The new age lip fillers

T he virtual discussion on ‘Lip Fillers’ in the Let’s Talk Series began with a nod to Dr Apratim Goel’s expertise and experience with lip fillers, having injected over 1000 patients over the last two decades. “The one thing that would wake me up in the middle of the night would be a lip filler; not tear trough, not under eye but lip filler!”

Dr Akanksha Singh Cornuit led the discussion by asking Dr Goel what is it about lip fillers that she finds so interesting. ”What excites me about lip fillers is that firstly I have started my journey of fillers with lip fillers; and secondly it is the one area that has given me no complications. The cost to the patient is very less and the satisfaction index is so high.”

Dr Cornuit veered towards social media trends of Russian lips and devil lips, to which Dr Goel added, “I see a change in the product. I also see a change in our injection techniques and I also see a change in consumers. Back in the day, there was one Restylane. I remember in 2004-5, I injected one filler for everything. Today, Galderma has given Lyft for chin advancement as well as Defyne, Volyme and Kysse. We can now give accurate designed results and talking to patients is becoming easier as well.”

Dr Goel drew comparisons between when she started using fillers in 2004-05 and the present:

• Earlier anaesthesia had to be injected in the vestibular block to numb the lips. Now, we just put a topical anaesthetic.

• Iused to practise the technique that you have a single point, and I would use a long needle, not the cannula. I would make one entry and then slide along and use a typical fanning technique, changing the planes and fanning both. Some people would swell up more than others, but I have not encountered a hematoma per se.

• Since the focus became more on the central lip and nobody wanted just volumisation of lips, it was more about the cupid’s bow philtrum. So, we had to go into multiple fanning. I use the smaller needle that you get along with the filler. I still don’t inject the cupid’s bow but now we use multiple techniques.

• Initially when I saw Russian lips on Instagram, I dismissed it as a marketing gimmick. However I realised that making vertical pillars in the lip also reduces any vascular complications. In the bolus technique, I use a lot in the lower lip, not in the upper lip, when the lower is much thinner. So, that is how the technique has evolved.

Highlights

“I’ve had a lot of males and transgenders. But primarily I have females of the age group between 20 to 35. These days they’re inspired by Instagram, for example the Game of Thrones -Khaleesi lips. The older lips literally suck the filler. Whatever quantity I tell them, I end up using more. I like injecting younger lips. The motivation is high. They are willing to take the downtime, which I don’t see so much in the elderly.

“The second thing is regarding the type of fillers, for instance Kysse is designed for the lips. But having injected lips for literally over two decades, I am a bit unconventional with the volume. I like to use Restylane Classic on the lips - it’s very soft, works for any age group, and the movement is very easy.”

“I find it very difficult to correct traumatic scars and cleft lips with fillers. When we try to, it goes into the lesser resistance area and I’m not happy doing fillers for post-surgical scars, too.”

“I’m a very conservative injector, though filler is my favourite, I don’t go crazy about the volume injected. I’ve never injected more than 2 ml, and not in one go. I opt for .05 or .75 or 1 ml max.”

“A needle is more precise, helps me give definition and volume. I’ve never tried cannula, but I have seen people use it. Lip filling is an art. For me, it is always needles when it comes to lips.”

Dr Cornuit and Dr Goel then engaged in an interesting discussion over case studies, ranging from asymmetrical lips and trauma to volumising thin lips and downward smile.

Dr Goel expounded, “Major concerns while injecting are the muscle and the artery. If you were to hit a nerve, at the most there will be little numbness, tingling, or pain or discomfort, which will go away. My main concern is what are the vascular structures in that area?

In the injection of lips, we have orbicularis oris, the muscle. One possibility is that you will inject in front of the muscle - superficial injections - which we usually do. The other is that you could go behind the muscle and inject. It will also depend on the material, which we are injecting. Sometimes you can see the line, the filler. Even if you have threaded it, you can see the thread. Is that okay? It depends on the filler. If you’re putting a Kysse or boluses, it’s perfectly okay, because the filler will behave the way it’s supposed to, when it is put in the tissue.

When a patient says my lip is inverting when I smile, I try to go behind the muscles. But when it is just the aesthetics of the lip, like a volume, I stay in front. In all my Russian techniques, I stay superficial. But when I put a bolus, I go behind. Sometimes you run a risk that the product could be felt by the patient.”

Throughout the discussion, the one aspect of lip fillers that emerged quite clearly was the fact that the type of fillers and the technique used has to be in tandem with what the patient wants. It is important for the practitioner to be transparent with the patient on how much is achievable with lip fillers and have realistic goals.