A dual plane for lips too?
My favorite technique for lip volumization, which I have developed in recent years, is based on the creation of a double plane or dual plane; first a submucosal plane and then a second subdermal plane.
The intra - submucosal plane allows the lip to be volumized and hydrated in a very natural way. Defects such as lumps are extremely rare, because the filler is protected by two anatomical structures, that act as cushions. It is the orbicularis oris muscle in a deep plane, while on the surface there is the submucosal fat pad. Furthermore, by conveying the filler first in this space, the nerves' fibers are anesthetized, increasing the comfort of the treatment. It is a medium deep space. The tip of the cannula is not visible but can be perceived by observing the ripple of the mucosa.
Working in the subdermal plane it is possible to enhance the elevation of the lip both at the top and at the bottom, and it is also possible to draw the contours of the lip. It is better to perform this procedure after submucosal volumization, because it is more painful. Letting the anesthetic act at a deep level, the patient's comfort is excellent. This is an extremely superficial plane, the tip of the cannula is always visible on the surface during this procedure.
The result of the dual plane is immediately visible and harmonious, in addition there is no visible hematomas or defects, the patient's comfort was excellent for the entire duration of the procedure. Bleeding is reduced to zero because the plane is cleaved between anatomically separate structures, so no tissue or blood vessel has been damaged.
The procedure always begins with deep volumization and then moves to the surface. The amounts of filler used will reflect the patient's desire for vermilion volume and elevation.
Using the needle we usually run into two situations, both of which are caused because lips anatomy is not respected.
The first situation is the deep "intramuscular" injection which causes bleeding and bruising, but also a longer duration of the effect because of the encapsulation of the filler (deep lumps). Here an abyss literally opens up, because the filler lasts longer and by using the right techniques you can minimize the risks. Surely the safest technique is that of the microbolus, which causes defects that are difficult to perceive by the patient, while maintaining a longer duration due to the encapsulation of the filler and the formation of collagen. Although it seems an attractive choice, especially for the patient, I don't usually perform this technique because in case adverse events happen, they are always serious and not easy to resolve. Intervention with hyaluronidase is often required.
The second situation is superficial or intradermal injection, with the formation of superficial and visible "cobbled lip" defects. They are usually minor defects that resolve spontaneously within a few weeks.
The correct plane is No. 3, extremely difficult to perceive with the needle, a lot of experience and sensitivity is required. The best technique is vertical with micro boluses.
The photo shows the needle technique, correctly performed, at the resolution of the bruises, therefore about 7 days after.
However, I still prefer the creation of the double plane with cannula. Both for the naturalness of the result, but in particular for the healing time equal to zero and for the absence of multiple entrance wounds for possible injections, in fact only two injections are practiced, instead of dozens as in the case of the needle. In all cases, my patients can go out for dinner or an aperitif right after the procedure.
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