The aging process of the lips and perioral region generally involves different tissues, so it is almost impossible to get good results with just one filler.
Dr. Simon Ravichandran and Emma Ravichandran present their multi-product approach to rejuvenate this delicate area.
Thus, the authors are convinced that lip augmentation, performed without taking into account and correcting other age-related changes in the periorbital region, cannot provide natural results in patients of older age groups.
Approach to periorbital correction and lip augmentation
The approach presented by the authors to lip augmentation and correction of the perioral area as a whole consists of five points:
1. Replenishment of deep volumes in the premaxillary, pear-shaped and central maxillary zones.
2. Injection correction of the border of the red border of the lips.
3. The introduction of the drug directly into the red border of the lips.
4. Smoothing wrinkles around the mouth.
5. Replenishment of volumes in the subcutaneous plane.
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The following are the preparations and correction techniques that the authors prefer to use in order to obtain the most natural and harmonious results.
Replenishment of deep volumes in the perioral region
In Fig. 1 shows the premaxillary, pear-shaped and central maxillary zones, in which volumes are replenished in the deep plane. For patients with significant volume loss, the authors recommend injecting deep boluses of a lifting viscous filler (Belotero Volume or Intense) directly onto the periosteum.
Injections are performed with a 27 gauge needle (do not bleed the needle) after pre-aspiration; aspiration lasting at least 5 seconds is carried out before each injection of the drug. As a result of contact with bone structures, the needle becomes blunt, so a new instrument must be used for each injection. 0.2 & ndash; 0.3 ml of the drug is injected into each zone.
Injection correction of the border of the red border of the lips
To restore the integrity of the dermis, the authors use a filler intended for superficial injection (Belotero Balance or Belotero Lips Contour). The drug is injected using a linear technique intradermally along the border of the red border of the lips, including the arch of Cupid. A 12 mm, 30 gauge needle is used for insertion.
Creating attractive upper lip curves: Cupid's arch correction with HA fillers
At this stage, superficial injection eliminates the need for an airless needle or aspiration prior to each injection. During the injection of the filler, the needle is visualized through the dermis, and immediately after the injection, a temporary blanching of the border of the red border of the lips is observed. This effect should not be confused with blanching due to vascular damage.
Regular needle replacement is essential to ensure accurate insertion of the filler into the dermis and to prevent unnecessary trauma to the skin. As a rule, for the correction of one lip, the authors use 4 needles – one for each quadrant of the red border. To work in this zone, 0.4 & ndash; 0.8 ml of gel is used (Fig. 2 and 3).
As a rule, for the correction of one lip, the authors use 4 needles – one for each quadrant of the red border.
Injection of the drug directly into the red border of the lips
To increase the volume of the lips, it is necessary to introduce a filler between the border of the red border of the lips and the line separating its wet and dry surfaces. An increase in the height of the lip is achieved by injecting the preparation into the line between dry and wet surfaces, and a beautiful curve can be created by injection into the wet part of the red border.
The authors use a 38 mm 25 gauge Steriglide (TSK) cannula with an entry point slightly lateral to the corner of the mouth. The cannula allows you to maintain the correct depth of injection of the drug and reduce the risk of vascular damage.
The filler is injected in two or three lines (0.05-0.1 ml of the drug per line, depending on the required degree of volumization). After the injection, the doctor gives the gel the necessary shape with the thumb and forefinger. The smoothness and cohesiveness of Belotero Lips Shape or Belotero Intense fillers ensures natural results during lip movement (Fig. 4).
Perioral wrinkle fillers
The reason for the appearance of wrinkles in the perioral region are dynamic muscle movements, as well as age-related violation of the integrity of the dermis. Subcutaneous fat atrophy can also increase the appearance of wrinkles. However, the problem primarily affects the dermal layer of the skin, and therefore restoration of the integrity of the dermis provides the most natural results.
The authors inject microdoses of a soft filler such as Belotero Lips Contour, Belotero Balance or Belotero Soft very superficially directly into the wrinkles. Injections are performed with a 12 mm 30 gauge needle using the blanching technique. In most cases, it is enough to inject 0.1 & ndash; 0.2 ml of the drug.
"Blanching" – effective correction of superficial wrinkles with fillers
Replenishment of volumes in the subcutaneous plane
Typically, volume loss occurs in the inferolateral fat compartments of the lips below the corners of the mouth. The problem can be solved by injecting a volumizing filler such as Belotero Volume or Belotero Intense directly into the indicated fat pads.
The authors use a 27-gauge needle for bolus administration of the drug after preliminary aspiration (the air from the needle is not removed). A new needle is used for each injection.
Typically, volume loss occurs in the inferolateral fat compartments of the lips below the corners of the mouth.
Lip correction with fillers in order to increase volume or eliminate other aesthetic imperfections occupies a leading position in the list of the most popular procedures.
While lip augmentation with a single agent may be sufficient for younger patients without signs of aging in the perioral region, this approach will not provide natural results when working with older patients. In such cases, in order to obtain an excellent aesthetic effect, the authors use the techniques and preparations described above.
According to The PMFA Journal
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