Lips

Fig. 11.1

a, b Vascular supply of the lips. Reproduction of a lithograph plate from Gray’s anatomy (Henry Gray, Anatomy: Descriptive and Surgical)

11.2 Pitfalls

Injecting filler in the lips can easily activate the dormant herpes simplex virus in those predisposed: The patients that are prone to reactivations of this infection should be on antiviral prophylaxis medication when doing the treatment (see Chap. 21.1).

Every lip injection has to be differently tailored to the patient. Injections along the vermillion border typically enhance the projection of the lip. Injections in the red lip enhance volume. When injecting, it’s important to avoid an unnatural look (duckbill like look) or an unbalanced lip. With respect to “central or outer,” it is better to inject more centrally than laterally. This is because overzealous injections laterally can make lips look very unnatural, almost sausagelike.

Overfill or overcorrection of the vermilion border is not recommended. This creates an acute angle at the mucocutaneous junction that appears unnatural.

11.3 Lips Recontouring with Hyaluronic Acid and Blunt Cannula

11.3.1 Indications

Lips can be recontoured to bring the youthful look back by placing gel along the lip borders (vermillion). Redefining this edge with natural fillers leads to a more youthful and appealing look.

11.3.2 Contraindications

The filler should not be injected in areas that lack sufficient blood supply or that have an infection or inflammation.
No injection should be done if the hand has been previously treated with liquid silicone or other permanent fillers because new injection could lead to inflammation or infection of the implants.
Any hypersensitivity to any components of the filler obviously constitutes a contraindication for the treatment.
Anatomical alterations due to previous trauma or surgical intervention (cleft lip). Scarring often induce retracting scars that can cause asymmetry and unequal filling of the part treated.

11.3.3 Materials

0.8 cc of HA
Cannule 27G, 37mm length
Needle 26G, 13mm length
0.2 cc of local anesthetic (2% lidocaine, 2% mepivacaine) with epinephrine 1:100 000
Bandages and antiseptic solution (Fig. 11.2)

Fig. 11.2

Materials

11.3.4 Material Choice

In Europe

Glytone 3.
Belotero basic.
Belotero intense.
Restylane lip volume.
Restylane lip refresh.
Emervel lip.
Restylane.
Surgiderm 24 xp.
Juvederm ultra smile.
Juvederm volbella.

In Asia

Juvederm refine.
Restylane.

In America

Belotero basic.
Belotero intense.
Restylane.
Juvederm ultra XC.

11.3.5 Operating Time

The procedure usually takes 10 min.

11.3.6 Method

Procedure is shown in Figs. 11.3, 11.4, 11.5, 11.6, 11.7, 11.8a, b and 11.9.

Fig. 11.3

The procedure is shown

Fig. 11.4

Vestibular injection of 0.2 cc per side of local anesthetic (lidocaine, mepivacaine) will provide good anesthesia for the upper lip

Fig. 11.5

Anesthesia is performed in the entrance point located in correspondence with the labial commissure at the corner of the mouth with 0.1 cc of local anesthetic (lidocaine, mepivacaine) with epinephrine

Fig. 11.6

An opening is created with a 26-G needle

Fig. 11.7

A 27-G, 37 mm length blunt cannula is inserted perpendicularly to the skin surface through the hole created

Fig. 11.8

a, b The cannula is then pivoted parallel to the skin plane and made to slide with precision into the deep dermis along the vermillion border; we recommend touching the tip of the cannula to establish the position reached

Fig. 11.9

0.4 cc of filler is delivered slowly, while the cannula is withdrawn (retrograde injection); the injection is done from the lateral end of the Cupid’s bow to the entrance point of the cannula