Medesthetics

MAY-JUN 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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BANISHING LIP LINES As patients reach their 50s and beyond, lip lines and a lack of defi nition become key concerns. "I have a lot of patients in their 60s and 70s, and they complain that their lipstick is running, and they also have these so-called 'smoker's lines' that bother them," says Dr. Greenberg. "For these patients, I want to create a more defi ned lip border." He uses Restylane for the lip border and Juvederm, which is a little softer, for the bulk of the lip. "Working on the border and fi lling the lips will help a little bit with the lip lines, but they may also need microneedling or ablative laser skin resurfacing," says Dr. Greenberg. Dr. Hamori fi nds that the majority of age-related lip concerns can be addressed with fi llers and neuromodula- tors, such as Botox, Dysport or Xeomin. "The muscle around the mouth is very strong and that is what's causing the tiny, fi ne radial lines around the lips. It is these lines that most older patients worry about when they look in the mirror," she says. "A way to approach this is to weaken that muscle just a little bit. Botox is injected into the muscle around the lip to relax it, and then an HA fi ller like Volbella or Restylane is injected into the troughs of the lip lines to pop them out." DOWNTIME CONCERNS Downtime is a key concern for today's aesthetic pa- tients, and many are surprised by the extent of bruis- ing and swelling that occurs following lip injections. "Lips are tricky because this area is so well vascular- ized," says Dr. Greenberg. "Patients are going to bruise and swell." To reduce postprocedure swelling, he instructs his patients to apply ice to the area for 15 minutes on and 15 minutes off for a couple hours after treat- ment. "I also do an intraoral ring block on everyone," he says. "This shrinks the vessels and takes away the pain, so you get less bruising and no pain during treatment." To minimize the brusing that still occurs, he recom- mends arnica supplements and has all patients sit under red light immediately post treatment. "I have a LightStim, which is a red and infrared device that reduces infl ammation," he says. "I put my lip patients under the LightStim, and we don't charge extra. It is part of the procedure price." If a patient has more signifi cant bruising or an event, he will use a pulsed dye laser immediately after treat- ment, followed by a second session the next day. In an effort to reduce bruising and the risk of com- plications, Dr. Fabi uses blunt-tipped cannulae and a single insertion point on each side of the lips that allows her to inject product into both the lower and upper quadrants. "This decreases both bruising and swelling," she says. "With two little injection points, you can cover the entire lip and minimize downtime for your patients." Practitioners should also ask patients if they have a history of cold sores, which can be exacerbated by the fi ller injection. If a patient has a history of HSV, Dr. Greenberg gives them one gram of Valtrex in the offi ce and instructs them to take two more rounds of Valtrex—morning and night—for the two days follow- ing treatment. COMBINATION TREATMENTS As with many aesthetic concerns, patients seeking lip enhancement often benefi t from a combination of treatments. "If someone comes in with lip lines, for example, you can't reduce all the lines or make them disappear with injections," says Dr. Green. "You have to combine them with microneedling, chemical peels or a resurfacing laser, such as the Fraxel, to get a better look. It is almost always a combination of modalities that gives the best results for patients." Daniel Casciato is a freelance writer based in Pittsburgh. 40 MAY/JUNE 2018 | Med Esthetics Only 1cc of a hyaluronic acid gel fi ller was needed to defi ne and plump this patient's lips. BEFORE BA NISHING LIP LINE S As patients reach their 50s and beyond, lip lines and a la ck of definition become key concerns "I have a lot of patien ts To minimize the brusing that still occurs, he recom- mends arnica supplements and has all patients sit un der red light immediately post treatment "I hav e PERFECT POUTS AFTER PHOTOS COURTESY OF SABRINA FABI, MD; © GETTY IMAGES

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