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Aesthetics Journal
Lip augmentation
Aesthetics
Before
After
Before
After
Aesthetic nurse prescriber Sharon Bennett
In every patient assessment, it is important to explicitly ask patients what concerns them rather than to assume this yourself. This because, I believe, draw attention to something so small that the patient might not have otherwise noticed, or were not bothered about, is unnecessary. With younger patients especially, you can trigger a deep and long-term dissatisfaction in appearance. My patient, a 25-year-old, told me that, overall, what bothered her most was her lips and her skin quality. In my assessment, I noticed that her lips were small compared to her total facial dimension and overall balance. Her face also appeared long; the distance from her nose to the top of her lip was long and her upper lip was lacking. I decided that if I treated her using filler to elevate the lip, it would reduce the nose to lip distance and give a better proportion to both her frontal and profile view. In terms of her skin texture, she had open-pores, some dehydration and small imperfections. She’s Australian and has lived in the sun, so she has had sun damage and she is showing some pigment because of this. I firstly decided to treat her lips using Restylane HA filler. I don’t always use the same product for the lip, but for young patients wanting something a little more definitive I often choose Restylane, because it has high projection and includes lidocaine for pain reduction. I used a needle on this occasion because I wanted to inject more superficially, giving fine definition. I didn’t use a cannula here, but that’s a personal preference because I work better and more precisely with a needle. Initially, I injected along the vermillion border. I also injected into the red body of the lip to augment, as well as the philtrum to define and elevate it. I almost always inject both the upper and lower lip for balance; as HA also hydrates, if you only treat one lip then it might create an imbalance of hydration. In total, I used 1ml of Restylane. The main precaution I take while injecting, as all practitioners must, is to observe the skin as I inject and ensure that I am avoiding placement near the labial arteries. Anatomically I am familiar with their position, and they tend to lie deeper than my superficial filler placement. However, no two patients are the same and anatomy can differ from patient to patient. This is something we often see in cadaver dissections. To address my patient’s skin quality, I used the HA injectable Xela Rederm, which aims to promote skin hydration, while the added ingredient of succinate acid successfully addresses pigmentation concerns. You can inject this in many ways; I like to use a needle and place it at a superficial dermal level into the skin, but you can also use a meso gun or cannula. I treated her mid-face in lateral rows from the corner of the mouth up to the cheek
See all this and more at ACE 2018! Hearing how other practitioners conduct their facial assessments and treatments, as well as learning about their unique approaches to different procedures, is extremely useful in further developing clinical skills. At ACE 2018, which takes place on April 27-28 in London, the country’s top expert practitioners will discuss their experiences on the Expert Clinic and Masterclass agendas. Delegates also have the opportunity to engage in anatomy discussions, learn about complication prevention and management, as well as watch facial assessments and demonstrations at the sessions within the exciting, brand
Figure 3: A 25-year-old patient before and immediately after lip augmentation and facial hydration treatment by Sharon Bennett. Images courtesy of Surface Imaging Solutions using the VECTRA H1 3D camera.
bone and along the jawline; afterwards I gently massaged. For the younger patient, I have found that this treatment gives brighter, glowing skin, while lifting and oxygenating the cells. As the patient had a small asymmetry and her brows were a little uneven, with the left brow sitting higher, I finished off the treatment with some botulinum toxin to elevate the right brow to harmonise them. In terms of future treatments for this patient, she is only 25 years old so I don’t think there are any areas I would necessarily want to change further. We want to refresh and enhance what the younger patient has, and not alter their natural appearance. However, I think, looking at the profile view, that she would benefit from a little filler in the chin to balance the nose chin proportion better, but I didn’t have time to do that on the day. She also had some minor acne, which we couldn’t address on the day, but I would advise a skincare regime that could include retinols, some AHAs and antioxidants. Sun protection is particularly important because of her pigmentation, and to act as a preventative. Overall, I think the results I achieved are good; her lips now give her face more balance and it appears slightly shorter. Her face has also lifted and she looks hydrated. Although one usually needs around three of the hydration treatments to see optimum effects, she would have really noticed a difference immediately in her facial hydration and glow.
new, paid-for agenda, the Elite Training Experience. This agenda will provide delegates with a taste of some of the best training that is available in the UK from Dalvi Humzah Aesthetic Training, Academy 102, Medics Direct Training and RA Academy. There are limited places available and the 10% Early Booking Discount for the Elite Training Experience ends December 31. To register for free, or to book the Elite Training Experience, go to www.aestheticsconference.com REFERENCES 1. Shaw RB, Katzel EB, Koltz PF, Yaremchuk MJ, Girotto JA, Kahn DM, Langstein HN, ‘Aging of the facial skeleton: aesthetic implications and rejuvenation strategies’, Plastic & Reconstructive Surgery, 2011 Jan;127(1):374-83.
Reproduced from Aesthetics | Volume 4/Issue 12 - November 2017