Lip Augmentation - hyaluronic acid

Hyaluronic acid (like collagen) is an important element of the skin, which greatly contributes to maintaining its elasticity. Both the aging process and the harmful effects of the environment cause their loss, sagging of the skin and, as a consequence, the formation of wrinkles. The lips play a very important role in mimic expression, thanks to which the human mood can sometimes be assessed by observing only the corners of the mouth.

Lip Augmentation -hyaluronic acid- characteristics

In the lips there is a very high concentration of nerves, which makes them extremely sensitive and sensitive to pain. The lip skin is very thin compared to the cell layers of the rest of the face (it consists of 3 to 5 cell layers). In addition, the skin covering the lips does not contain melanocytes (in people with fair skin), i.e. cells that give the skin colour. For comparison, the lips of people with darker complexion are darker because they contain more melanocytes. However, despite the lack of pigment-giving cells, the lips take on a red colour, which is associated with their very heavy blood supply (more specifically, the flow of blood in superficial vessels).
The area of the lower lip is supplied with blood through the lower lip artery and the upper lip - respectively - through the upper labial artery. It is important that the skin of the lips does not contain hair, sweat glands or tallow. This means no lipid (fat) protection that is present in the skin of the other parts of the body. For this reason, the lips are more sensitive and have a predisposition to dry faster. The basis of the motor system of the lips is the round muscle of the mouth (musculus orbicularis oris). Its outer part, i.e. the one further away from the lip, contributes to the reduction of the oral cavity, the lip of the lips, as when whistling. The contraction of the part lying at the edge of the lip will cause the labia to bend inward towards the front teeth and reduce its visible part. All facial muscles that pull the lips or angles of the lips sideways, upwards or downwards, thereby expanding the lip of the mouth, are antagonists, i.e. act opposite to the circular muscle of the mouth.

Lip Augmentation -hyaluronic acid - benefits

The lips are a symbol of sensuality, which affects the attractiveness of a human being. According to the prevailing fashion, the perfect lips are full, symmetrical with a healthy colour. The fullness of the lip can be assessed by the height of its vertical diameter. In the case of juvenile lips, the lower lip has a larger volume than the upper one.
If the patients are not satisfied with the appearance of their mouths, you can use a filling procedure with hyaluronic acid (Enlargement and mouth filling with hyaluronic acid), which due to its consistency and durability is the most suitable. You can influence the degree of lips filling, the contours of their edges, the degree of marking the Cupid's bow, lifting the corners of the lips and smoothing fine, radially running wrinkles. Cupid's bow stretches across the lip of the labium and the skin of the upper lip between the two uppermost points of the upper lip.
The undoubted advantage of hyaluronic acid is the lack of the risk of allergic reaction from the body, due to the fact that hyaluronic acid is present in the human body naturally and despite the fact that the used in the procedure is obtained from combs of cocks and from bacterial cultures, by fermentation it is fully accepted by the body. Hyaluronic acid has the additional ability to retain water, so that the lips take after the treatment a fresh and firm look.

Lip Augmentation -hyaluronic acid- indications for the procedure

An indication for the procedure of enlarging and modelling the lips with hyaluronic acid is the desire to model the lips, mark the contours of their edges, mark the Cupid's arc, raise the mouth angles, or smooth out fine radially running wrinkles.

Lip Augmentation -hyaluronic acid- contraindications for the procedure

Although the procedure of enlarging and modelling the lips with hyaluronic acid is not particularly invasive, there are a few contraindications to its implementation. They coincide with the other treatments of aesthetic medicine related to the use of hyaluronic acid. Belong to them:
• Acne - in the case where the facial area undergoing treatment, in this case the lips and skin of the lips, are affected by acute or chronic infections, such as acne or herpes, do not use fillers. There is a high risk of infecting the injection site.
• Reduced immunity - reduced patient's resistance may be a contraindication to the procedure of Lip Augmentation -hyaluronic acid. Weakening of the immune system may be caused by the use of a specific drug therapy (eg in the case of immunosuppressive therapy - i.e. before transplantation) and autoimmune diseases in which their own tissues are recognized by defence cells as foreign and attacked by them. It should be kept in mind that the body is unable to effectively defend itself in case of infection of the injection site.
• Some medicines - there is a group of medicines that can be contraindicated for lip enlargement and modelling using hyaluronic acid (this also applies to other fillers). I am talking about anticoagulant drugs that thin the blood, which includes acetylsalicylic acid, as well as analgesic and anti-inflammatory. They should be discontinued in due time before the surgery, due to the increased risk of bleeding during the procedure, ultimately leading to the formation of hematomas and bruises, which spoil the cosmetic effect as a last resort, especially that the lips are perfectly vascularised area of ​​the face. Also taking so-called non-steroidal anti-inflammatory drugs, which include ibuprofen or diclofenac, should be terminated in a timely manner before the procedure with the use of fillers.
• Other treatments - if you have recently performed aesthetic medicine in the mouth area, consult your doctor. This applies to laser treatments, peels, dermabrasion, ie treatments involving mechanical abrasion of the epidermis and upper layers of the dermis with a special device with abrasive material (diamond brush, wire, sandpaper), as well as other treatments using fillers.
• Age - in the case of children and adolescents under the age of 18, one renounces from performing wrinkle repair using hyaluronic acid as well as other fillers.

Lip Augmentation -hyaluronic acid- before the procedure

Before the procedure of enlarging and modelling the lips with hyaluronic acid, the doctor conducts an obligatory conversation with the patient. He is obliged to discuss the course of the procedure, inform the patient about possible side effects, talk about the purpose of the therapy, as well as its alternatives, the duration of the effect after the procedure, the price of the procedure. Most generally speaking, he will probably raise all the issues described in this article. At this moment, the doctor will also ask about the patient's past history, that is the medical history, about possible hypersensitivity (e.g. anaesthetic), as well as previous treatments of this type. It should be remembered that some of them may be a contraindication to the procedure of enlargement and lip modelling using hyaluronic acid. Before surgery, it is also necessary to establish a way of anaesthesia with the doctor. It is also time for the patient to ask questions freely to clarify open questions. At the end of the conversation, the doctor will ask the patient for written consent to the procedure.

Lip Augmentation -hyaluronic acid- type of anaesthesia

Lip Augmentation -hyaluronic acid- type of anaesthesia
The procedure of enlarging and modelling the lips with hyaluronic acid may prove somewhat painful, due to the fact that the lips are very well innervated. Nevertheless, the use of an appropriate anaesthetic technique reduces the pain to almost zero. The first stage of anaesthesia is the cooling of the place being treated, i.e. the area around the mouth. Then, common in aesthetic medicine, local anaesthesia is used (in this case only the areas around the lips and lips are anesthetized), by using special creams, e.g. Emla 5% or other preparations containing an anaesthetic, mainly Lignocaine 2%. It involves injecting the area subjected to the treatment with such a measure.

The application of the product itself is quite unpleasant, it gives a burning sensation or spreading. However, it provides a rather painless course of the procedure as well as prevents pain even a few dozen minutes after its completion. In both the solution for injection and the cream, the active substance is lidocaine, a local anaesthetic drug with an amide structure. Lidocaine inhibits the formation and transmission of nerve impulses. Side effects of lidocaine include: metallic taste in the mouth, sensory discomfort in the lips and tongue, feeling of bewilderment, agitation, anxiety, euphoria, muscle tremors, drowsiness, disturbances in consciousness, headaches and dizziness, tinnitus, paraesthesia (feeling of numbness) or tingling), loss of consciousness, incoherence of speech, convulsions. However, they occur relatively rarely.

How is the procedure performed?

Lip Augmentation -hyaluronic acid- how does the procedure work?
The modelling / lip filling treatment with hyaluronic acid takes place in several stages:
The first of these is the removal of makeup. This operation seems to be obvious, because lips painted with lipstick can be a hindrance for the doctor performing the procedure. Moreover, during the injection, i.e. injection, the place of injection could get dirty with the cosmetic. It is worth to come for a treatment without make-up.
The next step is the disinfection of the body area undergoing surgery, in this case the area of ​​the lower lip and upper lip. Disinfection is the process of destroying or removing vegetative forms of microorganisms (e.g. bacteria) to a safe level for humans. Various disinfectants are currently used; choosing any of them is at the discretion of the doctor. Nevertheless, it is a completely painless part of the procedure.

Then an anaesthetic is given. This is the least pleasant part of the procedure. It involves some painful stings and the introduction of anaesthetic, usually Lignocaine, into the mouth area. This can cause a feeling of stretches or burning. You can also use Emla cream 5% (where 1 g of cream contains: 25 mg lidocaine, 25 mg prilocaine). It takes some time for the anaesthetic to start working. As a rule, it takes about several dozen seconds.
After the administration of anaesthesia, the right part of the modelling and lip filling procedure starts with hyaluronic acid. For the purpose of the procedure, the lips are divided into four default quadrants: upper right, upper left, lower right and lower left. The doctor performs injections using the linear method. In this technique, the lips are punctured on the sides and tunnelled subcutaneously in the medial direction. The order in which the doctor performs the injection is not insignificant. And so: in the first place the right upper lip of the patient undergoes the quadrant filling, then the upper left, the lower left and finally the lower right. Within each quadrant, the injection looks almost the same.
In the case of the upper right quadrant, the therapist turns the lip (squeezing) between the thumb and forefinger. Puncture is always 0.5 cm medially from the angle of the mouth, and the needle is inserted into the Cupid's arc under palpation control, i.e. under touch control. The puncture runs parallel along the contour of the lip. Hyaluronic acid is given during the extraction of the needle. Then the doctor makes another injection at the right highest point of the upper lip and follows the outline of the Cupid's arc towards the centre.

The upper left quadrant - next in order - is filled in the same way as the right one. The lower ones are also filled in accordance with the above scheme, with the difference that they should include the anatomical absence of Cupid's arc. Each quadrant has approximately 0.1-0.25 ml of hyaluronic acid volume.
The modelling / filling procedure of the lips with hyaluronic acid also contributes to the filling of possible small wrinkles on their surface.

The lip contouring scheme is similar, with the difference that injections are made at the border of the skin of the lips and labial lip (along the contours). In addition, the cupid arc is omitted, and for each quadrant there is 0.1 ml of hyaluronic acid volume.

The procedure of underlining the arches of Cupid and nasal gutter differs slightly from the others. First, the doctor performs the injection at the highest point of the arch and guides the needle to its centre. The operation repeats on the opposite side. The injection technique is linear, as before, i.e. the needle is tunnelled subcutaneously; also under palpation control. Then, in the second part of the procedure, the doctor punctures at the highest point of the arch and directs the needle along the border of the nasal cavity towards the nose. However, this time it uses a compression technique, which means that it grabs the vertical fold of the upper lip with the thumb and forefinger, so the injection takes place at the so-called compression. Both in the case of linear and compression techniques, hyaluronic acid is injected during the extraction of the needle. In order to emphasize the Cupid arc, the minimum filler volume is used, while the volume of the acid used is about 1 ml per side.
The procedure of lifting angles provides for three injections per side. The first of these doctors performs over the apex of the mouth angle, the puncture depth is 1 mm and the volume of injected filler is equal to 0.1 ml. The second injection, contributing to a slight elevation of the upper lip, is performed slightly above the first one to a depth of 1 mm and 5 mm towards the centre of the lip.

The third in turn is performed below the first piercing to a depth of 5mm, and hyaluronic acid is injected during extraction. For both the second and third injections, the filler volume is 0.1-0.2 ml.
Then directly after the injections, the doctor performs a massage to model the filling and its even distribution. By aggregating the material used (in this case hyaluronic acid), you can develop palpable nodules that are also modelled and smoothed at this point. In addition, lip massage can be a good method to relieve pain after surgery, although in such a short time after surgery should still work the anaesthetic agent given at the beginning.
The final stage of the procedure of enlarging and modelling the lips with hyaluronic acid is cooling the area of the lower lip and the upper lip. This is mainly aimed at reducing pain and preventing the formation of swellings after previous injections.
After the surgery, please report to the doctor within the time limit set by him to assess cosmetic and aesthetic effects, as well as progress in convalescence.

Lip Augmentation -hyaluronic acid- time and course of convalescence

The convalescence time varies between patients. It is estimated from several days to several weeks.

Lip Augmentation -hyaluronic acid- effects after the procedure

An important advantage of plastic surgery and aesthetic medicine is the fact that the effect is visible immediately - immediately after the procedure. When enlarging and modelling the lips with hyaluronic acid, enlargement of the tissue at the injection site is visible. Hyaluronic acid injected into the skin fills the mouth as if from the inside, making it fuller and firmer. However, this cannot interfere with the natural function of the mouth (e.g. when speaking) and feeling (e.g. during a kiss).

Lip Augmentation -hyaluronic acid- recommendations after the procedure

Immediately after the procedure of enlarging and modelling the lips with hyaluronic acid, the lips should be cooled slightly to keep the tissue reaction as low as possible. During the first few days (a week) after the injection of hyaluronic acid, excessive pressure should not be exerted on the treated skin area, and all kinds of sports exercises should be practiced with moderation. It is also advisable to use all kinds of lipsticks, lip glosses and creams at this time. In the following weeks, it is recommended to avoid excessive cold, heat or sun exposure. It would therefore be necessary to temporarily cancel visits to the sauna or solarium.

Lip Augmentation -hyaluronic acid- how long do the effects last after the treatment?

The effect after the procedure of enlarging and modelling the lips with hyaluronic acid stays constant, therefore to achieve a good result, it is not necessary to repeat the treatment, which is its undoubted advantage. An exception is the procedure of lifting the mouth angles, which requires repetition, in cases when the initial reduction of the mouth angles is very pronounced. However, it is difficult to estimate the time after which the procedure should be repeated.

How to avoid complications after the procedure?

It should be noted here that it is not always possible to avoid complications. The patient can, however, reduce the risk of their occurrence by following the doctor's instructions after the procedure and by going on appointments.

Possible complications after the procedure

Generally speaking, treatments related to the use of hyaluronic acid as a filler are safe. However, they carry a certain risk of complications and side effects. These include: itching, hematoma, sensation disorder, excessive pigmentation, skin discolouration. Sometimes the patient's body responds to the procedure with flu symptoms, i.e. head and muscle pains, general malaise, nausea, etc. Rarely, as a result of improper injection of the filler or poor distribution, clumps may be visible or felt to the touch. Sometimes the filler may be moved to a different area of the face, so that the filling effect will be visible in an undesirable location.
In some cases, tissue necrosis may occur as a consequence of injecting the filler into a blood vessel and causing embolism. However, it should not take place when it is professionally performed.
It is possible that the effect of wrinkles filling will be hardly visible due to the injection of too little hyaluronic acid or as a result of uneven diffusion of the filler (hyaluronic acid).

Lip Augmentation -hyaluronic acid- recommended additional treatments after the procedure

Often, the patient has other wrinkles and imperfections on the face which can be compensated by applying filler treatments. Additional recommended treatments include:
• Rhinoplasty with nasal surgery
• Removing eye shadows under hyaluronic acid
• Filling the nasolabial furrows
• Wrinkle filling with hyaluronic acid (crow's feet)
• Wrinkle filling with hyaluronic acid (lion's wrinkle)
• Levelling the valley of tears with hyaluronic acid
• Firming with hyaluronic acid (Skin Booster)

Author: Jakub Kledzik, MD
Substantive verification: Piotr Bargiel, MD
Literature:
Art or medicine: a guide to aesthetic surgery; 1995; Andrzej Sankowski, Sławomir Łoń; Aesthetic medicine without secrets; 2016 Marek Wasiluk; Fillers in aesthetic medicine: Good looks are well-being; 2011; Gerhard Sattler, Boris Sommer, Bernard C. Kolster; Atlas of treatments using fillers in aesthetic medicine: volume 2: Aesthetic treatments in skin rejuvenation; 2010; Gerhard Sattler, Boris Sommer; Methods of soft tissue filling used in cosmetology; 2008; editors: Jean Carruthers, Alastair Carruthers