ATA Faculty Dr Paula Mann BDS.MFDS.MFGDP recently featured in Clinical Dentistry discussing ‘My Lip Treatment Evolution – Considering Injection Planes’.
Merz Innovation partner Dr Paula Mann discusses why your choice of dermal filler and the anatomical injection plane are essential when planning treatment for lip restoration and rejuvenation.
When I started in aesthetic medicine, I had only one dermal filler available for all my lip treatments. I used this to treat the lip and perioral area in patients of all ages. However, regardless of how good my diagnosis, planning and technique was, the result was sometimes disappointing.
At times I felt the lips looked a little unnatural, with over eversion at the vermillion border where the product could migrate from the point I injected it into. And so, I set myself a task to achieve better results.
This is a topic I discuss with a lot of aesthetic injectors. What is limiting our ability to achieve the best result when it comes to lips?
To understand this, we must appreciate many factors; the science and rheology of our dermal filler, the anatomy of the lip itself, and our patients’ concerns.
I have lost count of the number of patients who ask for a lip treatment and quickly voice anxiety that it should not look fake or obvious. In most cases, my patients of all ages want a natural enhancement or restoration without any obvious tell-tale signs. I was introduced to the BELOTERO® range of dermal fillers around eight years ago, and it completely revolutionised the results I can achieve. I like the range for three different reasions:
- The science behind these products. BELOTERO®’s unique CPM® technology makes it unlike any other dermal filler. BELOTERO® has a second phase of cross-linking, creating areas of high density and low density. (1) This allows smooth integration into the tissues (2) at a histological level, translating into natural-looking results (3) that you and the patient can appreciate.
- BELOTERO® has demonstrated a lower risk of inflammatory response than other dermal fillers* (4), so I feel confident in its use.
- The availability of a range of fillers with a tailored rheology(1) to suit the anatomical tissue plane into which it is designed to be injected.
I love the challenge of creating the best lip for my patients. To respect their facial anatomy, I need different dermal fillers to meet the dermands. I have at my disposal a duo of two lip dermal fillers with different rheological properties best suited to their indicated injection planes.
BELOTERO® Lips Shape (5) is used to restore or enhance the lip volume and commisures in the submucosal plane.
BELOTERO® Lips Contour (6) is used in the superficial or mid dermis for lip contour, definition, correction of fine lines and mild commisures. The syringes are 0.6ml and can be used individually if wished. Our younger patients want sharpness and definition of the vermilion border and cupids bow, lift of mild commisures, along with an aesthetically desirable increased volume. Patients who are noticing ageing changing seek to restore the structure of the vermillion border, reduce fine vertical perioral lines, lift sad downturned commisures and replace lost volume. In each case, we must remember that the superficial fat compartment of the white lip, the vermillion boredr and the red lip are continuous.
This means there is potential for migration of dermal filler within this plane. We must use an elastic, cohesive product (7) (BELOTERO® Lips Shape) submucosally in the vermillion (body) of the lip only. While my preference is a 25G cannula to treat the body of the lips, a 27G needle can also be used. A second, very cohesive product, BELOTERO® Lips Contour, should be used to define the vermilion border. It is injected intradermally using a 30G needle. This will help avoid migration into the white lip distorting the natural contours and texture. Taking advantage of the CPM® technology of BELOTERO® means there is low risk of device/filler migration and there has been no reported Tyndall effect for BELOTERO® meaning we can place BELOTERO® Lips Contour in the superficial dermis of the perioral region to soften fine perioral lines (13).
My patients are consistently delighted with this treatment. They report how well the product settles and feels natural. It is a huge confidence boost for some to be able to wear lipstick again without it bleeding over a weak vermillion border and for fine lines to be airbrushed away, leaving a smoother perioral appearance.
This duo of lip fillers is generally sufficient to create an optimal corrective or aesthetic result. However, I can take advantage of the availability of these products in 1ml syringes if I wish either more volumisation or correction. BELOTERO® Lips Shape is known as BELOTERO® Intense (8), and BELOTERO® Lips Contour is BELOTERO® Balance (9). An extensive, versatile armamentarium to create a tailored treatment plan. By appreciating the science, anatomical plane and lip complex changes, we can choose the most suitable product for the treatment indication. The unique way in which BELOTERO® Lips Shape and Contour are created will allow you to product exceptional results.
My lip treatments have evolved over the years into highly satisgying treatments for myself and my patients. The BELOTERO® range means I am never disappointed with my results.
1. Micheels P et al. Two Crosslinking Technologies for Superficial Reticular Dermis Injection. A Comparative Ultrasound and Histologic study; J Clin Aestheti Dermatol 2017; 10(1) 29-36.
2. Micheels, P. et al. Effect of Different Crosslinking Technologies on Hyaluronic Acid Behavior: A Visual and Microscopic Study of Seven Hyaluronic Acid Gels. J Drugs Dermatol. 2016 May 1;15 (5):600-6.
3. Fischer TC et, al. Hyalron Filler Containing Lidocaine on a CPM Basis for Lip Augmentation: Reports from Practical Experience. Facial Plast Surg. 2016 Jun; 32(3):283-8.
4. .A. Z. Taufig et al. Journal für Ästhetische Chirurgie 2009•2 : 29-36.
5. BELOTERO® Lips Shape lido IFU 2020
6. BELOTERO® Lips Contour lido IFU 2020.
7. Sundaram H et al. Cohesive Polydensified Matrix Hyaluronic Acid for Fine Lines. PRS Journal. 136:149S, 2015.
8. BELOTERO® Intense lido IFU 2020.
9. BELOTERO® Balance lido IFU 2020.
10. Sarnoff DS, Gotkin RH. Six steps to the ‘perfect” lip. J Drugs Dermatol. 2021.
11. Trookman Nathan S., et al. Clinical Assessment of a Combination Lip to Restore Moisturization and Fullness. J Clin Aesthet Dermatol. 2009 Dec; 2 (12): 44-48.
12. Wollina U. Perioral Rejuvenation: restoration of attractiveness in ageing females by minimally invasive procedures. Clin Intervv Aging. 2013; 8: 1149-1155.
13. Prasetyo 2016 – Hyaluronic acid fillers with cohesive polydensified matrix for soft-tissue augmentation.