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Dr Tim Pearce
There always seems to be a compromise between adding volume and creating detail or definition when it comes to treating lips with dermal filler, something that you will learn as you gain experience in lip augmentation.
If you have a product that is great at volumising, it is likely that you will not be able to create the neat lines required for a natural vermillion border using the same product; and conversely, if you use a finer product that is excellent at creating definition, it will probably be poor at adding volume and your patients will not be happy. What if we told you there was a way to produce both augmentation and sharp enhancement when treating lips?
In this blog, Dr Tim Pearce will share some expert tips to enlighten you on how you can achieve medically beautiful lips by creating definition to the vermillion border with one filler, and volume to the lip body with another, and this need not cost double either as many products now come in sub-1ml syringe sizes.
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!
The fight between volume and definition when treating lips
Dr Tim advocates the dual filler strategy when it comes to lip enhancement. This will allow you to create stunning results and will set you apart as an expert in lip treatments.
When we treat a patient with a very small top lip, we are aiming to increase the volume in the lip so that there is a closer match to the golden ratio, but such patients often do not have much definition in the Cupid’s bow and vermillion border.
Finer or thinner hyaluronic acid gel-based filler products like Juvéderm Volift or Juvéderm Volbella sit well in the superficial layers, hold their integrity, and do not spread into the white part of the lip. This means that they maintain the crisp white reflection just at the edge of the pink-white border, thereby preserving the crucial detail in the philtrum and vermillion border that we need to create a beautiful lip. However, these two products are poorer than others at creating volume, so should be used in combination with a thicker, more hydrophilic dermal filler in the body of the lip.
Dr Tim’s approach is to first place the thicker product in the body of the lip using a cannula to reduce the amount of trauma. This is achieved by inserting the cannula through a small pilot hole medial to the modiolus so you can slide it into the lip body and deposit up to 0.5 ml in the tubercle of the lip. He gently finds his way with the cannula, not pushing too hard to avoid tearing any structures.
A top tip from Dr Tim, if you are right-handed, is to place the index finger of your left hand on the white aspect of the lip to prevent the cannula from going too superficially. This helps to stabilise the tissue, control it, and prevent the cannula from going in an unwanted direction.
Upon placement of the filler, he often rolls the white lip downwards in a further attempt at guiding the product to stay in the body and away from the white aspect of the lip, both on the anterior and inferior surfaces. The aim is maximum projection in the pink lip and maximum definition on the white lip.
After completing the volume in the lip body, check that it is smooth, massaging the product into place. You can then go on to place small linear threads (0.05ml) of the fine dermal filler in the vermillion border and philtral columns.
Take your time to ensure accuracy, placing the needle just on the pink side of the pink-white border and leaving 0.05mls of dermal filler on the way out. Immediately compress the white lip to ensure that none of the product spreads and then allow a small amount of time for it to integrate. Use your left hand (again if you are a right-handed injector) to apply pressure above the pink part of the lip to help stabilise the product. You can perform a little bit of sculpting with a squeeze of the finger or a cotton bud.
Finally, treat the junction where the lip meets the cheek, so that the natural weak point between orbicularis oris and the cheek is strengthened.
How to rotate the lip outwards when injecting dermal filler
Outwards rotation of the lips away from the mouth is one of the most common results you will be looking to achieve as an aesthetic clinician.
Dr Tim places Juvéderm Volift in the surface of the lip to exert an outward pressure that rotates and lifts the lip. When you place the filler into a more superficial plane – where these tissues are more tightly packed – the hyaluronic acid gel naturally wants to spread above and below where you have placed it. This exerts a natural upwards rotation on the lip and will allow for greater projection than if you inject a little bit deeper into the body, where you tend to add volume, but without the stretching effect of these more superficial injections on the surface of the lip. The stretching and strengthening of the superficial skin exert the upward effect on the lip, showing more of the pink which is ultimately our aim.
It is worth noting that although this technique is superficial, it is still below the papillary dermis, so as the needle is in place, the lip should only blanch when you lift the needle and exert pressure on that surface, you should not be able to see the white outline of the needle position; at a neutral position there should be blood flowing above the needle.
Achieving medically beautiful lips using two types of dermal filler
In conclusion, Dr Tim’s approach uses Juvéderm Volift in the superficial tissue to rotate the lip upwards, define the vermillion border and the philtral columns, followed by Juvéderm Ultra 3 in the body of the lip using a cannula to add more sustainable volume.
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.
