Occasionally, we are fortunate to have a moment of inspiration that changes the way we view a problem that we are facing. For me, this moment happened at the intersection of third grade engineering and lip filler. I have been injecting dermal fillers for eight years and, like most of you, my first passion was injecting lips with dermal fillers. I eagerly soaked up any mention of better ways to create the perfect lip. I would pore over photos that other injectors posted and try to understand how they accomplished their results. I tracked down the source behind every mention of new, innovative lip filler techniques. I even paid serious money to watch some of the world’s best injectors inject and would hound them for clues on how to become a better injector. The more I researched, the more I became stumped. I kept recognizing a certain pattern in the shape of lips that for the life of me I could not figure out how to correct.
I want you to take a moment and analyze the lips in Figure 1. When I have taught this live some of the first things people note are:
- She has asymmetry left to right with her left more pronounced
- Her Glogau-Klein (GK) point is more crisp on the left
- She has volume loss with evident wrinkling in the top lip
- Her bottom lip is larger on her left
- She has large lower lip tubercles, large top lateral tubercles and a small top central one
- The oral commissure on the right is more downturned
These are all perfectly true observations and things that we need to be aware of when we are injecting lips with dermal filler. But the thing that jumps out to me is what the lip does just medial to the oral commissure, which is most prominent in this case on her right side. The lip starts to buckle over itself as we approach the oral commissure. This tends to happen more significantly on one side and with classic lip filler injection techniques we often end up exacerbating the problem.
Lips are a highly mobile structure that gain their shape and volume from the orbicularis orismuscle. Also known as the musculus orbicularis oris, the orbicularis oris muscle is a complex, multi-layered muscle that attaches to the dermis of the upper and lower lip through a thin, superficial musculoaponeurotic system. It also serves as an attachment site for many other facial muscles around the oral region. One of its functions is to act as a sphincter around the mouth.
Using a soft hyaluronic acid (HA) dermal filler, the end goal is to straighten a curved muscular structure that has additional vector forces acting on it (Figure 2). There are two clinical pearls that can be drawn from the anatomy to help you achieve this. First, we are trying to create a straight line within a curved structure. One of the common goals of lip filler injections is to create a straight line at the wet to dry border at both rest and with animation. Second, there are many competing muscular forces in the lip tissue. My general philosophy is that muscles are always going to win in a battle of force against HA dermal fillers.
I was able to find the solution for my lip filler dilemma when observing my son’s school project where the goal was to make a bridge structure and to see which design from each classmate can hold the most weight.
I took this concept back to my practice and with a patient’s approval, I was able to put it to the test. We found this theory actually worked very well in practice. The reasons why are actually pretty simple and have been known in structural engineering and architecture for centuries.
This is a sample article from The Aesthetic Guide.#Injectables#Innovation-Aesthetics3.0
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