Microdroplet lip injection Using Restylane Juvederm

Hi, Good morning, I'm Dr. Nadiri. I'm going to show you another injection series. You've seen me do lots of lip injections. You've seen me use a variety of techniques in variety of substances. Restylane, which is one of our oldest FDA approved fillers, is still one of the best fillers for the lips. It's FDA approved for the lips, but it also gives lips beautiful shape. So I love to use Restylane for the borders. Now she's actually had lip injections with me before. So the starting point isn't natural lips. It's actually a little bit fuller. And some people wonder, well she has nice full lips. I wish I had her lips. Why she needs fuller lips? Depends. It's a matter of personal taste. Some people love fuller, more exotic lips and some people want very, very subtle augmentation. If you're in your 50s and 60s and you just want a little augmentation to take time back to lips that you had maybe 10, 15 years ago, then we'll use half a CC, maybe a 3/4 of a syringe, maybe something very soft like Jupiter. But if you're young and you want more exotic lips, you want better shape, more roll, we'll use Restylane for definition and a little bit more bulk and volume with Juveda Multiplus. There's other fillers. Juvederm Velour is a beautiful soft filler that's available now if you want an extremely soft augmentation. Juvedal Volbella is a beautiful filler. It comes in a half size syringe so there's lots of options. Not every lip is the same, you have to treat it differently. My injection techniques are different from serial to vertical to microdrop lip techniques to even long heal technique. Some people ask what's your favorite technique? It just depends on the lip and I use a lot of these things. You have to have a lot of tools for each different lip and even on the same patient there's different areas of the lip which will requ to use a variety of techniques. So we're going to get started here. So I'm starting with breast lid. We're going to do. She has nice volume overall. She definitely does want it to be fuller. But we want to get a little more definition to the border and rest on. Does a beautiful job with that. So I'm starting on her right side. You can start on any side you like. Did you feel that much? Good superficial injection. These products all have additional lidocaine in them. We use a Topical numbing cream. You still do feel it. It's not 100% numb. It's not like general anesthesia, but I think it's very bearable. So we're going to the vermilion border to give the lip a little bit of a roll. I go very slow. If you look at videos online, you've seen some people have a very sharp jabbing technique. They believe that if you penetrate quickly, you feel less. I don't agree with that, but again, you do still feel a little bit. So I've done the right. I'm gonna let the lidocaine kick in. I'm gonna go to the bottom a little bit now. We don't want to widen the mouth too much, so I'm not doing much on the right. Go ahead and swallow. Sometimes patients with numbing cream tend to hold their secretions in their mouth, but you can easily swallow it. Barely any bleeding. There is any bleeding. Hold a little pressure. It stops. I'm not a fan of injecting and massaging. Massaging, massaging. I like to do smaller droplets. So the massage that I do is basically this. And you're done. I go to this side. You can stay right there. See it better this way. You can see how I penetrate. I want to get nice definition. So my bevel's up. I'm injecting as I go as well as. As I pull back. So retrograde and anterograde. There's a few areas of the lip that are more sensitive. The border is more sensitive. Be cognizant of that. The central lip is more sensitive. Be cognizant of. If the needle starts to dull, it gets more painful. Be cognizant and switch it. Swallow for me. Perfect. I'm gonna go here. No bruises. She's doing well. Getting a nice definition Again with the lips. What you need to know is natural anatomy of the lips. The central tubercle, ideally, should be a little bit fuller on the bottom. The lateral tubercles should be fuller so they kind of fit together. But once you start really injecting a lip more and getting a more exotic or full lip, sometimes that gets obliterated. But if you're doing a very conservative augmentation, then you can definitely pay attention to those. So again, I'm feeling it. I don't feel a single lump that's doing well. Letting this filler kick in, the lidocaine kick in. I kind of go back and forth a little bit, because as I go back to an area that's already had the filler as I go back, it's just a little bit less painful. There's no dental block here, it's just topical. So now you can see I'm going tangential, not truly vertical at a 45 degree angle. Trying to get more fullness to the central lip. Again, it's just a variety of techniques back and forth. You can see this area needs more volume. So we're going to go here. There was recent publication talking about the no touch technique. Essentially what they're doing is this. They're penetrating the mucosa of the lip from the skin. They're calling it a no touch technique or something along that line. It was nice and catchy. At the end of the day you are going to get swelling to the lip. No matter what you do, it's impossible not to. A little bit of a air of weakness right there because you know this is a different technique. Entering it this way and that fixed it so it's little, little droplets. See a little bit of weakness right there. You can see them right in the mucosa. Lips together, swallow. Good. You're getting numb, right? Hard to tell where your lips are on or numb. Again. You have to know your patients. When it's a first time patient, you got to get to know them. What do they like, what do they really want, what's their personality, who do they hang out with, how do they dress. All these things determine what type of cosmetic procedure results are going to make them happy. That goes for injections, cheek injections, lip injections, rhinoplasty, anything. So there's no bruises. Lips look really good. There is definitely swelling here which is going to settle down. And I'm going to do a second syringe more to the red lip. This is going to be rejuvenated, ultra plus the shape is there. Now we're going to get some bulk. Now it's going to be two full. It's going to be too full for four or five days. But as it settles down she's going to like it. So what I'm actually going to do before we do the lip injections, obviously they're fuller right now and she's numb, but when she was smiling the lips would thin out and you'd see her gum. Now gummy smile is one reason to do this Botox injection. But thinning of the lips is really the main reason we're doing it for her. So I'm going to do a little bit of Botox. It's just to the vermilion border. One drop which is fairly numb. By now, two drops, you can't feel things. Exactly. That's why we do the Botox. After the filler, three drops, four drops. What this does is it just prevents the oricularis muscle from thinning so much. So it's not so much for gummy smile. If I was doing it for gummy smile, I'd be doing more up here as well. But this is to prevent the lips from thinning. So that's the Botox. She's very full and most of my patients at this point would stop and say, you know, I'll come back in a month or two, we'll do more. But she's far. It's taken a while to get here. She knows that there's going to be a lot of swelling right now, it's going to settle down. So she wants to go a little bit fuller. So I'm going to use Juvedim Ultra Plus. Now the Ultra plus is a little bit larger. Needle does tend to give you more puffiness. It can bleed a little bit more, bruise a little bit more. But it's definitely going to be what she wants a week from now. Remember, we're looking at a week from now. See, it's a larger, that's 27 gauge needle. You definitely feel a little bit more. I don't use Ultra plus in the lifts often I use Restylane and Ultra. But when we do want more volume and more fullness, Ultra plus is the way to go. Velour can be used, but the hydrophilic nature of Ultra plus in somebody like her is going to give her more long lasting results. The newer Galderma and the newer Allergan fillers, Voluma, Velour and Verbella are much less hydrophilic. They just don't attract water the way their older fillers, Juvederma, Juvederm Ultra plus attracted water. So those are fantastic for tear troughs and other places that you don't want that hydrophilic attraction of water. But for lips you do want it because it's going to give you a little bit more longevity of results, a little bit more puffiness, a little bit more of a central look. And also it's going to hydrate the lips. So some people like the top to be fuller, some people like the bottom to be fuller. I think the same size is more of a preference of people these days. So we're able to get these lateral tubercles for her, Which despite the fullness of the lips can still look a little natural when the fullness settles down. If you notice, with the Restylane, there was hardly any bleeding. Smaller needle, no bruises. Still don't see any major bruises. But definitely ultra plus bleeds. A little bit more. Maybe the tiniest little bruise right there. Looks like a pin prick. Easily cover with lipstick. Just hold some pressure. That's all you got to do. I've seen people dab and dab and don't do that. Just grab it or hold some pressure and that makes it stop. Working. The lips together. Lips open. Central tubercle for her a little bit. Remember I said the central part does hurt more. And that's it. We're done. So the Botox kicks in about two weeks from now. The filler, she can enjoy the results. Today, lips are going to be numb for a couple of hours, so avoid hot liquids or soups, coffee. But tonight she can put some lipstick, go up, looks good. And what's going to happen is over the next four or five days, it settles down, starts to look more natural. And again, she already had lip injections before with me a few months ago. This is upkeep. Great job. Cool. Thank you.