or displacement of the tubercles towards the midline (narrowing of the corresponding part of the mouth and strengthening of the bends);
• filler injections into lateral areas of tubercles – displacement of tubercles from the midline (expansion of the corresponding area);
• filler injections in anterior or posterior areas of tubercles – displacement of tubercles anteriorly or posteriorly, respectively.

There are only 5 areas of natural projection of soft tissues on the lips – three on the top lip and two on the bottom.

The technique allows you to use one or more tubercles that can be "moved" in different planes and directions, depending on the desired result.

In many cases, the position of the lip cusps is not so easy to determine, which complicates their correction. To facilitate this task, the author uses H-shaped planes (Harris planes or H-shaped lines) to determine the center of each tubercle (front view).

Photo 4: 10 steps for a non-surgical lip lift – bolus injections into the lateral tubercles (steps 1, 5, 6, 10), injection in straight lines (steps 2, 4, 7, 9) with filler injection into the central tubercle (steps 4 and 9), as well as in curved lines (steps 3 and 8). The H-shaped planes (white lines) show the ideal position of the cusps, while the H-shaped curved lines (yellow) define the optimal curve in relation to the chin

H-shaped lines:

1. A line drawn from the upper point of the right column of the filtrum at the base of the nose through the right peak of Cupid's arch, intersects the centers of the right upper and lower tubercles.
2. A line drawn from the upper point of the left column of the filtrum at the base of the nose through the left peak of Cupid's arch, crosses the centers of the upper left and lower tubercles.
3. A line drawn middle from the base of the nose crosses the central cusp.

Read also: Hyaluronic acid lip correction: how to get a natural result and avoid complications

If the lateral H-lines are extended to the line of the lower jaw, one will find that the ideal curve of the lower lip corresponds to the curve of the chin (Harris curves).

In general, the technique of non-surgical lip lift with HA fillers with a change in the position of the tubercles allows you to preserve the natural anatomy and give them an ideal shape.

Based on Prime magazine.

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