Dr. Shervin Naderi demonstrates lip augmentation with Restylane, using a dental block with 2% lidocaine for anesthesia. The block numbs the cheek, lip, and nose for about 1.5 hours. This patient needed less than 0.4 cc of filler.
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We are going to demonstrate the lip injection technique again. This time we have a beautiful young woman, Kristen, here, who, similar to our previous patient, she would like injection to her upper lip. The difference is she's not as brave as Jessica. So we're going to do what's called a more humane technique using the dental block. I use 2% lidocaine with epinephrine to not only numb the lips, but also lessen the chance of bleeding or bruising. It's a similar fashion to when you get your lips numbed at the dentist. Basically, the area goes numb for about an hour and a half or so. And roughly half to two thirds of patients decide and choose to have their lip injection technique with a dental block, which makes it much more bearable and much more comfortable. The injection we're using a mixture of lidocaine with epinephrine. It's with a small but long needle, which I inject under the lips and numb up the entire portion of the face as in a regional block. Kristen, lay your head back for me. I just gently grab the lips. You can keep your teeth together and basically I just gently penetrate this area, feel rather nervous and just start infiltrating. It's definitely more bearable than getting the injection directly into the lip. As this goes through an area that's less sensitive than the lip tissue itself. Gently infiltrate one side. And then we do a similar procedure to the other side. Gently turning your head. What I feel is I go down all the way to where the nerve penetrates and comes out of its orifice. The numb sense pretty much involves the entire cheek, from the lower eyelid down to the lips, as well as a little part of the nose. And then finally, there's a little area here where there is an accessory nerve that comes through that I numb up. Do you feel numb and heavy kind of all around? I do okay. Giving the dental block a few minutes to work. It takes about five minutes or so to kick in completely. And we're going to get started with the lip injection technique. First, as in any injection, I use a little bit of an alcohol wipe. Kristen, you can put your head back and you can keep your lips together. Sterilize the lips. Like we talked about, Restylane comes in a sterile container. We mentioned how it comes in two different sizes, the 0.4cc and the 1cc. Often when you're doing both lips, 1cc is required, but when we're just injecting one lip, the half size or the 0.4cc will suffice. Ok. It's up to you if you want to keep your eyes open or close is fine. So it's a very gentle technique penetrating the mucosa. And I inject as I pull back. There are different techniques for injection of any filler. Some inject as they move forward. I think there's more control while you're pulling back or injection. Most of the time there's hardly an bleeding as you can see. Still have not had a drop of blood, but the lips are very vascular and getting some bleeding is normal. Ironically, the bleeding that you see and that you get does not necessarily translate into bruising if the blood is allowed a pathway to exit. After the injection I do a gentle bimanual massage to make sure that the Restylane is distributed evenly and I can feel with my hands as well as be able to see with my eyes how much Restylane is where and how symmetric the lips look. After I confirm, I always leave a little bit of Restylane for the end, just to fill in the areas, Make sure everything is nice and symmetric. You can get a nice roll, especially when the lips look nice to start with and you can always end with a little bit of massage. Great. This concludes a lip inj. She did not even require the entire 4/10 of the CC, so a little bit that's left will be banged for her.
