Minimal Pain or Bruise Lip Injection Washington DC Expert Cosmetic Surgeon

Hi. We're going to do another injection series for the lips. We're going to use Juvederm on this young lady's lips. She's coming here looking for more lateral lip show. People come in here and they ask me for various things when it comes to the lips. Again, no two lips start out the same. No two lips ever end up looking the same, given the right side on the left side of the lips can be different on each individual patient. So we have to have the right goals. So if we look at these lips, she's got nice lips to start with. She does have lip show, especially centrally. So it's definitely more of a heart shaped lip. But she wants to have a little bit more lateral lip show. And you can see laterally there's a little bit more white lip than there is red lip. Now, ideally you want to have this type of a look where there's more of a roll. That may not be possible with injections. Injections have limitations. We don't want to make the lips look so sausage like or duck like, but we can try to get this a little bit fuller. There is a surgical procedure which is called the lip advancement, where the skin right here is excised as it's put back together and does a nice roll. However, it does affect the vermilion border. It's very fake looking, especially in younger women. It's not something I would advise. In older patients you could do a little bit lip liner or lip tattoo and cover that up. But in younger women, we like to maintain it with line lip injections. So I'm going to demonstrate that with a long needle technique. Again, I use a combination of long and short needle. Long needle technique has less bruising, less pain, less entry sites. People can get back to work a little bit quicker. So again, I'm using the long needle technique. You've seen this before. It's a 27 gauge 1 1/4 inch needle. It's not the one that comes in the package. I occasionally use what comes in a package as well for fine tuning. But this allows me less entry points, it's a more comfortable injection and less bruising usually. So the technique is as such. I roll the lip out, I take the entry point, I prime the needle to get a little bit of the juvederm to come out. Enter slowly. This is the one that they feel the most right at the entry. Then it's a slow progression. Now I release the lip because I don't want to artificially change the way it looks. Occasionally roll it out. And as I'm pushing, it's an anterograde injection. I'm depositing the Juvederm as I'm penetrating. It usually pushes blood vessels out of the way. You get less bruising. And by doing this and checking, I can see exactly what's happening. If you take the lip and move it around too much, you artificially distort the lips, you may get a different result. So I can feel where the needle's entry point is as well as where it's depositing and I can see it fill up. I'm not really checking what my thumb is doing. My thumb has been doing this for years. I know exactly how much pressure to put on it. But for newer injection. Doctors or nurses, you need to be checking and see how much you deposit. So that's what one side does. I don't see any bleeding. There's zero bruises and actually fills up there nicely. I let the lid again start working. I may come back to this side a little bit later, but now it's going to start numbing up. And again, no bruises, very natural. No lumps or bumps. We'll go to the other side. It didn't hurt at all. So for a right handed surgeon as well as a left handed surgeon, there's going to be various techniques. You have to adjust from side to side. Again, penetration, that's the one that she'll feel the most. And then little by little, you're advancing slowly. Don't jab it in, it's not good form. Go slow. The proper submucosal depth. I know where my needle is. I can feel it and I can see it. I'm not going to be filling her centrally right now because really for her I'm trying to get the best lateral lip show as possible. So if I start putting it centrally and I can't get as much laterally as I want, well then it's just not going to look right. So again, I don't see any blood coming out. There's no bruises. We'll go a little bit to the lower lip to balance it out. You ready? Okay, entry point. And slowly you can see where the needle is. You can see right where the head of the needle is. So it's anterograde as well as retrograde as I'm pulling out. Also filling. Right there, tiniest little bleeding, you just hold a little pressure and it stops and you don't get any major bruises. If you see the fillers separate and fill up different layers, you just massage it and it's as smooth as butter. That's the beauty of Jupiter. Leave your mouth open just a little. Again. Entry point. Sliding gently. The slower you go, the less pain they feel because the lat again starts working. And again, visualize it filling up. Now things are starting to numb up. That's our only bleeding point. I'm going to switch. I've used half of the filler. We're going to switch to the short needle and do a little fine tuning.