A clinician (Dr. Shervin Naderi) demonstrates lip augmentation and nasolabial fold volumization using Juvederm Ultra. He describes preparation (dental block, alcohol wipe), injection technique (injecting while penetrating and on withdrawal to reduce bleeding/bruising, tactile smoothing for symmetry), product notes (Juvederm Ultra vs Ultra Plus), volumes used, and brief post-procedure care (pressure on minor bleeding, minimal expected bruising).
Questions this video answers
September 3, 2009.
Approximately three quarters of a syringe (plus a prior ~1 cc injection a few months earlier).
Juvederm Ultra (clear hyaluronic acid gel); Ultra Plus (thicker) mentioned for comparison.
Chapters
Okay, so we've had enough time for the dental block to work. She's numb. We're going to start with the Juvederm injection. What I like to do is take an alcohol wipe and just basically wipe the lips. Take any lipstick or anything else off. You can't really sterilize the lips, but the alcohol does help remove any extra stuff that is sitting on the surface. Now, this is Juvederm Ultra. There's also an Ultra plus, which is thicker. It's more similar to Proline, which we'll be doing next. Juvederm Ultra is a clear syringe, and it's a clear hyaluronic acid gel. Okay, so we're going to start. I like to kind of keep the patient's mouth slightly open. Not wide open, just slightly open. And what it does, I start penetrating the needle. And uniformly injecting. I like to inject as I'm entering to push away any small blood vessels. That decreases the chance of bleeding or bruising. It's very common to bleed and bruise from the lips. They're very vascular. But doing that technique is a little nice modification which actually lessens the chance of bleeding and bruising. So the penetration and filling is from both sides as you enter and as I pull back. Now, as you can see with her, she has a very nice lip roll, which means I really see her red lip nicely. This is partially because we've actually injected her before in the last few months. But with this type of lip, I don't need to inject the vermilion border, which is the border between the red and white. If I wanted to get more of a roll, I would do it slightly differently. The take home message is every lip is different and the injection has to be done different. As I said before, if you fill the lips like a sausage link, they'll look like sausage links. Open your mouth just a little bit. A lot of times patients will not have sensation or control over their lips, so they may think that the mouth is open when it's not. You just have to gently remind them. After I fill the first round, I do two things with my hands. One is I feel how much filler I have on each side. The tactile sensation definitely helps, making sure we have a symmetric fill. The second thing it does, as you fill the lips by smoothing it out, you don't have any lumps or bumps or nodules. Feel okay? Mm. We're going to go to the bottom lips. Same thing. Penetrating filling as I penetrate, avoiding the labial artery and Also filling as I pull back, You can see with her so far we haven't encountered any major vessels, so she hasn't had any major bleeding, which means she won't really have any major bruising. So far, We're not quite done yet. After I smooth it out and have them hold their lip together, I take a step back to get a better look. They look very symmetric. I like to overfill it just a little bit because it loses its volume. Just two little areas that I see a slight little shadow filling those out. And you can see this is a different technique. It's a perpendicular injection. Put the lips together again. Her right side is naturally a little bit less full than the left side. A little more on this side. And we're done with the lips. That took about three quarters of a syringe of Juvederm and we had done about a cc just a few months ago. So this is just adding up. On top of that, what I like to do next is I have this extra Juvederm. I definitely do not want to waste it. So we have injected the nasolabial folds in the past for her and we're going to do the same thing here with the remainder of this. This is a fantastic injection for that purpose. What I'm going to do is take a little alcohol wipe against our lives area. You don't have to follow me. Exactly what I wanted, What I did is I changed the needle to a fresh needle. It's sharp and it also doesn't have the bacteria from the lips on it. And what I do is I again penetrate straight in to the highest nasolabial fold. And this technique is different than the filling technique of this method. And I use both to basically push up and volumize the tissue. Do the same thing on this side. She doesn't need it lower down. After I inject it, I massage it, smooth it out. And as I feel it right now, there's absolutely no lumpy bumpiness. And that's the beauty of Juvederm. So that concludes an injection of Juvederm Ultra to the lips and the nasolabial folds. This little bit of point bleeding will not bruise. It's very minor and essentially holding pressure for about just two minutes. Top set. I'll have you hold this gentle. And she's lucky that there was no blood vessels in the way for the lips. So essentially the lips are done. She shouldn't have any major bruising. She can cover it with lipstick and she'll be ready to go out tonight. It.
