Cheek, Tear Trough & Lip Natural Injection Technique by Dr. Naderi

Hi, good morning. We're going to make another injection video today. We're going to do a combination of techniques. We're going to use a combination of actual fillers. I'm going to show you rest on lift. Lift is spelled L Y F T. It's indicated for mid face injections, but other areas can be used off label. I'm going to show you Juvedor Voluma, which again is indicated for mid face injections. But again it can be used other areas. It can be used with advanced techniques into the tear troughs, into the lips, into the smile lines. But again, the FDA indication is for the midface. You got to be careful if it's your first time using it. It is thicker, it is heavier, so is rest alone lift. I'm also going to show Juvedym Ultra XC and that we're going to do into the lips. So essentially what we have is a little bit of mid face volum loss. You can see right where my thumb is sitting right in this area. There's not a lot of volume. She has nice cheekbones, but she's flat here and it accentuates the lower lid. Fat pads. Traditionally, surgically what you could do is remove the fat pads. I'll have you look up with your eyes and you can see as you look up, the fat pads become more accentuated. There's a little bit of hyperpigmentation as well. But this hollowness there can be improved with fillers. Now looking straight on, you can see again as you lift this area up, as you lift the mid face up. It just doesn't prove it. There are multiple reasons for dark circles under the eyes. It's not just one treatment for all. You have to understand if it's hyperpigmentation, volume loss, shape of the eyes, thinness of the skin, you can't just treat everybody with the same technique. And ultimately makeup is extremely important. If somebody says, I don't want to wear makeup at all, it's really tough. You have to use some makeup for coverage. But you can make significant improvements with fillers. And then we're going to accentuate the lips as well. We're going to try to get a little bit more width as well as fullness on the lips. So hang tight. I'm going to show you these techniques. You can clearly see mid face hollowness and creation of tear troughs and accentuation of the lower lip. Fat pads, also known as eyelid bags. These are going to be corrected. You can see the numbing cream on the lips and cheeks. I'm going to start injecting their right mid face. Right now. I have juvederm voluma. She has been numbed with topical numbing. Has been topical numbing cream on her, on her cheeks and her lips. There's no dental block. The materials all actually have additional lidocaine in them as well. So here we gotta go. Close your eyes. You're gonna feel a little bit of sharpness. The numbing definitely takes the edge off, makes it better. Now inject to the point that I like to see the results. I don't like to poke any more than I have to. So with every injection, I'm going to make it count, meaning I'm not going to unnecessarily inject her with 100 spots. If I can do it five or six. However, I'm also not going to put too much in one spot. The needle is moving. As I'm going in, I'm injecting. As I'm coming out, I'm injecting. So what happens is risk of intravascular injection is very low because of the fact that it's not in the same spot. You can see already it's starting to lift up there. Now we will come out here a little bit, but I'm trying to get the improvements down in this area first. The more medial you go towards the mid part of the face, the more tender it is. More innervation in that area. If you see a bleeder, a little blood vessel, just hold some pressure. That's all you got to do. Just quickly hold some pressure and then minimize the risk of bruising. But you can see right now as you're going, if you just compare one side of the face to the other, there's no makeup, there is no camouflage, there's nothing. But if you just compare this tear trough, this mid face is so much deeper than here. It just looks much healthier on the right side. Now this area starts to thin out. So what I'm going to do is I'm going to skive it a little bit to be able to go up to the tear troughs. And you saw I used the voluma again. I encourage people that have not used voluma extensively and people who have not injected tear troughs extensively not to do this. But for those of you who are advanced injectors, voluma is not as hydrophilic as juvederm, multiplus or ultra, and you get really nice results. So if you pan around, you can actually definitely see the difference between the two sides. And I've used just A little bit more than half a CC of injectable and you can start seeing how this area is lifting up. I'll let you kind of move around a little bit and show how it's lifting up a little bit compared to the other side. Now, this is only just a little bit more than half a cc. We're going to keep going. We're going to keep going until I get the correction that I want. So I'm going to follow the contour that I like to see her cheek have. How are you doing? Nothing, not too bad, not too bad. Okay. Not bleeding much at all. But if there is a bleeder, like I said, just hold a little pressure and it stops. I'm going to come to this area that Allergan calls V1 and V2 junction V1 and V2. These areas basically are equivalent to the cheek bones. So you've got the cheek area, which is the fatty, meaty part of the cheek, and then you also want to sculpt the cheekbones themselves. How do you feel? Okay, good. So I put 1cc of Juvederm Voluma right here. You saw a couple of drops into the V1, V2. Most of it went to V3. And I actually did her tear trough with the voluma as well, which, again, it's a really advanced technique. Please be careful because it can be quite lumpy, bumpy in that area. But this now has given her this side of the face, a much more rested look. Some redness from the injection, not a lot of bruising. Some bruising will come in a few days, but it's not too bad. But again, compared to the first flatness of this area, the depression here that's accentuating the fat pad, this area is so much smoother. For perfect results, you still want to remove some of this fat pad surgically, but this is so much better that she doesn't really need surgery at all. So we're going to go do the other side. So I'm going to show you that. Very gentle technique. You can see how the needle penetrates. It's very slow. There's no stabbing, there's no jabbing. Patients already nervous as is. You want to have very nice, gentle technique. Sometimes I sneak up from below. There's a variety of techniques I use. There's less blood vessels in the way when you sneak up from below to get to the tear troughs, you've got to know the anatomy. Plastic surgeons who do this on a daily basis do know the anatomy. For the newer injectors, dermatologists the family physicians, the other types of injectors that are doing these injections. I urge you, please look up the anatomy. You have to know your anatomy because there are certain areas that you want to be more superficial, certain areas you want to be more deep. So what I can do is tiny little bleeder there. I'm just actually going to hold a little pressure. Every finger, every move has a purpose. So I'm holding pressure here while injecting here. And I can hold pressure on both sides. You can see, you can see the immediate improvement, how it's lifting up really nicely. Keep her eyes closed for me. Those large fat pads that she had at the beginning are pretty much 90% better. Years ago we would have told her her only option is allure blepharoplasty. Today, patients who have mid face or tear trough problemus don't need to get a blepharoplasty if they can get this type of injection. I mean, just look at that. Just look at the beginning to. Now if you scroll back to the beginning of this video where we started, compare reminder of before injection hot limits. Again, the starting point. Yes, there's some hyperpigmentation there that you'll need some makeup for, but the contour is now smooth. You can't put makeup on a trough. You can't put makeup on a depressed area. But this with makeup is going to look like a million bucks. I hold my patient's head steady with my other hand. I do my injections now. Remember, everybody has one side that's higher than the other. Almost every single patient has that. One cheek, one eye, one eyebrow. One side of the face is higher than the other. That's the side that people like to take pictures from. If you ask somebody what's your favorite side to take pictures, that's the side that has the higher eyes and cheek. So what you can do, once you've added volume to both sides, you can try to even people. You cannot make people 100% symmetric. This eye is higher. If you look at the position of the eyes, eyebrows, cheeks, this side is higher. This is the more attractive side, the more lifted side. But what I can do is balance it by coming up here in a little bit, try to make it more symmetric. So I'll do that a little bit later, but now I'm really happy with this. So what I did was 1cc of Voluma on the right. I did 0.7 on the left. I'm going to take the rest of it and to try to create an illusion of more symmetry Is lift this cheekbone for her and that lateral canthus for her with the remainder. So to create more symmetry, you don't always put 1 and 1 cc on both sides. After all those injections, this is the first real blood vessel that got underway. So you just hold a little pressure. The rest of this is going to see some little bit of bluish green, yellowish discoloration in a few days. But it's easy to cover with makeup. Larger blood vessels are harder, so that's why you want to make sure you hold pressure. You can see how the mid face has lifted up. The troughs are gone. The lower leg fat pads are barely visible now compared to the beginning. And this is just with two cc's now, some people need four, six or more, but two, they're an incredible result right there. So now I'm using restylane lift. I built a foundation with the voluma. I'm going to sculpt it with lift, which is basically a firmer filler. It gives us more of that kind of chiseled bony look. And I'm going to spot treat. It's a smaller needle, smaller deposits, and I can contour a little bit better with the lift. I like this technique. People asking the two be combined. Yes, they're both hyaluronic acid. They can be combined, they can be layered. You can get a really nice result. This is more of a micro droplet. Little by little, Tear trough itself. You continue the sculpting over here. You're feeling this a little bit more because it's a new area. It's not as numb, Actually. Smaller needle. Doing okay? Yeah. Good. Out of all this, the only real bruise we've gotten is out here. But she's gonna go home and ice it. And you can see if you're observing my technique, you'll see I go in different methods in different ways. Got a previous scar here from something. Usually when this scar, it's tethered a little bit more. Look beautiful cheekbones being created. Teardrops are better. I'm looking for areas that I want to improve, actually. Really nice. Get up a little bit. Look up with your eyes for me. Look straight. Perfect. This area is perfect. A little bit of weakness right there. I don't want to lift this area up too much because remember, we said this is the higher area to begin with. So if I make this perfect, then it's gonna always be up to the right side to try to catch up to this left, which is her nicer, higher side. I want to make sure that she's more symmetric. I'm going to focus more on the right. This is really nice. This is lifted up. There's really no more need for any more fillers in this area. What I'm doing now is just slightly overfilling. And the reason is some of this obviously, is going to be swelling, which is going to go down. So for her to have a really nice look, even six months from now, a year from now, we want to have a full correction and maybe a slight over correction. It creates a really nice look. This side, the tear trough is a little bit more apparent because her hyperpigmentation is a little bit more apparent on that side. But with makeup, this gets covered beautifully. Close your eyes. I'm going to switch needles. After a few injections, needles tend to dull, so I've gone ahead and changed the needle. Makes it penetrate a little bit easier, a little bit less pain. Don't be hesitant to change the needle throughout, because as you get to the bone, it does tend to dull out a little bit. I'm going to lift this area up a little bit more for her, and then we're going to go to the lips. Looks really good. Now we're getting into a zone called V4, which is a submalar area. Remember, this is the higher side, right? Higher, eye, higher, everything. So I'm trying to create the illusion of symmetry by lifting this area up more for her. Okay. How bad was that injection? Bearable. Okay, good. So that's three cc's, two of voluma and one of lift. And you can see what effect it had. No makeup. She looks so much more rested than before. We're gonna go to the lips next. Okay, we're gonna go to lips. You'll see a variety of techniques. You'll see a variety of patterns of injection. All of them are gentle, all of them are smooth. There is no jabbing or stabbing. My first pass, I'm just trying to get a little bit of material, the juvederm throughout. My goal there is for the lidocaine to start working because the filler has lidocaine in it as it starts working, my second and third passes will be much more comfortable because when I'm contouring, those can be a little bit more uncomfortable. Once the first pass has gone through, it makes it a lot easier for her. Go to the bottom lips again. This is only topical numbing. I used to do dental blocks on probably 95% of patients. Now I do that on maybe 1%, because with a good numbing cream and nice smooth technique, you don't need a dental block. Dental block itself is not comfortable. It involves injecting inside the mouth. It can cause swelling. Patients are numb for hours. So this is a very conservative spreading of the Juvederm throughout the lips. I've used about 0.35cc. Now I'm gonna have you relax your lips together and I'm gonna spot treat. They go in different patterns. Keeping in mind that she's young, more youthful lips, but we still want them to look natural. Don't want them to look ducky. Again, over and over again. We have to stress nobody starts off perfectly symmetric. Usually the midpoint of the face is a deviated axis, meaning if you look at yourselves, you draw a straight line up and down. For vast majority of people, the middle of the eyes and the middle of the lips do not line up. There's usually a little access. So the two sides of the face, the two sides of the body are not ever perfectly symmetric. What you're trying to do is create a beautiful three dimensional look. People that get focused so much on the symmetry miss the big picture. One more pouty lips, more youthful lips. A little bit better vermilion border. The central part of the upper lip should be fuller. The lateral parts of the lower lip should be fuller. That is a classic lip, Not a whole lot of bleeding. Leave your mouth open now a little more. You've seen me use the long needle technique. She has a small mouth to begin with, but a long needle would not be a good technique for her. Put your lips together, you can start seeing them shape. Open them up a little bit. Now I'm going to come from a different direction. The white part of the lip is also important. You perceive her. Two sides are different on her. You cannot achieve fullness in some people without getting more fullness to the entire lip, not just the red lips. Put your lips together, you can start seeing the shape. See how much prettier they are. I like that look. Very nice, very pouty, very classic. Nice borders to the lip. Good central tubercle, good lateral tubercles. Not ducky, not sausage. Like when you look at the whole face. If you come back a little bit to the midline, you can see a very beautiful result. Thank you. So here we are. Four cc's of total volume. One went to the lips. Juvederm ultra. Two cc's of Juvederm voluma to the cheeks and tear troughs. And 1cc of rest will lift again to the cheeks and tear trough. Look at the cheekbones. You can look at the mid face, the tear troughs and just look at the face. Look how much younger she looks. This is without makeup. This is right. Then the lips don't have any lipstick on them. They just look more red because of the injection. That's what fillers can do immediately. Once she puts makeup, she's ready to go out. Thank you. Immediate results with very little swelling, bruising or downtime in this situation. Patient looks younger and more rested. Thank you. The Naderi center offices are located in Chevy Chase, Maryland and in Reston, Virginia, the suburbs of Washington, D.C. area. We have three physicians focusing on three different parts of the body.