Injection skills you need to create beautiful lips

Dr Tim Pearce

July 28, 2022

Have you ever really thought about the skills you need as an aesthetic medical injector to create beautiful lips? Is it all about technique?

In this blog, Dr Tim Pearce will strip back how you can get great results with lip filler treatments that produce low amounts of swelling, bruising, and other side effects, including reducing the risk of vascular occlusion, but the answers might not be what you might think. He explores the analogue skills you require including precision, patience, and awareness when you are injecting that all contribute towards achieving the best results for your patients with minimal risks and increased safety.

Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>

Is lip augmentation with fillers all about technique?

Dr Tim believes that there is an over emphasis on the things we can measure when it comes to injection technique and skill – Do you use needle or cannula? Do you aspirate or not? – with less focus on the things that are harder to quantify. As well as the black and white answers to the previous questions, there are a litany of other skills that you can develop and hone to make you a better injector – Dr Tim calls these the analogue skills.

Analogue skills play a vital role in the safety of an injector, reducing side effects and improving aesthetic results, but often little attention is paid to their development.

It was watching a novice aesthetic clinician during a training session at the SkinViva Training Academy that Dr Tim first noticed a lack of analogue skills. The delegate was using a cannula for the first time and used a large, green needle to make the entry hole, snagging the skin and creating an additional cut as they exited. They then proceeded to push the cannula into the tissue in a rough manner. Needless to say, the patient was unhappy, and the process was far from gentle.

This highlights that most injectors can USE a cannula, but you begin to realise that there are many ways to do so, the level of pressure you exert and how you move it are analogue skills. Such a skill, that comes down to the level of patience that an individual employs whilst trying to navigate a neat path through the tissue with their cannula, are almost impossible to measure. Your gentleness, your patience, and how aware you are of the depth and resistance on your instrument as you inject are all core skills. Over the course of a career, they will play a role in determining how much trauma you cause, alongside associated side effects and complications.

A similar set of analogue principles apply when you are using a needle – How aware are you of the depth of your injection? Are you performing checks? Are you gently finding your way to the right place? Do you observe the filler as it comes out of the needle and causes a small raise in the tissue, or are you too busy looking at the measurements on the other side of the syringe?

How to become an expert lip injector

What is happening in the mind of a seasoned injector versus that of a new injector differs based on the level of processing of inputs and outputs at the same time – observing and reacting.

For example, if you are treating the lip, are you observing how easy is it for the needle to pass into the lip? Does it tether or snag as it is going in? Is your needle dull or is your angle of entry the problem? How aware are you of the different stages of the injection? In other words, if you slide just the first two millimetres of the needle in and then change angle and slide the rest in, you end up with a needle that is parallel with the surface of the lip, which is often exactly where you want it to be. Injectors who do not pay attention to this may be deeper at the needle tip than they are at the entry point.

Think about how in tune you are with the resistance of the injection. Are you aware when you are injecting that you are in connective tissue that is resisting your injection, or do you just inject without noticing?

A good illustration would be the vermilion border; if you are going to inject the vermilion border and you enter exactly on the edge where the muscle is inserted into the surface of the skin, that is an area that is particularly high in connective tissue, thus, when you inject, it hurts the patient more and sometimes you get some blanching. Plus, it is also exactly where the filler may spill into the white part of the lip and cause migration. If you move the injection point just a millimetre into the pink vermilion, right up against the insertion point of orbicularis oris, it is a much easier place to inject. It is also aesthetically better because you are elevating the pink part of the lip right up against the white and not projecting the white lip forward which is not what we want to do, and it lowers your risk of migration.

Dr Tim notes that this tactile feedback is understood by an experienced injector, such that even with his closed (not that he would!), Dr Tim believes that he could probably tell if he was in the wrong place, simply because of the attention that his brain has learned over the years to give to these analogue factors – resistance, ease of injection etc.

Mastering analogue skills to become a better aesthetic injector

There are many analogue factors, and this is not something that you learn overnight – there is a world of difference between an experienced injector and a novice – with experience, your injection process become richer, and you make more nuanced decisions as you inject.

So, how do you reach this nirvana and become a lip filler expert? Dr Tim’s advice is to slow everything down – put yourself in the moment and absorb as much information as you can about every tiny stage of the process. Shut yourself off from the rest of the world and focus on the procedure, every millimetre movement of the needle, the path you are taking, the underlying anatomical features, how it feels, your injection speed, how you aspirate etc.

The type of injector or clinician who devotes a large amount of mental energy into thinking about every miniscule step of the procedure is almost certainly going to be safer than those who are quite coarse, thoughtless, and are simply delivering procedures, whether they perform prescribed safety steps, or not. Lose yourself in the moment, absorb information – we are not just doing, but observing and thinking whilst doing at the same time.

You can find Dr Tim Pearce on Instagram if you have a question that you want him to answer on running an aesthetic practice.

Lip Filler Treatment & Complications

With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.

If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.

→ 8D LIP DESIGN COURSE 

Aesthetics Mastery Show

For more insight, watch the Aesthetics Mastery Show, where Dr Tim considers the skills you need as an injector to create medically beautiful lips, explaining how analogue skills such as precision, patience and awareness all contribute to achieving the best results with minimal risk for your patients.

Is your worst nightmare causing a VO?

If you want to be a great injector then you need to get over your fear of complications. Register here for the next webinar to help you overcome your complications anxiety >>

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Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 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.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.