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Dr Tim Pearce
At the recent Inner Circle 2022 event in Switzerland, Dr Tim Pearce sat down to interview Julie Horne RN, co-founder of the Swiss Aesthetics Institute, founder of the Julie Horne Academy, and one of the world’s most well-known and talented lip injectors. She shared her story to success as a world class injector, multi-million-dollar business owner, and nurse – but admitted the 18-year-old her would not believe it!
In this blog, Dr Tim Pearce will find out how Julie approaches ‘tricky’ M-shaped lips, resolves indentations, and avoids lumps without massage when treating lips, explaining why knowing your anatomy is vital to success with lip fillers.
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What is an M-shaped lip?
Julie first explained that in the average lip, there are three tubercles in the upper lip – one in the centre and one on each side – followed by a flatter area towards the oral commissure. In a patient with M-shaped lips, they usually have more volume in their central tubercle and less volume in their lateral tubercles, which means that the upper lip becomes shaped like an M. When they gently close their lips, you will often see that they have two holes, either side, where you can see straight into their teeth because the central tubercle is touching the lower lip.
Some patients do like having an M-shaped lip, according to Julie, but at her clinic she has experienced high demand from patients who would like to correct this anomaly, so made it her mission to find a solution.
To come up with new techniques, we must experiment, she said, with safety always a priority, managing the risks involved, but there is trial, and error when honing the processes. It was a journey towards finding what works, with the help of friends and family who had M-shaped lips, who allowed her to develop the technique. There were mistakes along the way as you learn; it does not happen overnight. Julie now believes she has cracked the code when it comes to the perfect technique for correcting M-shaped lips.
She also explained that collaborating with anatomists to understand the delicate anatomical structures of the lips has helped her to develop and improve her injection techniques. Julie is currently working with anatomists on a lip compartment study – something we should all keep an eye out for in the future.
“The M-shape lip is now my favourite lip to treat”,
enthused Julie during the interview.
She explained that this is not simply because her technique produces very natural and sustainable results, but the gratitude of her patients, and the reward this gives her makes it so worthwhile. Seeing the ‘happy tears’ is amazing and a huge reward that Julie enjoys and is the reason why she loves to inject and treat patients with M-shaped lips.
What is paradoxical indentation?
Dr Tim asked Julie is she could explain what she believes is happening when you inject a lip but is seems to pull inwards – called paradoxical indentation.
There is connective tissue that is attached to the surface of the skin in the lip, explained Julie, and the paradoxical indentation often happens when you go a little bit deeper in the mid layer of the lip, just in front of the orbicularis oris muscle, or maybe just right in the very superficial part of the orbicularis oris muscle. If you inject filler volume in that compartment, the connective tissue that is attached to the surface of the skin will pull inwards to create an indentation.
Julie struggled with this, like many practitioners, when starting out, attempting fanning between the hills and valleys of the indentation to affect a correction. Then one day, she considered squeezing the lip when a deep indentation occurred, to add pressure on the filler to encourage it towards the surface, and it worked, the indentation became 3D projection.
Do you massage and mould lip filler during and after treatment?
Dr Tim added that he believes that 40-50% of the procedure is what happens after you have injected, using your supporting hand, as this technique to correct indentations illustrated. He asked Julie about her philosophy on massaging – does she do it, or try and get everything correct with the needle:
Julie noted that she does not massage, press or mould the lips too much during the treatment, working with precision as she injects. As a slow injector, she does not rush, but takes her time, working precisely so she moulds as little as possible, and follows a specific pattern in specific layers of the lip. Consequently, she explained, if she were to squeeze and massage the lip, she would more of less destroy the specific patterns that she has created whilst injecting.
Similarly, the more you manipulate the lips during treatment, the more they will swell because it is irritating the tissue, warned Julie, which can affect both your before and after photographs and be disliked by the patient. She therefore prefers to carry out everything she can with the needle, and if the result is nice and smooth, having felt gently for lumps and bumps, then she can avoid post treatment moulding.
If she finds any indentations, then a small squeeze will resolve the problem. Small bumps often resolve with targeted, mild pressure, rather than broad massage.
If there is a small nodule on the surface of the lip, Julie uses a technique she calls scratch moulding. She explained that when treating lips, she prefers to use filler products that integrate into the tissue, and are not too firm, because she wants the result to look natural; hence, she likes to use flexible fillers that move during animation for natural expression. With these types of filler, if you get a visible nodule on the surface during the treatment, she will use her gloved fingernail to slowly scratch across the surface of the lip to blend the nodule into the tissue, without the need for more firm squeezing or massaging.
Julie also advises her patients to avoid massaging or heavy touching of their lips for three to four days post treatment due to the local inflammation and trauma from the injection of the needle. They must allow this swelling to naturally go down and for the lips to settle. If they choose to massage their lips too early, this will increase the healing time, extending the inflammation due to irritation of the tissue. After this time, if they notice any lumps or bumps, Julie has provided an aftercare video that explains and demonstrates scratch moulding and gentle squeezing techniques that patients can use on themselves. She explained that this significantly reduced the number of patients who returned to clinic asking for help to remove lumps and bumps from their lips.
You can follow Julie Horne RN on Instagram for more insight from one of the world’s foremost lip filler experts. You can also find Dr Tim Pearce on Instagram if you have any questions or comments about treating lips.
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Aesthetics Mastery Show
Julie Horne’s Lip Injection Tips | Treating M Shaped Lips | Preventing Lumps
To find out more, watch the Aesthetics Mastery Show, where Dr Tim asks Julie Horne how to treat tricky lips like M shaped and thin lips, plus reveals why her in depth knowledge of anatomy has helped her get to the top.
The video has already been viewed over 18k times on YouTube and has had plenty of comments both from practitioners and members of the public.
Amanda Aydin replied to say:
“Thank you for this video addressing the trial and error (safely) reality in aesthetics! We are all always students and that is one of the best things in this career field. Also my favorite part of aesthetics is when you hand the client a mirror and the are so happy with the results. Its very rewarding. Thanks for the video!”
Read more and join in the discussion on our YouTube channel.
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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.
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