Focus on lips and surrounding area: innovative and therapeutic strategies by means of the use of a technologic “pen” and a “dynamic” filler

Focus on lips and surrounding area: innovative and therapeutic strategies by means of the use of a technologic “pen” and a “dynamic” filler

The treatment of lips and perioral region requires, as always, a special attention compared to other areas of the face: on the one hand we are totally aware of the importance of the harmony of female lips for the “beauty” of the whole face, on the other hand we have to face a very delicate and sensitive area. The fear of the pain and of artificial results, absolutely justified, requires the maximum effort to make the injection more effective and more comfortable. Reshaping the lips is not only a matter of volume! Indeed, the volume represents only one of the different factors to consider, and not always to improve, along with the shape, the lip contour, the direction of the labial commissures, the characteristics of the vermillion (firmness, thickness, plumpness, projection), and possible asymmetries. Therefore, the attention to details becomes increasingly important, as well as the anatomical reference points, the proportions the lips together and of the lip itself, in relation to the profile, with nose and chin. The volume correction should be the “bare essentials” and always adapted to the age of the patient: “beautiful” lips are not “young” and “perfect” lips but lips which have been enhanced and improved, always respecting the basic morphology and the individual physiognomy. Nowadays the evolution of injection techniques, even more targeted, together with the use of two innovative tools, a technologic “pen” and a “dynamic” hyaluronic acid, allows to administer a more precise injection, delicate and, above all, painless.

INJECTION TECHNIQUES

The “natural” aspect of retouched lips depends on the technique; the practitioner has to assure the patient that the result “will not be noticeable” and he has also to calm down the patient who often loses “the overall view”searching for the lost youth… Therefore, my preferred technique is the“multi-punctures technique”which results from the combination of all the available injecting modes, often to use all together: it consists in administering multiple injections of small amounts of hyaluronic acid, often overlapping.

The linear threading technique is fundamental to give firmness and / or volume to the lips, if administered with a parallel needle direction, a few millimetres below the border; if the direction  of the needle is perpendicular to the border (vertical or oblique direction) the projection of the visible mucosa will be increased and / or redefined, and it will improve the plumpness; in order to redefine the lip contour, only if necessary, it is always preferable to use the linear technique, injecting a very little amount of product, exactly in the area between the lip and the mucosa; the fan technique can be used in the upper lip to increase the thickness of the mucosa (where it represents the main part), by inserting the needle into the tubercle of the philtrum column and injecting in a radial manner. A combined technique (parallel and perpendicular together) consists in a sort of a fan-shaped injection with a single entrance point, starting from the labial commissures, going before in the lower lip border, then in the inner lip mucosa and continuing (vertically) in the dermal part of the lower lip without removing the needle. This injection technique allows to get a “corner lift” not only by raising and supporting the commissures, but also reducing the introflextion of the mucosa of the lateral sides of the lips. The micro-bolus injection in the middle part of the lower lip can improve the extroflextion of it, as well as refine the superficial folds, and vertical peri-labial wrinkles. Vertical wrinkles, often difficult to correct only with the filling, can be “attacked” from three sides: first by injecting a little amount of product transversely to wrinkles and being careful not to alter the projection of the upper lip skin, then injecting along the wrinkle starting from the bottom (vermilion) upwards or downwards depending on the preference, and finally injecting a very few amount of hyaluronic acid perpendicularly in the wrinkle.

TECHNOLOGIC PEN

The technologic “pen” is a medical, electronic device, cordless, which does not replace, of course, the hand of the practitioner, but improves the performance, and it is particularly useful in this anatomical region. It is obviously possible to choose the mode (flowmode or drop mode), the speed of the injection and the quantity to inject; the device controls, with constant flow, the extrusion of hyaluronic acid, avoiding to apply the pressure that the practitioner should necessarily exert on the plunger of a traditional syringe. The injection becomes more delicate and more “tolerable” to the patient. For the treatment of the lips, the use of the “pen” is advisable, in general, at the slowest speed, in flow mode, injecting into the submucosa a minimum amount of hyaluronic acid, possibly using a nanoneedle: it is thus possible to inject, in safety, by means of all of the above mentioned techniques and, despite the quantity of injections, with minimum traumatism.

“DYNAMIC” HYALURONIC ACID

The “dynamic” hyaluronic acid is particularly suitable for the labial mucosa because it is a “resilient hyaluronic acid” that preserves the natural viscoelastic properties of natural hyaluronic acid; an exclusive crosslinking method preserves the long chains of hyaluronic acid in a dynamic structure and reduces the amount of BDDE (RHA technology and “Preserved Network” method). Therefore, this filler is particularly suitable for the treatment of the lips but also for vertical peri-labial wrinkles, which most depend on the expressiveness of everyone. In the perioral area, and in the case of vertical wrinkles, it is advisable to use a filler at a concentration of 15 mg / ml (RHA1, in which is also present a part of free hyaluronic acid) or 23 mg / ml (RHA2): the duration of these products will be slightly lower than the”specific” hyaluronic acids, more concentrated and “stronger”, but the aesthetic result may be preferable due to the “dynamic” integration of the product with the tissues. In conclusion, the experience and the aesthetic preferences, in synergy with always new and specific technological tools which increase the patient compliance, permit to achieve an optimal aesthetic result.