How to defend the vermillion border from lip filler migration
Dermal filler migration, predominantly across the vermillion border of the lips, is a common problem that we are seeing highlighted more and more, especially in younger women.
This occurrence highlights the need for better understanding of the 2D and 3D anatomy of the lips, the products that are being used and how they work in the skin, injection technique, and the nuances of the individual patient sat in front of the practitioner. Dr Tim Pearce notes that above all, we are aiming to prevent filler migration, so as aesthetic practitioners we need to understand how all these factors work together.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want reassurance about how you’re treating patients, then step one is to register for the free webinars by Dr Tim
Things to consider when approaching a lip filler treatment
It is important to consider and evaluate some fundamental assumptions about the treatment you are about to perform; then weigh up their importance and impact on the treatment you are about to perform.
- A good filler integrates well within the tissue. This happens almost immediately, thus it does not migrate. If this statement is true, then we can predict what will happen during the treatment.
- Dermal filler is held in place by different tissue compartments. This forms part of your understanding of anatomical structures and those which create boundaries within the tissue
- It does not matter which product you use; the injection technique is the most important factor. Any product will be good in experienced hands. It is valid that anatomic knowledge and technique honing leads to good placement, it is difficult to adequately prove that the product choice doesn’t matter at all.
Defending the vermillion border
The lip anatomy includes the lip body and orbicularis oris muscles which divide the main compartments of the lip. We do not want filler product getting into the hyperdermis or white part of the lip. A beautifully defined vermillion border is an essential aspect of beauty and maintaining the border is what gives you a good result. You are aiming to create definition on the border but without losing it through migration.
To achieve this, you must know how your chosen filler product behaves in the skin, what keeps it in place, and which factors you can change to maximise the end result. Good training always includes theory, practice and reflection so if the product you are using doesn’t behave how you had expected, then you should reflect on what you can do differently next time, whether that is changing your technique or trying another product.
If you are looking to hone your skills, you may wish to consider a lip filler masterclass on advanced techniques for augmentation and restoration.
Is the Russian Lip technique responsible for filler migration in lips?
One hypothesis proposed to account for the rise in cases of filler migration comes from another well-known cosmetic doctor, Dr Steven Harris. He suggests that the Russian Lip technique, which involves injecting downwards into the vermillion border from above, might be a cause of the problem. He suggests that this technique creates holes or tracks through the orbicularis oris muscle during the downwards insertion of the needle into the lip body. These tracks then remain ‘open’ and allow the filler product to seep outwards from their original placement and migrate above the vermillion border during lip movement.
This is an interesting proposition. However, the Russian Lip technique does vary across practitioners. Certainly, it does cross the vermillion border at a 90-degree angle, but the exact needle placement for entry can vary in relation to orbicularis oris and the underlying lip artery. Dr Tim believes that practitioners should be injecting anterior to the muscle and in the superficial part of the red/white border. The entry point, in his opinion, should always be in the pink of the lip and not on the very border between the white and pink.
Could this be a combination of the product choice as well as the technique? The mobility of the filler could be an issue if you are causing a high-pressure area in the lip body, due to increased volume, with a low-pressure area existing above the lip border. If you have created small tracks for the product to travel through and the product is particularly mobile, with slow tissue integration, then this could account for migration. The speed and level of tissue integration, as well as the propensity to migrate, does vary across products, but we simply do not have enough data to compare to prove or disprove this hypothesis. However, we must also consider that massaging the lip after injection does not immediately cause migration, so are there open tracks and are differences in pressure really causing any significant migration?
Within the lip, there is a potential for filler to flow underneath orbicularis oris and rest in the cavity below. However, this is most notably responsible for the beak or duck bill look and more common in patients who have been having multiple treatments over multiple years. Dr Tim believes that this scenario is probably more likely than the product being pushed into the hyperdermis due to a Russian Lip technique, but, like many things in aesthetic medicine, we are lacking a clinical study to determine one way or another.
How to successfully enhance lips without causing lip filler migration?
Dr Tim’s take-home message is that using a good quality product that integrates quickly, stays where you have put it, if injected correctly, will maximise your chances of it staying and not spreading to different areas.
Are you still anxious about delivering cosmetic injectables safely?
If you want to learn more about mastering medical aesthetic treatments and complications, or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2017 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
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