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Dr Tim Pearce
The skilled aesthetic injector understands that there are multiple factors controlling the physical result of a lip augmentation procedure, alongside the risks associated with carrying it out. Many often put it down to technique alone, as the sole driver of both short- and long-term results; however, a wise injector realises that material choice is critical, something that a naïve injector will learn with experience.
In this blog, Dr Tim Pearce will share some introductory expert tips on why the dermal filler materials you choose, and their properties, are crucial to successful lip treatments, alongside your choice of injection tools and techniques.
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.
What dermal filler qualities do we look for when treating lips?
You cannot consider the immediate result of the procedure alone, warns Dr Tim, because, for our patients the result of any procedure comes from the behaviour of the product over time – their longer-term result – not just how good they look immediately after treatment. This is a much bigger consideration when selecting the right dermal filler product to use.
There are many qualities that we seek when choosing a dermal filler product for lips, many of which may not be apparent after immediate use, but include:
- Easy to inject
- Immuno-inert with a low chance of forming nodules
- Sterile
- Good lifting capacity
- Good elastic properties
- Low hydrophilicity, for most indications
- Non-toxic
- An ability to retain shape over time
- An ability to hold position over time
- Have a predictable and consistent rate of degradation, to allow you to anticipate when retreatment will be required or appropriate
- Easily reversible (hyaluronic acid (HA) based)
Dr Tim is dismayed that these properties are extremely poorly studied over time, and only recently via in-vivo observation. MRI studies have shown that dermal fillers persist for up to twelve years in some cases. However, they do not stay in the same place, as injected, indefinitely, and it is likely that the properties of the products change over time.
The longevity of dermal fillers has been studied only with respect to clinical presence of the result, warns Dr Tim, not the presence of exogenous hyaluronic acid in tissue. He notes that it is likely that lost result is largely due to diffusion of the dermal filler, as well as breakdown, and says the importance of this cannot be overstated when we consider that we are managing some of our dermal filler patients over many decades.
Which properties of dermal fillers are best suited to lip treatments?
Hyaluronic acid-based dermal filler products contain carbohydrate polymers, single chains of varying lengths that are cross-linked together to increase the half-life of the products when placed in the tissue. The lengths of the polymer chains and the number of cross-links affect the size of the particles, and is correlated to viscosity, hardness, longevity, and the ability of the product to lift, alongside the likelihood of causing lumps (dependent on indicative use).
Smaller particle HA products are used more superficially, and larger particles are used deeper in the tissue for structure, notes Dr Tim. The concentration of HA per millilitre (ml) affects the properties of the filler product and impacts the hydrophilicity over time.
Cross-linking and other proprietary modifications made by the manufacturers effect the viscosity and longevity of the product(s). This may have some downsides, as filler becomes less natural, the chance of reactions may increase. Dr Tim highlights that many filler products are now made to emulate important components of the face. Generally driven alongside the dermal layers – the superficial dermis requires hydration and some ‘skinbooster’ products work specifically on hydration, other products are targeted to the superficial fat pads, deep fat pads, or down onto bone. When considering treating the lips, aesthetic clinicians should seek products which can add hydration, volume, and shape, and many manufacturers have products branded and targeted for lips.
Properties of dermal fillers used in lips include:
- Soft, suitable for superficial injection and able to hold their shape and position over time.
- Shorter- and medium-chain, cross-linked hyaluronic acid-based products are recommended for lip augmentation.
- Viscosity is an important factor; higher viscosity products may cause lumps in soft tissue and should be avoided or used with caution.
Most dermal filler products that are well suited to lip treatments are a balance between the properties that achieve good lifting, volume, and shape (high viscosity, high HA content, and high hydrophilicity), and those that are better at definition and detail (with lower viscosity, HA content and hydrophilicity).
A full breakdown of the most suitable types of dermal fillers for use in the lips is available in Dr Tim’s 8D Lip Design training course. Similarly, he explores the longer-term results of lip treatment as dermal fillers degrade and breakdown, as well as discussing the rheology of HA gels and how they behave in the skin over time, compared to in-vitro data.
Dr Tim is regularly asked,
“which filler is best for lip treatments?”
and his response is often,
“there is no ideal filler, just injectors who know how to use a filler in an ideal way”.
Much of the understanding of how a product performs, especially in the long-term, comes with experience, observation, and reflective practice. He discusses this in greater detail within the 8D Lip Design training course, explaining why there is not a simple answer to the original question.
To become a wise injector and learn the products best suited for lip treatments for your patients, Dr Tim advises you to make notes at review appointments. Compare photographs at different angles and observe how the result changes in the long term based on the product properties and your injection technique.
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.
