You may be interested
Dr Tim Pearce
On 19th October 2021, Dr Tim Pearce hosted a Live on Instagram and interviewed one of the world’s foremost experts in lip fillers, Julie Horne RN, to discuss vertical lip filler injection techniques.
Julie has performed over 16,000 lip filler procedures and has never experienced a single vascular occlusion whilst performing treatment, she clearly knows her stuff!
Julie Horne developed the fencing technique which is a vertical injection technique that she has honed and perfected over many years. Julie chose to name her technique fencing, as distinct from more ubiquitous tenting methods. She visualises the process as akin to fences or fence posts holding up the tissue, creating support at the top of each post (vertical line of filler) in the white roll of the top lip and at the base of each post in the fascia in the wet-dry junction.
She explains that although her technique is similar to tenting and other vertical injection delivery, she has modified the approach and not all vertical injections are the same, they vary according to the position of the needle bevel and the angle of approach. When she injects, she does not just move her needle in a straight, downwards manoeuvre, but takes small, millimetre encroachments into the tissue so she can follow the contours of the lip in a superficial plane, avoiding going too deep with a simple vertical technique. This she believes this provides a safer and more successful approach to vertical injections.
In this blog, Dr Tim Pearce highlights some of the stand-out points from his interview with Julie Horne and invites you to catch up with part one of the interview now hosted on You Tube as part of the Aesthetic Mastery Show.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.
What is the vertical fencing lip filler injection technique?
Here are some of the discussion points and questions asked by Dr Tim during his interview with Julie.
Why should we use vertical injections for lip filler treatments?
Julie explained how at the start of her career, approximately 7 years ago, when she embarked upon training in lip fillers, she was primarily shown and practiced her treatments using horizontal techniques. However, after deciding that lips were her passion and would become the focus of her aesthetic offering, she soon discovered that she was not able to achieve the results that both she and her patients were seeking, using only a horizontal injection technique, and she set out to find that ‘something else’.
After many further years of controlled experimentation, trying differing techniques and observing tissue reaction and results in multiple patients, Julie felt that she had finally found the consistent technique she was looking for with a vertical approach.
However, not all vertical approaches are the same. Julie explained how she was looking to create vertical height in the medial third of the lips, within the medial canthus lines, alongside sharp lip borders that taper outwards laterally, as this is the primary desire of many of her female patients. To achieve the height in the medial part of the lip, this can only be achieved with a few carefully placed vertical injections.
Julie explained how she positions her needle below the white lip, in front of the orbicularis oris muscle, and above the wet-dry junction, in an extremely superficial layer. Her injection technique involves only injecting into the red component of the lip, and never into the white part of the lip. This superficial technique results in greater closeness to the connective tissue on the anterior wall of the lips, which is a perfect space for building the vertical scaffolding needed for height, than can be achieved by injection into the mucosa.
How many injections do you average when performing a vertical injection technique?
Julie explained how her approach to lip filler injections is very much patient-led, both in terms of their anatomy and their desires. This means that her treatment may involve both horizontal and vertical injections, and injections that follow a more curved pathway within the anatomical structure of the lips. She always performs a full examination to establish arterial placement in the lips of each of her patients.
When placing vertical injections with her fencing approach to achieve height within the lip, she averages approximately 16 injections, 8 per side which is certainly a reduced number compared to some extreme tenting techniques which can involve up to 50 or 60 vertical injections in a more ‘sewing machine’ fashion.
What is the psychology of your patients? What do they want to achieve?
Julie explained that her typical demographic is women aged 35-55.
Like many aesthetic clinicians, Julie noted how when her patients are sat in a consultation for lip filler treatment, they will often explain what they DO NOT want from treatment, rather than what they really desire. Most are choosing a natural look and spurn over-inflated lip filler options such as the Russian or Baby Doll look. However, they still want something edgy and defined, but seek a subtle, yet observable differences that remains within the normal, natural range for lips.
Dr Tim explained how he has noticed that over time, his female patients begin to enjoy the look and feel of their lip enhancement, after the initial fear of looking unnatural subsides. He reminded male injectors that it can sometimes be difficult to empathise with the feeling that women experience after lip filler treatment, the self-confidence it can bring, the feminine empowerment and sexual assertiveness that comes from treatment.
How do you reduce swelling when injecting lips?
Julie suggested that several things can affect how much swelling a patient will experience from lip filler treatment.
She explained how she punctures the bevel of her needle through the red portion of the lip, and injects very carefully and slowly, taking her time, which reduces the immediate trauma. She believes that other injectors may be entering the lips higher up when delivering vertical injections which results in increased swelling above the lip line, in the white lip.
Similarly, the act of moulding and massaging the filler product within the lip can increase the likelihood of causing considerable swelling; Julie does not massage the lip once product is placed.
By careful placement of inter-linked threads of hyaluronic acid filler gel, she feels that she needs to use less product, which reduces trauma, but leaves no spaces within the structures which could create weaknesses, and thus lips swell less immediately after treatment. Julie also noted that the use of topical anaesthetic creams can compound swelling in the lips. Lips will swell somewhat in the hours post-treatment though, this is natural.
How do you treat thin lips?
When considering patients with thin, inverted lips which may lack a cupid’s bow, Julie explained that you need to prepare the patient for a journey with their lip treatments. Firstly, starting by adding volume to the red lip using a cannula, superficially, in front of the muscle to build up body, restore the volume loss and overt the lip, before considering further treatments with a needle to achieve more definition, after approximately two months. She concluded that, with ageing, the lip anatomy changes so these patients need a more step-by-step approach for increased safety. Why not also check out Dr Tim’s recent blog which looks at the best filler injection techniques for older lips.
You can follow Julie Horne RN on Instagram for more insight from one of the world’s foremost lip filler experts.
Aesthetics Mastery Show
Dr Tim Pearce interviewed one of the world’s foremost lip experts, Julie Horne RN Julie Horne on the Aesthetic Mastery Show LIVE 19th October 2021. Over 2,000 injectors joined to watch the experts discuss the vertical fencing technique.
Further resources
Browse our FREE downloadable resources and access FREE eLearning by following Dr Tim on social media.
Are you still anxious about delivering cosmetic injectables safely?
If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.
Subscribe to our YouTube channel for really useful regular tips and advice. 
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.
