Dr. Shervin Naderi demonstrates staged lip augmentation with Juvederm, spacing treatments 3-4 weeks apart to avoid a ducky look. He shows injection angles, product selection, and how to check symmetry as you build volume gradually rather than all at once.
Questions this video answers
Three to four weeks.
Even one cc sometimes can look very artificial.
Restylane and Juvederm; Restylane is described as stiffer and better for borders/definition, Juvederm as longer-lasting and more concentrated.
Chapters
Hi, welcome to another injection series. What we're going to demonstrate today is Juvederm, and I'm going to show you a little different technique. You guys have seen me inject with a long needle threading technique. You've seen me do short needle technique. We've done micro droplet. When we start with thinner lips, a lot of patients kind of look at thin lips and say, okay, how can I get it volumized? I went to somewhere and ended up looking ducky, etc. You can't make thin lips go full in one shot. It's just not going to happen. If you look at Kylie, for example, and her lips, when she started thin and she went to where she ended up, she had to go multiple stages. You have to expand the lip and this has to happen within three to four week intervals. If you do it on day one, and then once it waits six months, it's all gone, essentially. But if you do it all in one shot and try to put three syringes in the lip, it's going to look very ducky, very stiff. Even one cc sometimes can look very artificial. So you're going to do it in steps. And if you're going to do it on day one, then three to four weeks later you do a second injection. Three or four weeks later, you do a third injection, and so on and so forth, giving the lip shape and slowly stretching and giving it the right shape. Now, Restylane and Juvederm are the two favorite products of mine for lip injections. Restylane is a little stiffer, more structurally sound. So when you have to create borders and definition, I prefer it. Juvederm lasts a little bit longer, it's a little bit more concentrated. Our patient prefers Juvederm, so we're going to stick with that. But I'm going to show you a variety of techniques. So the lips have been numbed just with the topical numbing. There's no dental block here, it's just topical numbing. It really takes the pain down to a very tolerable level. You still feel it, but it's not that bad at all. And I want to show you that technique. So I'm going to rest your head back. Start on one side, And you can see there's not much lip show laterally at all. The wet lip is kind of overhanging the red lip. There's absolutely no way of rolling this out all in one shot. This has to be done in stages. If you do a lip lift and pull it up, it can be done, but with injections it can't. And if you over inject it, it gets very stiff and ducky. So we're going to start with little tiny droplets. And what I'm doing is going kind of tangential. I'm actually starting at the vermilion border and going at 45°, Pumping out the lip. The next one is right next to it. Since it's in 45 degrees, the area that fills up is just a little bit ahead of me. So it's kind of numbing as we go. Smooth it out and that's it. I mean, if you've injected the right amount, you don't need to massage it terribly much. Now you can see she's kind of got fullness in the central lip. If I start putting too much here, this will look very ducky. So we're not going to do that. Lower lip is doing okay. So we're going to come back to the other side. And I go back and forth when I do the microdropper technique because you want to allow the lifting them up a little bit as you go back the second time, third time over the same area, it gets more comfortable. Go ahead and swallow a little bit. There we go. The lips and the throat tend to numb up with the numbing cream. Sometimes patient's tongue and throat goes numb. So now we're going to go in the other direction vertically. Little tiny shots. All of this is meant to spread out the red lip and get better lip show. Perfect little lips together. You're starting to see some definition out here. And keep going. So it's a multiple plane trying to stretch the lip. See the red lip over the white lip. Go the other direction again. Vertically it. Now we go into wet, dry border. I still really haven't put anything in the central lip yet because I want to see how much lip show I can get laterally. Make sure she's nice and smooth. Okay, this is going to be the first of a series of injections. Now I'm going to come back and do a little bit of the vermilion border. The border is more sensitive. Always hurts a little bit more. Tend to wait till some of the numbing is kicked in elsewhere on the lip. But it still is a little bit more sensitive. You can see the border, the border injections are more superficial. Barely seeing the needle, but you can follow it. You can start seeing some shape form. Now, I don't want the upper lip in a patient that doesn't have a lot of lip show. If you start injecting the upper lip, it's going to over project the lower lip. And so you got to balance out the lower lip in her. The lower lip is more of a standard injection just to kind of make sure you have enough lower lip show so that the upper lip doesn't get projected over it or over jetted. Very gentle. There's no jabbing, there's no stabbing. Very gentle moves. You can start seeing some more now. Here's another technique that I'm going to use in a patient like this. So to create a little bit more of this, I'm actually going to into the red lip and giving the red lip and its continuity with the white lip in this area some volume still. I've done nothing to the very central tablet yet. You get a little bleeder. Just hold a little pressure so it doesn't bruise, but you can start seeing the lips shape a little bit more. Tiny little bleeder. Still no bruises. We tell patients to relax, not to clench. Sometimes patients tend to want to give themselves a little distraction. They may clench their hands or grip a ball, grip an armchair, or even dig their fingers into another finger and all that stuff basically raise your blood pressure, creates more bleeding. So it's going well. Now I'm going to do a little bit swallow. I'm going to do a little bit to the, just lateral to the center, not the center itself because again, you've got a good projection, the center. Smile for me. Good. So I smile to check for symmetry. Now try to blow whistle. Good. I check for symmetry that way as well. Relax the lips. Now this is going to be full. I want that fullness because we're trying to stretch this and get more of a lip show. We talked about this being a project, meaning it's going to take several sessions. But you can see, see, she actually can see the red lip now, whereas before you couldn't see it. Very symmetric. Very, very symmetric. At this point when you do the injections, the lip is definitely more numb because we've been putting these in there. I feel it to make sure there's no lumps or bumps. Looks really good. Smile one more time. Good. Relax it a little bit. I feel like we need a little bit right there into this space. The other side was a little bit different. So this side now needs it. And that's it for the lip injection. So we're going to clean it up. There's no bruises that I see. Despite all the bleeding that she had, there's no bruises. Looks good. You can kind of see, feel it with your fingers. Make sure there's no lumps or bumps. You don't want to send the patient home with bumps or lumps. And this is the first session in about three or four weeks. We do a little bit more and build it up from there. How bad is that? Not bad at all. Not too bad. Okay. Barely felt it. Cool. That's it.
