Dr Beatriz Molina shares her technique when using Emervel to treat the lip and perioral area
Lip treatments are a particular favourite of mine. Treatments of this area can have a big impact, and make a substantial difference to patient self- confidence. My choice of product when treating the lip and peri-oral area is Emervel Lips hyaluronic acid (HA) dermal filler. The Emervel Range offers an optimal balance between cross-linking and gel calibration, creating four degrees of cross-linking (resistance to deformation) and three degrees of calibration (lifting capacity). This optimal balance therefore provides (1) the broadest spectrum of distinctive soft textures and (2) the optimal match to the tissue type at each injection site. In a recent FRESH study, 85.7–100% of patients injected with products from the Emervel range for lips, upper lip lines, nasolabial folds and marionette lines, said they would like to be injected with the same product again. Scores ranged from 85.7% for Emervel Lips to 100% for Emervel Classic (upper lip lines). The versatility of Emervel Lips allows practitioners to treat vermillion border, body of the lip and upper lip lines with only one syringe.
When treating the lip I divide treatments, depending on which areas my patient and I have agreed to treat. I look specifically at the following factors: amount of volume loss or enhancement for lip, symmetry and treating only vermillion border and/or also perioral area. All of this will influence treatment technique (layering, crosshatching, linear threading) depth of injections, and tools (sharp needle or blunt needle (cannula). For quick lip volumising treatments, or just for lip definition, I use needles. The needle is versatile, and creates great definition within the vermillion border and volumes the body of the lip well. Emervel Lips has 0.3ml lidocaine and injects easily through a 30G needle so comfort for the patient is optimised. However, if I am treating the peri-oral area as a whole I prefer using a 25G cannula, as I feel it is less traumatic for patients and can treat a wider expanse. I believe that when treating the lips it is essential to take the whole perioral area into account and to assess patients’ balance and asymmetry, not only face-on, but also from in profile. Normally I begin with two small injections of lidocaine in the chosen access point, which will vary depending on the area of treatment. I then use the 23G needle to puncture the skin to allow easy penetration of my 25G cannula. It can be challenging when a patient has a noticeable amount of volume loss in mid-face, presenting heavy jowls and deep naso-labials creating deep mouth commissure lines, but only wants a lip treatment with one syringe of product. In these cases I will limit my treatment to just the lip and upper lip lines. The versatility of Emervel Lips means that you can provide an impactful treatment with noticeable improvement. However, I would always recommend a full treatment to the mid-face first, making the overall result much more balanced. Another challenge is uneven lips and uneven smile. Always ensure you take a range of patient photos at rest, smile and profile. Uneven smiles will normally require a combination of botulinum toxin (BontA) and filler. I prefer to treat with BontA first two to four weeks prior to balance the smile before defining with Emervel Lips filler.
First 2 small injections of lidocaine 2%.
Second do your access point with a 23G needle
Third I would normally use a 25G 2” cannula (you may also use a27G) and do a fanning retrograde technique which allows me to treat upper and lower perioral lines as vermillion border and commisures of the mouth from one access point. You may even want to treat nasolabial folds and marionette if indicated from the same access point.
In summary, the key to a successful treatment is:
The initial assessment
A technique that suits you
Keeping facial features in balance and in keeping with age
Making small tweaks and improvements to create a huge difference
Assessing the face as a whole is the most effective approach and will always deliver best results. You have one opportunity; if a patient is not impressed on their first visit, it is likely that the initial assessment and consultation of needs was incorrect.
Cartier, H., et al., ‘Perioral rejuvenation with a range of customized hyaluronic acid fillers: efficacy and safety over six months with a specific focus on the lips’, J Drugs Dermatol, 11(2012) (1 Suppl), 17-26
Kestemont, P., et al., ‘Sustained efficacy and high patient satisfaction after cheek enhancement with a new hyaluronic acid dermal filler’, J Drugs Dermatol, 11(2012)(1 Suppl), 9-16
Rzany, B., et al., ‘Correction of tear troughs and periorbital lines with a range of customized hyaluronic acid fillers’, J Drugs Dermatol, 11(2012) (1 Suppl), 27-34
Segura, S. et al., ‘A complete range of hyaluronic acid filler with distinctive physical properties specifically designed for optimal tissue adaptations’ J Drugs Dermatol, 11 (2012) (1 Suppl), 5-8
Upgrade to become a Full Member to read all of this article.