Perfect lips from Teoxane

Olga Antonyuk , dermatologist, cosmetologist, aesthetic medicine specialist, national trainer of Teoxane

Lips have always been a symbol of female sensuality and attractiveness; they are one of the areas of the face that attracts the most attention and makes a significant contribution to the harmony and beauty of the entire image.

According to research by psychologists and neurolinguists, when we look at a motionless human face, our attention is primarily drawn to the eyes and nose. However, as soon as we begin to speak or express emotions, the interlocutor’s attention immediately shifts.

Lips are a socially significant area and perform many functions: communication, expression of emotions, eating, facial decoration, they also emphasize individuality. The lips are primarily a sensitive part of the face, since they contain more receptors than even the fingertips. Women always try to emphasize them with the help of cosmetics to accentuate their attention - a kind of manifestation of femininity. Since ancient times, lips have been a symbol of femininity, and the first memories of lipstick have a 5-thousand-year history and were discovered in the Sumerian civilization.

From a marketing and commercial point of view, the global trend today is 46% of patients who are interested in fillers and come for lip correction. The growth in demand over the years has embraced entire generations of women seeking to express their individuality and excellence.

It’s no secret that naturalness and naturalness have recently become the TOP trends of our time. But what do women really want?

Let’s take a closer look at what requests patients most often turn to specialists for. Usually these are very thin or flat lips, asymmetrical or with an unclear contour, surrounded by wrinkles or with defects. When examining a patient, a doctor - a qualified specialist with a higher medical education, perfect knowledge of anatomy, injection techniques and the properties of the products he uses - chooses the method that is most suitable for his patient. And this could be:

• contour correction or revitalization;
• elimination of facial tension with botulinum toxin;
• volumetric correction, or lip augmentation;
• smoothing the relief, wrinkles, creases of the perioral complex as a whole;
• strengthening of anatomical structures (elimination of defects).

Most younger patients prefer fuller lips, while older patients want to restore lost volume and their natural, youthful lip shape. Because needs vary widely from patient to patient, I adapt my anatomical knowledge and injection technique skills to select specific correction techniques for any individual patient.

The rapid evolution of fillers based on hyaluronic acid opens up enormous opportunities for connoisseurs of aesthetic medicine and beauty industry specialists. The use of drugs lacking dynamic properties, due to the increasing demand for natural correction, is gradually being replaced by the use of more adaptive materials, such as dynamic fillers.

If we talk about lips from the point of view of anatomy and physiology, first of all it should be noted that this is a very mobile area of the face. The main muscle that forms the lips, the orbicularis oris, is in contact with 18 more facial muscles that help realize the multifaceted functions of the lips. Thus, we can say that lips never remain static, on the contrary, they are always in motion.

Macroscopically and anatomically, the lips consist of the following structures (Fig. 1): nasolabial folds, philtrum columns, philtrum, Cupid's arch, white border, superior vermillion, inferior vermillion, lateral commissures, labiomental sulcus. The size, shape and relationship of these elements are exclusively individual and form originality and individuality. However, there are certain ethnic characteristics that are genetically inherent for each of the human races and are determined by characteristic parameters. For example, Ukrainian women are characterized by typical Caucasian lips: a clearly defined contour, a clearly defined Cupid's arch and labial profile, a pronounced projection of the lips and the shape of the columns of the philtrum. The ratio of the thickness of the upper and lower lips approaches 1:1.6 (Fig. 2).

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1 - nasolabial folds; 2—filtrum columns; 3 - filtrum; 4 - Cupid's arch; 5 - white border; 6 - upper vermillion; 7 - lower vermillion; 8 - lateral commissures; 9 - labiomental groove

Signs of “ideal” lips according to Farkas and Klein:

• symmetry;
• clear outline;
• preservation of bends;
• ratio of lower to upper lip sizes = 1.6;
• distance from the red border of the upper lip to the septum of the nose = 18-20 mm;
• distance from the red border of the lower lip to the chin = 36-40 cm.

Anatomically, the lips are not similar to any other area of the face, having their own unique structure, a special dense network of arteries and veins, innervation features, etc. Accordingly, the specialist must have an aesthetic taste in tune with the patient, thorough anatomical knowledge, polished with various injection techniques and aesthetic seeing the face of a specific patient.

The main task for such a professional in aesthetic correction of lips is the choice of the correct injection technique and the correctly selected drug. What does it mean? The correct technique is the one that will ensure the desired result is obtained in a safe way without the risk of complications. And the right filler in this case will be the one that will be of the highest quality, safest and will be able to adapt to facial movements and will always look natural.

Unfortunately, lips are also subject to age-related changes. After 30 years, you can notice the first signs of aging: blurred contour, decreased fullness of the lips, flattening of the columns of the philtrum (Fig. 3). Over the years, these changes progress, resulting in the formation of purse-string wrinkles and visual thinning of the red border of the lips due to their inversion.

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Age-related changes in lips

The aging process is manifested in thinning of the muscles, atrophy of subcutaneous fat, dento-alveolar loss, ligamentous laxity and increased laxity of the perioral skin.

Today, there are many techniques for lip correction, which often change depending on popular Hollywood stars, Instagram trends and following fashion trends. Fortunately, recently the trend towards naturalness and individuality has become increasingly stronger. More and more often we are talking about personalizing lip contouring procedures and determining the unique ID of each lip.

The lip augmentation techniques that are most common today are fan, linear, bolus and Parisian (Fig. 4).

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Lip augmentation techniques

Techniques for working with a needle make it possible to create a contour, volume (linearly retrograde, bolus), correct the columns of the philtrum, correct the “pouch”, correct the labiomarginal wrinkles, and raise the corners of the mouth.

However, among various techniques for beauty and lip rejuvenation, I give preference to anterograde filler injection, since this technique allows you to achieve the desired result with a small amount of the drug, is not traumatic and most closely matches the correction result that patients mainly request. In Fig. 5—determining the vermillion boundary with a needle using the anteroretrograde technique.

Fig.5.

Determination of the vermillion border with a needle in the anteroretrograde technique

Main characteristics of this technique:

• safe technique - very low risk of intra-arterial filler injection;
• filler injection is carried out by advancing the needle;
• RHA 2 / RHA 3 / Kiss - filler flow in front of the needle.

The cannula is mainly used to create volume while maintaining the contour of the lips, correction of lip-marginal wrinkles, correction of the corners of the mouth, and safe work especially with low-viscosity drugs.

When evaluating methods for correcting highly dynamic perioral areas, in addition to technique and the correct level of injection, in my opinion, the key is also the selection of dermal fillers that can accompany and support the natural movements of the lips, which is fundamental to achieving natural-looking results. For this reason, I prefer dermal fillers from the Teoxane LipUnique collection, which provides a complete set of tools to meet the patient’s needs and high-quality aesthetic results. Thanks to the balance between stretchability and volumizing properties among Teoxane fillers, I can choose the most suitable product for any indication in the perioral, highly facially active area of the face. For example, the very high extensibility of RHA®1 can be used to fill fine, active perioral wrinkles, such as purse-string lines. To achieve a natural lip eversion, low volume and hydration RHA®2, which allows for easy placement and shaping of the filler into the lip mucosa.

Teoxane's unique retained chain technology allows for flexible and dynamic gels that resemble natural HA. This is ensured by the preservation of long HA chains, the preservation of natural and mobile interactions between long HA chains, when a small amount of BDDE is required for cross-linking and a low degree of MoD modification (~1.9-4.0%) (Fig. 6).

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It is very important that all Teoxane injection products have officially received the UniCert quality certificate. The doctor uses a certified effective premium product in his work. The patient feels absolute confidence and a sense of security because these products are safe and have passed all the necessary clinical trials. ⠀

It should be remembered that the drug must have a long-term effect corresponding to the density and injection technique, and this is an advantageous feature of fillers in the premium segment.

The wrong choice of drug for correction can subsequently lead to the appearance of lumps, nodes, overcorrection, contouring of the filler, its migration and other undesirable effects, simply an unaesthetic result.

And, of course, we must not forget about the comfort of the procedure itself. During the injection, the patient should not experience pain, at least slight discomfort, and the presence of the correct form of lidocaine in the drug formula contributes greatly to this. Actually, just like after an injection, the filler should not be felt in the tissues, when talking, smiling or touching the lips.

My mandatory checklist before correction:

• discuss the patient’s wishes and expectations;
• tell him about the sequence of actions during injection;
• inform about the composition of fillers and the drug used;
• discuss the long-term effect;
• choose the appropriate anesthesia;
• inform about possible side effects;
• discuss rehabilitation time and cost of the procedure.
• And here it is, the expected result...

Thanks to the correctly chosen rheology and technique of drug administration, even within one procedure we get a visible and natural result that is harmoniously visible both in the static and in the dynamics of the face and lasts for a long time (photo 7-16).

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Photo 7-12.

Lip augmentation with Teosyal RHA Kiss, 0.7 ml, linear anteroretrograde technique, gel 30 G 1/2 13 mm

Photo 13-16

Anterograde technique for administering RHA2, 1 ml, 30G 12 mm needle

First published: PRO Cosmetology by Cosmetologist, No. 2, 2020