What is hot in aesthetic medicine?
Since many celebrities have confessed that their youthful lips and perfect pout are due to ‘fillers’, this cosmetic procedure is in big demand from the general public. The treatment attracts regular headlines on the front pages of magazines and online publications.
In my clinic, we receive enquiries nearly every day about lip fillers – mainly young girls interested in adding volume to their already beautiful, youthful lips. Some are not happy with the shape, whereas others just want their lips to look bigger. The middle age and older generation are more considered when thinking about their lips. They want their lips to be very natural and minimal, to improve the lip border and prevent lipstick bleed. For younger people, getting noticed is important.
Dentists are perfectly positioned to compete in facial aesthetics. Dentists deal with this area every day. Lip and smile lines play a major role in smile design. Lip fillers are a safe, predictable, and very rewarding treatment if used correctly.
If you are not offering lip augmentation in your surgery I have outlined a brief explanation below of how this procedure can help improve your patient’s smile.
Consultation and assessment
It is very important to understand the needs of the person in front of you (de Maio, 2014). A successful outcome depends on careful consultation. With lips, even an initial consultation can be a challenge. Often, patients expect an unrealistic result (especially when some people want lips like celebrities).
For younger people, getting noticed is important
In these situations, especially first time patients, I advise natural enhancement. But with the right training, it is possible to increase the volume and shape of lips dramatically while retaining a natural look over a few treatments.
Communication is important; the lips are a vascular area and most patients should expect to bruise. After the treatment, lips tend to swell, which will take few days to resolve. Therefore, I would not categorise lip fillers as a ‘lunch-hour’ treatment. If a patient has an important event to go to, it is advisable to do the procedure at least one week prior to allow the lips to settle.
Following a detailed clinical history, it is important to fully examine the lips and surrounding anatomical structures. Ask the patient to smile, to blow a kiss, and look carefully at the lips while they are talking. All the time you will be checking for symmetry, skeletal type, teeth position, muscle hyperactivity, smile line, smoker lines, oral commissures and the corners of the mouth, how prominent or flat philtrum columns are, and nasolabial angle.
Injection techniques
There are many different ways to treat lips with dermal fillers; using needle and cannulas, injecting directly and indirectly, using linear threading, bolus and a multiple puncture technique. There is no one right or wrong way. It all depends on what you are trying to achieve, what the original lips look like, and how experienced and confident you are as an injector.
There is one rule that you should never forget, and this is aspirate, aspirate, aspirate. Although lips are relatively safe area to treat, it is always better to be safe than to inject a filler into a vessel, potentially causing necrosis. Limiting the number of injections will reduce the risk of bruising and swelling.
Different approaches and products will be used for lip volumisation and rejuvenation.
Dealing with side effects (de Maio, 2014)
Serious complications are extremely rare. They can occur due to poor injection technique or when there is too much product placed in one treatment. Common side effects include bruising (between five days and two weeks).
Arnica cream can be used after injection to minimise the risk. A small percentage of patients can develop post-treatment swelling. Reassure the patient, advise a cold compress if it is occurring on the same day, and a warm compress the following days. Non-steroidal anti-inflammatory drugs (NSAIDs) and anti-histamines can help too.
Lump formation is rare. Massage can help or, occasionally, hyaluronidase can be used to dissolve the filler.
When used effectively lips fillers are a great way to restore age-related lip atrophy or to improve the appearance of thin lips. Patients are very pleased with the results from this minimal procedure leading to a great sense of fulfilment for both patient and practitioner.
Case 1
- Upper and lower lip augmentation using 1ml of Juvéderm Volift
- Upper lip – cannula was used
- Lower lip – indirect approach was used with needle and bolus technique.
Case 2
- Lips augmentation with 1ml Juvéderm Ultra 3
- Direct treatment with needle
- After photo was taken immediately after treatment.
Case 3
- Lip rejuvenation: treatment of perioral fine lines
- Juvéderm Volift retouch: 0.5ml
- Cannula was used to treat vermilion border
- This patient also had upper face Botox treatment and mid-face rejuvenation with dermal fillers.
References
Vorodyukhina O (2015) Look beyond your patient’s mouth. Dentistry
De Maio M (2014) Selection of patients. In: De Maio, Rzany B. Injectable Fillers in Aesthetic Medicine. Springer-Verlag Berlin Heidelberg
All rights to the photos reserved by Shine Medical. Patients gave full consent for photos to be published.
If you are interested in learning how to deliver lip filler procedures or to build on your current experience, Dr Olha Vorodyukhina regularly runs a master classes on lip augmentation and peri-oral rejuvenation. For more information and booking, contactwww.cosmeticcourses.co.uk or www.shinemedical.co.uk.
Dr Olha Vorodyukhina graduated in dentistry from Ukranian Medical Stomatological Academy in 2005. She qualified with a GDC in March 2013 and continues to practice as a dentist and facial aesthetics practitioner in Nottingham and Leicester. She speaks at national and international events and her non-surgical cosmetic repertoire includes basic and advanced Botox (anti-wrinkle) injections and dermal filler treatments, lip fillers, non-surgical eight-point face lift, skin peels, micro-needling, and CO2 therapy.
