Treating the Perioral Area

Are you treating the lips in isolation? Aesthetic nurse prescriber Jennie Hawkins explains the importance of taking a step back to assess and treat the whole perioral area for optimum outcomes

When I first began injecting more than 11 years ago, like many other practitioners new to aesthetics I was trained in lip enhancement. What I didn’t quite appreciate at the time is that no structure on the face exists in isolation and this is particularly true for the lips. When I came across Dr Mauricio De Maio’s ‘8 point lift’ where a single treatment session addressed multiple areas of the face, it completely changed how I consulted with my patients. As I began widening discussions with them, I was able to educate them on how the lips are both directly and indirectly affected when we place filler in the cutaneous upper lip, oral commissures, marionettes, and indeed wider areas such as the nasolabial folds, chin and cheeks.1,2

How can you enhance the whole perioral area? As the structures around the lips are connected and have a direct correlation on how the lips look, when you assess these structures and improve them, they can have such an impact on the lips themselves that sometimes the lips don’t even need treating. Incredibly, we can reduce the action of a depressor muscle or that of a hypertonic elevator muscle, as well as help to re-establish the tone and lifting effect of an elevator muscle using filler – known as myomodulation.3 When it comes to the perioral area, there is a complex ‘tug of war’ with this buccolabial group of muscles. By understanding and utilising this, we can improve the position and function of the lips, and indeed beyond them. For this reason, the surrounding areas such as the chin, nasolabial folds and cheeks always form part of my treatment plan with patients who are considering perioral rejuvenation. I believe this is the key to truly delivering harmonious, individualised and seamless facial reshaping treatments.

Product selection When treating the perioral area, I consider the full Juvéderm Vycross and Ultra ranges. My choice of product will depend on the target tissue and the impact I need to exert on them. I need to understand the dynamics of the skin, subcutaneous, muscle and bony layers and how this now presents as a line/volume loss/or a structural deficit for each patient. I am looking for: consistent and reproducible results, seamless tissue integration, good longevity and natural-looking facial contouring at rest and on animation. My method to achieve this is with the full range of Juvéderm products using a full-face approach to treatment.

• Lips – Juvéderm Smile, Juvéderm 3 (mid and deep lines and lips), Juvéderm Volift,

Juvéderm Volbella4,5,7,8 • Skin – Juvéderm Volbella (mid lines and soft volume to lips) and Juvéderm Volite (hydration and elasticity)4,9 • Chin – Juvéderm Voluma and Juvéderm

Volux (structure/stability)6,10 • Nasolabial folds – Juvéderm Volift (deep lines, volume)7 • Cheeks – Juvéderm Voluma (volume and contour)6

Top tips for successful perioral treatments Don’t treat in isolation! View the perioral area as an extension of the chin, cheeks, jawline and neck. Do not prioritise form over proportion and function, and utilise the bony plane of the face to help stabilise the perioral area. Always ensure you assess and treat on an individual basis because what is ideal for one patient will not be so for another. Remember, by considering the whole of the perioral area, and not just the lips, we are better able to respect the natural proportions and balance for each patient and, critically, respect the anatomical function of the mouth.

Before After

Voluma (1ml) placed as a bolus to bone at the zygomaticotemporal region of the zygomatic arch. Voluma (1ml) was also placed as a bolus to bone, medial to the protuberance of the chin and then subcutaneously at the sublabial crease. This article was produced and funded by Allergan Aesthetics, an AbbVie Company.

For more information go to: www.juvederm.co.uk UK-JUV-2150182 Date of preparation: Apr 2021

REFERENCES

1. M. de Maio. MD Codes™ A Methodological Approach Aesthetic

Plastic Surgery. 2020. 2. Allergan and M. de Maio. VYCROSS 2nd Edition.

INT/0836/2016a. 2017. 3. M. de Maio. Myomodulation with Injectable Fillers. Aesthetic

Plastic Surgery. 2018. 4. Juvéderm® VOLBELLA DFU. 73363JR10. 2020 5. Juvéderm® ULTRA SMILE DFU. 73664JR10. 2019. 6. Juvéderm® VOLUMA DFU. 73650JR10. 2019. 7. Juvéderm® VOLIFT DFU. 73652JR10. 2019. 8. Juvéderm® ULTRA 3 DFU. 72490JR12. 2016. 9. Juvéderm® VOLITE DFU. 73655JR10. 2019. 10. Juvéderm® VOLUX DFU. 73561JR10. 2019.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ Adverse events should also be reported to Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026.