December 12, 2022

Dr Tim Pearce Botox Needle Syringe

To understand how to successfully perform lip filler treatments, you must get to grips with the foundational principles behind choosing the best injection techniques to achieve your aesthetic goals.

In this blog, Dr Tim Pearce will share some introductory expert tips on core injection techniques and strategies for lip filler procedures.

This educational piece is based on content from the world’s first online lip training with interactive 3D anatomy and injection animation – introducing the 8D Lip Design training course.

Founding principles of lip filler injections

The founding principles, or the technical core, of delivering lip filler injections include your product choice and the properties of the material, plus your understanding of the anatomy and histology; core to your treatment designs are the concepts that surround individual elements of your injection technique or style, how and where you inject, and how you support, mould, and shape the product immediately post procedure.

According to Dr Tim, there are eight core strategies or injection goals when it comes to lip augmentation; these are not the same as the aesthetic goals but are closely related. Before every injection you carry out, you should be very clear in your head about the strategic goal of each injection.

Injection goals include widening, everting, volumising, defining, shaping, resisting movement, supporting (against gravity), or softening superficial lines.

It is vital that you understand the principles behind common injection techniques so you can both confidently deliver them and explain your method and approach to your patient to achieve their aesthetic goals.

Lip Anatomy PosterYou can buy a limited edition beautiful lip anatomy poster for your aesthetic clinic as a helpful reminder of the core structures of the lip.

There are many ways to place filler into different parts of the face, including the lips, to achieve different results and these can be broken down into different domains or core aspects of technique, as follows.

Depth of injection

  • Deep – into the lip body, the middle of the submucosa.
  • Intermediate – in the more superficial, one third of the submucosa
  • Superficial – just under the submucosa by 1-2mm in the anterior compartment of the vermillion lip.

Shape & volume of injection

  • Linear threads – 0.05-0.1ml per length of the needle.
  • Boluses – 0.05ml or more as a single deposit.
  • Micro-boluses – small beads of 0.0125ml or less.
  • Cone shape – a mixture between a bolus and linear thread, creating a cone.

Angle of injection

With respect to the vermillion border in lips, options include,

  • Vertical injections, at ninety degrees to the vermillion border,
  • Horizontal injections, and
  • Oblique injections.

Patterns of Injection

Patterns of injection are simple combinations of injections.

  • Fanning – a series of linear threads splaying out in a fan shape from a single-entry point, usually in one tissue plane.
  • Coning – a series of linear threads playing out in a cone shape from a single-entry point, but within deeper and more superficial tissue planes.
  • Towering – crossing many tissue planes from deep to superficial with one injection, usually with more product deposited in the deeper plane and less placed as the needle moves more superficially. This pattern is not commonly used in lip procedures but may be useful.
  • Stacking – parallel linear threads stacked on top of each other, usually in the same tissue plane of the lip on the anterior wall of the vermillion.
  • Fencing or tenting – is typically multiple-entry linear threads lined up in parallel to each other at approximately ninety degrees to the vermillion border. In practice, these can be combined with a fan or cone-shaped pattern to add volume and eversion.
  • Cross-hatching – superficial linear threads placed across each other in a grid shape. This pattern is not commonly used in lip procedures.
  • Ferning – first described by Dr Tom Van Eijk, involves linear threads of filler emanating on either side of a central line. This pattern is not commonly used in lip procedures.
  • Painting – often performed with cannulas, delivers thin, parallel lines of filler, placed in multiple passes in the same tissue plane, using very low volume.

These patterns can then be combined into treatment designs to achieve different results including vertical and shallow injections, horizontal and shallow injections, superficial bolus injections, deep bolus injections (horizontal or oblique), deep and vertical injections, and superficial sheets of filler. A full explanation and illustration of all these injection patterns and useful combinations for treating lips is outlined in Dr Tim’s 8D Lip Design training course.

According to Dr Tim, a significantly underrated part of performing lip augmentation treatments lies in what the practitioner does to the shape and position of filler after it has been injected into the skin. Despite many training courses touting that good technique is all that is required, Dr Tim believes that no matter how well you inject, the path of the filler product is partly dictated by the unique connective tissue structure of the patient, meaning that the product will flow according to the density of those fibres. Thus, sculpting and massaging of the product once in the lip is an essential part of the core technique to avoid lumps, pouches of product, and other undesirable placement.

Dr Tim demonstrates some helpful sculpting techniques in his 8D Lip Design training course for the vermillion border, the tubercles, the Cupid’s bow, and the lower lip angle which you can use when treating your patients to ensure the dermal filler sits where you intended.

Why not take a look at Dr Tim’s archive of blogs discussing lip filler treatments.

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8D Lip Design

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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