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Author: Yana Goncharova – Candidate of Medical Sciences, Associate Professor of the Department of Dermatovenereology and Cosmetology of the Donetsk National Medical University, Director of the Clinic of Aesthetic Medicine “Lege Artis” (Ukraine, Donetsk).<hr /> Modern possibilities of cosmetology and aesthetic medicine make it possible not only to effectively correct the color, contour, shape, size and volume of the lips, but also to eliminate signs of skin aging (wrinkles and loss of volume) in the perioral area, and to level out congenital asymmetry and post-traumatic defects. The goals of such a correction can be different - from rejuvenation to giving the lips a “fashionable” shape. Correction methods, accordingly, are determined by the assigned tasks. In this case, additional factors cannot be ignored, such as the state of the dental system, the patient’s age, etc. One of the most common methods of lip and perioral correction is the use of hyaluronic acid as a filler. Recently, the technique of lip contouring with hyaluronic acid has significantly replaced the use of permanent fillers, which can be explained, on the one hand, by the high risk of complications resulting from the use of the latter, and on the other hand, by the emergence of new technologies that can significantly delay the resorption of hyaluronic acid. Hyaluronic acid gels from major manufacturing laboratories fully meet the requirements for injectable implants for lip augmentation and lip correction. They are easy to introduce, evenly distributed in tissues, do not contour, do not migrate and provide a very natural effect. Hyaluronic acid practically does not cause allergic reactions and undergoes complete degradation. Age preferences Working with hyaluronic acid in the area of the red border of the lips involves a combination of two methods: contour correction and volume increase. Options for combining these methods depend on specific conditions and indications. The task of increasing lip volume is set primarily by young patients (under 30 years old). In this category of clients, there is no need to talk about signs of age-related changes in the red border of the lips, namely pallor, dryness, wrinkling, decreased volume and lengthening of the lips. We are mainly talking about increasing the volume of initially beautiful lips in order to make them more full and sexy. Such a desire is a tribute to fashion, and it is dictated by the standards of beauty offered by the mass media today. To be fair, it should be noted that modern standards differ from those proposed by fashion magazines at the beginning or even the middle of the last century. Patients in this category are often ultimately dissatisfied with the result and disappointed by the short duration of the effect. Another category is young girls with initially too thin or disproportionate lips. In most cases, correcting such defects is a rewarding job, although it often requires repeated correction and great professionalism. Statistics show that the most popular lip correction is the correction of age-related changes observed in patients 41–55 years old. According to the classification of E. I. Gubanova and co-authors (2006), people in this age group exhibit moderate changes, characterized by the presence of single superficial wrinkles of the upper lip, moderate or pale coloration of the red border, slight drooping of the corners of the mouth, flattening of the lip contour, smoothing of the “arch” Cupid&quot;, a decrease in the volume of the upper lip. Correction in this case is largely preventive and gives excellent results. The lips look very natural and give a more youthful appearance to the entire face. Lip contouring in women over 55 years of age requires an integrated approach, often including prosthetics or dentition correction. Limiting yourself to just correcting the red border will most likely lead to disappointment and will not solve the problem. Features of correction In most cases, the contouring procedure begins with contour correction. For this purpose, a linear insertion technique is used along the border of the white roller. Correcting the contour allows you to make it clearer, smooth out adjacent “purse-string” wrinkles and slightly increase the volume of the lips. However, in order to correct the shape of the lips, increase their size and correct involutional changes, additional administration of the drug is necessary. For volumetric lip surgery, it is preferable to use high-viscosity drugs (Restylane Lipp, Surgilips, etc.). In this case, the volume of the drug injected into symmetrical areas should be the same. Unfortunately, with lip asymmetry, it is not always possible to completely correct the defect with additional volume. Correcting the volume of initially small lips requires about 1 ml of hyaluronic acid gel, large lips - 2-3 ml. On average, it is recommended to administer 1.5–2 ml of gel at a time. After completion of the procedure, if the gel lays down evenly, massage is undesirable, as it can lead to increased hematomas. Cold is applied to the lips. Any manipulation in the lip area is accompanied by immediate swelling, which lasts up to 3 days. It is important to warn the patient about this, since the appearance of the lips immediately after the procedure and after 3 days will be different. The so-called “blowing effect” is observed - a decrease in lip volume observed immediately after the procedure by 25%. And finally, the lips are very sensitive to pain, so the procedure is recommended to be performed under general anesthesia with 2% lidocaine or ultracaine. It should be remembered that due to anesthesia, the lips may slightly change their configuration, so photographic documentation and agreement on the filling method are carried out before anesthesia. A technically correct procedure, combined with the patient being informed about the result and its duration, allows one to avoid the effect of overexpectation and is the key to the fact that the patient will return to you more than once, and each time will be satisfied with the result obtained.<hr /> Source: KOSMETIK international journal, No. 4(38), 2009, pp. 64-66

Lip contouring. Modern approaches