August 8, 2022

lip filler injections training

Lip tenting is a popular, but controversial technique. Viral images of shocking, bloody, so-called Russian Lip procedures have made the technique famous, catching the attention of both aesthetic clinicians and the public, but possibly unfairly so as there are ways of doing this procedure without causing unnecessary trauma from repeated vertical injections.

In this blog, Dr Tim Pearce will share some expert tips on the many versions of the lip tenting technique, including variations on needle entry and filler deposition as a bolus, linear thread or a combination. He will analysis how the technique works – looking at the interaction between the anatomy and the technique and uncover how you can get the best result possible with minimal amounts of trauma.

Shh…Dr Tim will soon be revealing a very exciting new ‘ultimate’ lip course that will cover EVERYTHING you need to know about injecting the lips. Sign up >> to be the first to know when it goes live!

What is the lip tenting injection technique?

lip filler injuryThe term ‘lip tenting’ refers to a style of lip augmentation with dermal fillers that relies on vertically entering the lip from above or below at right angles to the vermillion border.

There are several subtle but important variations on this technique, however, the controversy that it garners is mainly around the possible trauma to the superior and inferior labial arteries. Similarly, there is much discussion around how many injections are required – the Russian Lip technique, for example, can involve upwards of forty repeated vertical penetrations of the lip to place linear threads of filler – but surely there must be a simpler, less traumatic treatment that can achieve the same result?

Whilst researching this technique, Dr Tim discovered that there are up to nine different variations of the lip tenting technique. The biggest difference centres around the entry point of the needle – some clinicians choose to enter the white lip, at the white-pink border, just as it meets the pink, some enter the white lip higher up, approximately 3-4mms from the vermilion border, and some enter the pink lip.

labial artery lip tentingYou can see, based on the position of the labial artery in this cross-section illustration that entering higher up in the white part of the dermis is going to be closer to the likely position of the superior labial artery, thus increasing the chance of causing trauma to the vessel.

The labial artery sits beneath the orbicularis oris muscle therefore the angle of needle entry also plays a crucial role in this technique. It is possible to enter the white dermis, at an angle of approximately 30º, to skirt over the top of the artery and then into the lip, but if you enter too steeply, you will go straight through the accepted position the labial artery.

What is the rationale behind lip tenting

The main differentiating factor with the the lip tenting technique is that it is supposed to rotate the lip upwards and outwards more efficiently than other lip augmentation injection techniques. The concept is comparable to superficial injections in other, more common lip injection techniques in that if you are placing filler in the superficial part of the lip – as you run the needle out of the skin, it should exert an upward force and rotate the lip outwards.

If the technique is used with a bolus, when treating small lips, for example, you will be placing filler on the posterior aspect of the lip which may aid external rotation, as does a bolus placed on the anterior lip wall. Running filler from the needle in a retrograde linear thread as you withdraw will also be increasing the stress over the anterior wall of the lip and therefore aiding external rotation and eversion of the lip; this can be used on larger lips, in isolation or in combination with bolus deposition. Filler placed in the vermilion border, at the last point before exiting the skin, may also improve vermillion border definition.

lip tenting diagram

How can I minimise trauma with a lip tenting technique?

How can we reap the benefits of lip tenting but with the least amount of trauma? There are three aspects to consider when it comes to avoiding injury to the superior labial artery – the angle of entry, the position of entry, and the frequency of entry of your needle.

As mentioned previously, an angle of roughly 30゚should skirt over the top of orbicularis oris and the superior labial artery avoiding trauma. With a primary aim of depositing filler in the posterior side of the lip to project it outwards, there is no need for multiple injections because you will see, as you inject, that the product spreads along the potential space in the body of the lip. You may find that that the middle two-thirds of the lip – which should be the fullest – can achieve all the volume required through approximately four injection entry points, reducing unnecessary trauma.

Injecting the lower lip is the same concept but the anatomy is slightly different; the vermillion border on the lower lip tends to be much stronger and the angles are more acute, therefore, entering the lower lip via the white tissue is much more likely to transition directly through the path of the inferior labial artery.

A better approach is to enter the pink lip and change position to curve around the lip surface as you slide the needle in; you can then deposit filler in the same way as in the top lip, into the tissue just beneath the lip wall. The lower lip tubercles should be enhanced, and the lateral aspect respected, tapering off slowly so the bulk of the product goes into the lower lip tubercles. Post procedure massage and using good quality dermal filler brands are essential for avoiding lumps.

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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.



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.

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