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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26 JULY/AUGUST 2015 | Med Esthetics helpful—we don't treat the perioral area in isolation," she says. "Ablative fractional resurfacing works best, but some patients may balk at the fi ve days of downtime required. We use the UltraPulse Fractional CO 2 laser (Lumenis). But patients will usually be dissatisfi ed unless you do something to address the perioral area directly if that's their main area of concern." Lip Augmentation The newest treatment tool for lip augmentation is Restylane Silk. The hyaluronic acid-based fi ller is FDA approved specifi cally for lip enhancement and the treat- ment of wrinkles and lines around the mouth in people over the age of 21. "I have been hesitant to use fi llers in the perioral area in the past because it was diffi cult to get a natural-looking result," says Dr. Day. "Earlier fi llers added too much bulk. Now, with Restylane Silk, I fi nd I can support the tissue around the mouth and remove the look of tension while maintaining a natural, soft look. Restylane Silk's fi ne texture makes it a special product, but there is a learning curve. I was one of the early adopters and have found that proper injection technique can help prevent swelling. It's important to inject small amounts slowly. Never be aggressive in this area and do not massage the fi ller." In the FDA trial of Restylane Silk, 98% of the 221 pa- tients showed visible improvement 14 days after injection, and 76% still had lip improvement at six months, an ad- vantage over many other products that lasted only three to four months in the perioral area. The smooth gel al- lows the use of a smaller needle than typically required by many other fi llers, which also improves patient comfort. "I am delighted with Restylane Silk," says Dr. Mandy. "It gives a very natural defi nition and lustrous appearance without overfi lling. If it is used to volumize, however, there is the risk of prolonged swelling." Although it has been approved for use in the U.S. for less than a year, Restylane Silk does have a good safety record. "It has been available in countries such as Canada and Europe for over 10 years," says Dr. Bertucci. "Silk's proven effi cacy and safety record in other countries provides a level of reassurance when using the product. Silk has the smallest particle size of the Restylane products available in the U.S., and that makes it well suited for refi ning and defi ning lips as well as for treating perioral rhytides. Superfi cial injection is possible, meaning that fi ne lines can be nicely effaced. Integral lidocaine within Silk provides improved comfort over existing fi llers used for perioral rejuvenation that do not contain local anesthetic." Dr. Niamtu agrees that Restylane Silk offers some advantages, but he says the skill of the injector is more important than the fi ller being used. "Expert injectors have been treating fi ne lines for many years with various methods, including diluting the fi llers. Countries outside of the U.S. have had the advantage of more superfi cial fi llers like Silk for years—I think it will become a popular fi ller and that all major fi ller companies will offer similar products." David Alessi, MD, founder and medical director of the Alessi Institute for Facial Plastic Surgery in Beverly Hills, California, says Restylane Silk is similar to Belotero Bal- ance (Merz Aesthetics) and sees no advantage from one to the other. "I often combine Botox to the lip depressors with fi llers," says Dr. Alessi. "And don't forget about fat injections instead of fi llers for adding lip volume." Rejuvenation in Older Patients Rejuvenating the perioral area in older patients often requires multiple approaches. "My 'bag of tricks' for these treatments includes: light fi llers (low G prime) such as Restylane Silk or Belotero for fi ne line injection or lip To achieve the best results, look at the entire face before developing a perioral treatment plan. © GETTY IMAGES v r ggr r ot ssag t ll r." LIP SERVICE