Dr. Shervin Naderi shows how to inject Juvederm Volbella XC into thin lips with a conservative approach. He uses small amounts over multiple sessions spaced 3-4 weeks apart to build subtle volume and avoid lumps or bruising.
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Hi, I'm Dr. Sherpa Nader, making another video for the injection series. You may have heard the buzz about Bulbella. It's the newest offering from Allergan. It's a Juvederm product. It's basically similar to Voluma. Its cross linking is more similar to Voluma, a little bit more of a lifting structure, a little bit higher G, as opposed to regular Juvederm products that are softer, a little bit more concentrated. So Juvederm for years has been something that's been fantastic for lips, but horrible for teardrops. I've seen plastic surgeons, dermatologists, inject it into teardrops and almost always ends up in the Tyndall effect or a little bit of that swelling effect under the tear troughs. Well, finally, Allergan has a product that you can inject in the teardrops because it's lower, concentrated, not as hydrophilic, and you can actually use it nicely without getting that bluish, baggy result that we see today. We're going to do lips, we're not doing tear troughs, we're going to do lips with it. The nice thing about lips, again, is it gives you a little bit more shape, a little bit more lift. It's extremely smooth to inject. If you're injecting it, make sure you're not pressing on it too much. All of a sudden, too much is going to come out of the needle. It's very soft, it's almost buttery. When the lips are thin and they're quite thin, you have to start slow. You can't force it. If you want to go from thin to extremely full lips, you have to do it in sessions. For example, look at Kylie Jenner. Everybody knows Kylie's lips, but if you look at her starting point, this was done over multiple sessions. You have to inject it every three to four weeks apart. You have to do it three or four times. You can't just force three or four cc's into the lips. So patient expectation is important. Now, you've seen pictures on Instagram, you've seen pictures of our website of women who've had extremely exotic lips created by myself and my partners. That's a rare segment of the population. Most of our patients want very subtle results. Most of them want just barely noticeable results. They're self conscious. They don't want anybody to be able to tell that they had lip injections. So we do it slowly over much more, kind of a prolonged course. And I'm going to show you the injection of Lubella and the technique, it comes in 0.55cc syringes and we're going to demonstrate that right now. Okay. So you've seen the injections that we've had with the long needle and this is the short needle technique. The lips are thinner, you have to go from multiple different directions. So I have the patient laying back. Lips are open just a little bit. Start from the corner again. It's important to be really gentle. I've seen some real stabbing actions. Jabbing actions into the lips scares patients, scares viewers, scares the children. You can be very gentle. Any pain, doing okay? No screaming. You can actually see the product. Go ahead of the needle. I inject in both directions. As I'm pushing the needle in, my fingers on the plunger. But very, very gently, it pushes blood vessels slightly out of the way, minimizes risk of bruising. The center of the lip is always more tender, there's more innervation. Comes from both directions. And you can see there's really no bruises, not a lot of bleeding. Go into the bottom lip. Same technique, my hands on the way, you can lift the camera over my hand. You can again see my fingers on the plunger the entire time just below the border. Now all that injection, both sides of the lip and used about half of the syringe. And it's a half size cc, half CC syringe. So basically it's quarter CC that's been used. So if you think about it, it's 1/10 of a teaspoon that I just put on the lips. So what this does, it introduces the lidocaine into the lip. So the lip starts numbing further. I go spread a little thin layer on both sides, then I go back and add more to it because the lips get more and more numb, more and more comfortable. Just a little like that. Perfect. There's usually some big blood vessels right at the corner. You want to stay more superficially. In some patients, those blood vessels can be tortuous, like a pretzel almost. And you may end up hitting both ends of it or several ends of it. And then you get this big hematoma on the lips. Very smooth product when you put it in, it's almost impossible to get lumps if you're careful with the technique. So I don't do a whole lot of massaging. When you place it in the right place, you don't have to massage the heck out of it. You just rub it once or twice and it's done. Now I check for symmetry. I want you to smile for me. Big, big smile. Good. And I want you to blow a whistle. Good. Perfect. Nobody's lips are perfectly symmetric, but you check for symmetry this way. Now, if you notice, starting compared now to the starting point, the lips are a little bit more plump. The little lines or wrinkles in the lips are reduced. That side's a little fuller. So I'm just going to augment a little bit here. And then what I'm going to do is I'm going to show the mirror and I'm assuming from no record that she wants to be done now. So we'll finish here. This is a nice subtle augmentation of the lips. And then basically in a month or so, we're gonna add another half assisi and go from there. But that was the technique. It's really, really important. You don't want to be pressing on the plunger. That's one of the most important things that you can take away from this instructional video. It can be used into the teardrops. It can be used in non surgical rhinoplasty. It doesn't come in a full CC syringe right now. It comes in almost half CC's, but it's a nice, versatile product in your cabinet. Thank you.
