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Dr Tim Pearce
When it comes to facial aesthetics and injecting dermal fillers for cosmetic enhancement, the lips are one of the most likely areas for the occurrence of vascular occlusion; but the likelihood of blocking a blood vessel when injecting, which may go on to cause a necrotic injury, can be reduced with correct understanding of the lip anatomy and underlying arteries using a 3D approach.
In this blog, Dr Tim Pearce will share vital lip anatomy knowledge to give aesthetic clinicians more confidence when injecting lips with dermal filler for lip augmentation.
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Why do we need to consider lip anatomy when injecting fillers?
Dr Tim states that when injecting the lips, it is imperative to understand how far away the arteries are usually located from the surface of the lip because this changes how you approach the lip when injecting and doing so at different depths. Your resolution for depth and precision is crucial, and this takes careful thought, practice, and time to develop before true comprehension.
When you understand where the superior and inferior labial arteries are in a three-dimensional space, you will suddenly realise how many of the debates we have in medical aesthetics about injecting more safely are predicated on 2D models, he warns. As an illustration, he cites recent clinical papers on the use of ultrasound which often describe the position of the superior labial artery as being “in the vermilion border”, whereas many other published cadaveric studies often describe it as being “in the wet-dry border”; so, which is it you might ask. To evolve your learning, you must think about 3D anatomy and not simply 2D.
The differences between horizontal and vertical lip filler injections
There is much debate when it comes to horizontal and vertical lip filler injections. Still, Dr Tim points out that it does help to understand why the position of the needle, and many of the arguments that people extol in favour or against each one of these techniques, are usually based on a flawed resolution of the anatomy.
If we consider, as perceived by many, that a horizontal injection is safer because you tend to be pointing away from the labial artery – which is believed to be in the wet-dry border – this is not based on 3D anatomy understanding because the artery is not in the wet-dry border, nor is it in the vermilion border. In truth, it is 2 to 3 mm above or 2 to 3 mm behind both these structures; and it is this resolution of understanding that makes all the difference to how you might consider injecting.
The width of a needle is approximately 0.1 mm meaning that there is enough space within the 3 mm space for a good injector to slip between the artery and the lip wall. However, this – the factor of depth – tends not to be a consideration when debating between vertical and horizontal injections because it requires a three-dimensional understanding and causes much confusion.
The anatomy of the lip
When looking at the basic anatomy of the lip, it is a good idea to view it in cross-section, notes Dr Tim, to give you the concept of depth. However, you must also understand how the structures intertwine with each other which is best viewed in 3D.
Sign up for 8D Lip Design – the world’s first online lip training with interactive 3D anatomy and injection animation.
When viewing a 3D model, we can see the different layers of the lip, starting with the dermis, and then a very thin layer of hypodermis in the top lip; this is often where we are trying to treat fine lines and wrinkles. Next, we encounter probably the most important structure of the lip, the orbicularis oris muscle. This muscle has its origin on the maxilla or the mandible, branching out, reaching four different sections across to the modiolus where the two sides meet to form the biggest and the strongest part of the structure of the mouth. Underneath the orbicularis oris is the mucosa, and it is in this space that we tend to find the superior labial artery, which is the most worrisome aspect for most aesthetic injectors, aiming to avoid it at all costs.
Looking at the textbook data on where the artery tends to lie, we note that it has been quite well described as nearly always being underneath the muscle, typically at a depth of about 4 to 5 mm. It helps to know therefore that the superior labial artery is behind the muscle because you can see where the muscle is relatively easily. The orbicularis oris curves around and has an insertion point into the skin at the vermilion border – the vermilion border is the junction between the muscle and the two types of tissue, the white lip (the skin or dermis) and the pink lip (mucosa). This meeting point is a very important reference point when we start to inject because everything is relative to it and the artery that lies underneath the muscle, ensuring many ways to inject more accurately once you understand the 3D. It would not matter which angle you are entering in because the depth is the defining feature that makes you safer.
Should you aspirate when injecting lips?
Dr Tim’s position on aspirating when carrying out lip fillers is that he tends to aspirate nearly all the time, mainly due to muscle memory. However, he admits that it is possible to perform very safe procedures without aspirating if you are doing other things instead to mitigate the risk.
He is a big proponent of aspirating and recommends that you should aspirate when injecting dermal fillers in general. However, he is aiming to become a safer injector himself and notes that sometimes aspirating decreases your control because you are moving the needle around too much in certain circumstances, or you lose your position. Therefore, there are certain injections where he does not aspirate, despite doing so for most. It is vital to understand that it is not about whether you aspirate or not, the crux of the matter is about the totality of all the different safety measures that you take when treating a patient.
Every day is a school day
We can also learn and continue to learn from others to improve our understanding; it is a never-ending process. Dr Tim did exactly that when he allowed himself to be directed during a procedure by Julie Horne RN, co-founder of the Swiss Aesthetics Institute and founder of the Julie Horne Academy, one of the world’s most well-known and talented lip injectors.
During the live event Julie Horne Directs, Dr Tim Injects, Julie directed him in treating a set of lips according to the 8D framework, designing a solution for the patient and guiding Dr Tim to execute it to her plan which showed him some interesting, tiny differences between their techniques which changed the result significantly. If you are interested in learning more about these lip techniques, you can download and master the basics of Julie Horne’s lip technique.
Dr Tim is always keen to hear about the experiences of his followers. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram.
Read more on
- 8D Lip Design: the importance of lip anatomy knowledge
- Avoid vascular occlusions by understanding 3D lip anatomy
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 8D Lip Design Course will teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.
Aesthetics Mastery Show
How to avoid crucial lip arteries when injecting
Dr Tim says:
“The lips are one of the most likely areas to cause a vascular occlusion as a result of injecting lip filler. Knowing your lip anatomy will help to reduce the likeliness of blocking a vessel and causing a necrotic injury. In this episode I share some vital lip anatomy knowledge that I believe every lip injector should know.”
Watch the full Aesthetics Mastery Show here.
The video has received over several thousand views already and received comments of appreciation including:
@lelyabc8260
“I think I’ve already seen absolutely all of your videos. Just want to say, THANK YOU”
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“Thank you for this very instructive video”
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“Amazing video I watch all of them”
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“Amazing teacher you are”
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3D Anatomy Learning Experience
In the next few weeks, Dr Tim Pearce is going to be launching something amazing that involves an incredible 3D learning experience for injectors, a community of clinicians on the same mission as you to help you achieve your goals, and exclusive online access to him and his team. Be the first to join the movement by joining the priority waiting list.
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.
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