Botox & Juvederm Lip Injection in Virginia by Dr. Naderi (DC, VA, MD)

Hi. So we're going to do another lip injection series and we're going to do a combination of two things for her. The first thing is I'm going to place a couple of drops of Botox and by a couple of drops in her, I'm going to do about seven and a half units splitting between the two sides at the vermilion border on the upper lip to reduce a gummy show. When she smiles, the gum shows and I'm going to reduce that by weakening the orbicularis muscle. The orbicularis goes all the way around to sphincter muscle. But by relaxing and weakening the upper part of the lip, when she smiles, it lifts up less so you see less of the gum under there. It's also going to mean that when she smiles, the lip is not going to thin out as much, so more of her lip is going to show during smiling. Now, it's important not to over paralyze this because if you weaken it and you can't speak, it's going to feel and look horrible. It does take some getting used to. Even slight weakness of the upper lip will make it feel a little bit stiffer. It's going to take a few days to a few weeks to get used to it. But most patients love the way it looks. It can even help prevent upper lip vertical lines from forming. Then I'm going to take Juvederm Ultra XC and inject the lips. The red lip itself, she has a nice vermillion. She's young, she doesn't need much of a vermillion. But it's mostly the red lip that I'm going to do. I'm going to show you a new technique with a different type of a needle. Less injection ports, less chance of bruising. It's a little bit more comfortable. It's actually a longer needle, it's a larger needle, but it hurts less when we do it. So I'm going to do that now. First we're going to do the Botox and if you kind of zoom in and you can actually see better. So the injection, you're splitting between the two sides and I'm placing it right at the vermilion on her, this patient right there. And I'm going to put about half of this injection right there and I'm going to do the other half on the other side, And that's it. So this by itself will start weakening the muscle and make it feel little bits stiffer, which she'll get used to it and it'll make her smile look more central because the lip doesn't thin out as much and you don't see the gum, which is going to be a prettier smile. Now we're going to go to the Juvederm injection. Now this is a bigger needle, longer needle, it's a 27 gauge, 1 1/4 inch. But the beauty of this is that you can thread it across and get a nice improvement with just one injection on each side. So tilt your head back a little bit, open your mouth a little bit, leave it right there, not too far open and you can see I use my non dominant hand to turn the lip, see my entry point and as I'm entering you can see I'm not too superficial. You don't really see the needle through the skin but if I actually push it up you can feel it right there and I can tell exactly where it's going and I'm going across the lip two slightly to the other side. Then I'm going to start filling. As I fill, I'm not distorting the lip and I actually visualize it. One very important point is that as you're filling, I don't fill the exact same amount everywhere. So as I'm pulling back, depending on how much filling I want, I'm going to actually fill a little bit less right before I pull out like so you can see there's no bleeding, there's no bruising. She's got the fullness on this side and I'm going to go through the other side. Now it's really important, you don't want to put the same amount of volume all the way across. Otherwise it's going to feel like a sausage link and look like a sausage link. So depending on the patients, if they're too full in the middle, I'll put more on this side. If they're not full enough and they want a heart shaped lip, I'll put more in the middle and then as I'm pulling out I releasing my fingers, pressure on the plunger. So I'm putting less as I'm coming out and we're going to go to the other side. I think you'll see it better from that side. So I'm rolling this back again. You can see the entry point and as I do this, try to stay out of the camera's way. Typically I'll be standing over where the camera is right now. I go across and then again filling. As I come across to the other side, I'm going to do the same thing here you can see, I use my other hand. Pull this apart, go across the lip. Incidentally, if you ever did lip implants and we used to do quite a bit of lip implants, this is the injection pattern that replicates the entry point for the lip implant. You can see again, smooth progression, very little bleeding. If there's any bleeding, it's at the corners of the mouth, not in the middle of the mouth. Again, same thing on this side. Pulling this apart, entering, going across all the way. Make sure you stay at the same depth. You can even lift your finger up so you're not distorting anything. Visualize it. Go across the lip like so. Once I'm done, hold a little pressure at the entry points just to make sure there's not a lot of bleeding there. I'm going to massage it. I don't feel a single bump or lump there because it is Juvederm. It is very soft. A little bit of bleeding right at the entry point. But again, if she gets a bruise right here, it's barely noticeable. Again, this is just a normal bleeding point which will stop. So then I take a look at it. I'm going to evaluate it. Put your lips together for me as much as you can. Like that. Just relax it. Open your mouth a little bit. Perfect. So what I'm going to look here now is I'm going to switch to the smaller needle. This does have lidocaine. The lidocaine is kicked in now, the lips are more numb. So now I'm going to switch to the smaller needle and do fine point injections which are going to be more comfortable for her since the lidocaine is kicked in and she's going to bleed less since it's not going to hurt as much. And I'm going to just tilt her head back a little bit and I'm going to just do some fine point injections and give her a little bit more of a heart shaped lip right here. A little bit decent. You can see very superficial. We can create beautiful lips this way. Rolling a little bit. Use your non dominant hand. You want to use both hands. It's not just the hand that's injecting. The other hand is actually working for you too, making things easier for you. Now you can see that the height of the lips are a little bit different on her. That's very common for one side lip to be longer or higher than the other side. But you can try to make things better with your injection technique. So if this cupid's bone, if this vermilion border is higher than this. By injecting a little bit on this side you can lift it up. How are you feeling? Good. Perfect. Now I'm going to go back to the bottom here for a second and I'm going to create again a little bit more of a heart shaped lip here by injecting two points here. See how this smaller needle does bleed more? If you can create the shape that you want with the longer one and not have to go back with a smaller one you get less bleeding and bruising but that's very rare. Most people need a little bit of fine tuning with a smaller needle but even with that you see no bruises right now, very little swelling. The lips are dry but the fact is you get ready to go. She can put on a little bit of lipstick. She's ready to go out tonight if she wanted to. It doesn't look swollen or puffy because the injection technique didn't hurt as much. Thank you.