MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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24 JULY/AUGUST 2015 | Med Esthetics LIP SERVICE The challenge for physicians is creating natural-looking lip enhancement while also identifying the best tools to address surrounding concerns, such as perioral rhytides, marionette lines and deepening nasolabial folds. "The perioral area can be simple in young patients and complex in older patients," says Richmond, Virginia-based facial plastic surgeon Joseph Niamtu III, DMD. A Full-Face Approach Improving and enhancing the lip area requires physicians to take into account both the patient's treatment goals and existing anatomy. Hence, a thorough pretreatment evaluation is essential for optimal outcomes. "When I assess lips, I fi rst ascertain the goal of treat- ment. For example, if the goal is to provide structural change, such as signifi cant lip eversion, then a product with good lift capacity is essential," says Vince Bertucci, MD, president elect of the Canadian Dermatology Association and medical director of Bertucci MedSpa in Woodbridge, Ontario, Canada. "On the other hand, if lip shape is already satisfactory but there is volume loss leading to superfi cial rhytides within the vermilion of the lip, then a fi ner product such as Restylane Silk (Galderma) or Juvederm (Allergan) might be a better choice." He stresses that lips must be evaluated in relation to the entire face. "The lips do not exist in isolation. Balance, harmony and proportion must be primary considerations when contemplating lip augmentation and perioral reju- venation," says Dr. Bertucci. "For example, it would be inappropriate to create very large lips in an individual with a small face." He notes that it is not uncommon for younger patients, especially those in their 20s, to request lip enhancement that is out of proportion to the rest of the face. "Thus, we often have to educate patients about the importance of balance, harmony and proportion when addressing lips," he says. "Representative before and after photos go a long way in showing prospective patients that lips may be enhanced in a tasteful manner. For physicians, recognizing what is and isn't possible and setting realistic expectations is just as important as mastering injection techniques." When a patient comes to Day Dermatology & Aesthet- ics in New York City for lip treatment, Doris Day, MD, who specializes in aesthetic, laser and surgical dermatolo- gy, fi rst asks the patient to smile. "I want to see the struc- ture of their teeth. Lack of dental support, such as teeth that angle inward and therefore do not provide enough support for the lips can lead to major problems in the perioral area," she says. "I also look at the position of the lips at rest. Lots of women have a habit of pursing their lips, and nothing we do will work for long if they don't break that habit. I tell them that lips should only touch when kissing." She counsels patients to stop smoking and stresses the importance of good skin care. "It is important to practice good skin care. Ongoing use of products with active ingredients like growth factors and retinols can have a signifi cant impact," says Dr. Day. For older patients, the degree of age-related volume loss and sun damage will affect treatment choice. "For mild cases of perioral rhytides, soft tissue fi llers are often suffi cient," says Dr. Bertucci. "However, for more severe perioral wrinkles, I fi nd that combination therapy with fi llers, neuromodulators and laser resurfacing provides the best outcome." But factors other than age will infl uence treatment choice. "Cost and recovery time are also major consid- erations. Some patients may opt for aggressive CO 2 laser treatments with two weeks of healing, whereas other pa- tients may only have a lunch hour for recovery," says Dr. Niamtu. "When a patient presents with multiple perioral aging factors and says, 'I can only afford one syringe,' I tell these patients to save their money and return when they can afford the necessary volume of fi ller." Dr. Day's treatment approach is to gain an under- standing of why the wrinkles are there and then use the simplest, least invasive method to correct them. "I con- sider the whole face fi rst. If there's a lot of volume loss in general, lifting the midface can change the way the mouth is used. If there is a lot of sun damage, laser resurfacing is Midface volume replacement can signifi cantly affect the appearance of the lips and perioral area. © GETTY IMAGES