A Novel Injection Method to Improve Perioral Cosmesis with Hyaluronic Acid Filler

1Anny Xiao, D.O., 1Renee Lucero, D.O., 2William T Kirby, D.O., FAOCD 1Western University of Health Sciences/Chino Valley Medical Center; 2LaserAway, Private Practice Hermosa Beach, CA

INTRODUCTION Intraoral Injection Technique for Perioral Rejuvenation Advantages Limitations Decreased soft tissue Theoretical higher risk of Injectable fillers for facial rejuvenaon have become one of the most This intraoral perioral injecon technique was developed by Dr. Will Kirby and inspired by mulple paents who reported an trauma compared to bacterial infection due to frequently performed nonsurgical cosmec procedures in the U.S.1 improvement in their perioral aesthecs while wearing dental retainers. As such, this technique is designed to place HA filler intraorally percutaneous injection bacteria colonization of Perioral aesthecs play an integral role in maintaining a youthful in the same areas that would be volumized by dental retainers. While previous intraoral injecon techniques have been described for techniques, resulting in oral cavity, although appearance. Aging of the perioral area may result from repeve correcon of volume deficiencies in the midface, with placement of filler in the deep subcutaneous and supraperiosteal planes to less swelling and anecdotally not observed bruising.9 contracon of the perioral muscles, sun exposure, thinning of the skin, restore volume in the malar cheeks6,7, this injecon technique is a new applicaon of the intraoral injecon approach specifically atrophy of subcutaneous fat, ptosis of the malar fat pads and loss of designed for perioral aesthec rejuvenaon. Decreased tissue Requires very thorough structural bone support.2 Volume loss from the nasolabial and 1. Review informed consent with paent, including potenal side effects of any HA filler injecons, including swelling, tenderness, distortion (as a result of knowledge of the labiomandibular folds leads to deeper creases and shadows. The lips bruising, erythema, nodules, and vascular compromise. reduced swelling) underlying anatomy to facilitates more precise avoid injecting into become thinner with decreased definion in the vermilion border and 2. Provide the paent with a mirror and review their perioral anatomy to discuss goals and realisc expectaons. Assess the extent of perioral lines, folds, and shadows to customize treatment to each paent. aesthetic assessment perioral blood vessels or loss of subcutaneous fat in surrounding skin accentuates the perioral fine and placement of filler in near nerves 3. Determine which HA filler with low elascity and low viscosity will be used for injecon. wrinkles from repeve orbicularis oris contracon.2 Injecons of the appropriate 4. Cleanse the oral cavity with a chlorhexidine-based mouthwash and cleanse the perioral skin with chlorhexidine soluon. 7 hyaluronic acid (HA) filler can address many of these concerns in the anatomical locations. 5. Ulize non-dominant hand to manually evert the paent’s lower lip with to expose the interior mucosal side of the lip. Figure 3 perioral region to provide opmal facial harmony and rejuvenaon. Significant decrease in May be more difficult for 6. Inject approximately 0.1 cc aliquots of filler in four evenly spaced depot injecons in the lower mucosal lip, approximately halfway reported patient patient to visually PERIORAL ANATOMY down the vercal length of inferior mucosal lip, with each aliquot directly opposing one of the four mandibular incisors. The size of the discomfort when monitor the injection aliquots, total amount injected, and placement of each aliquot may be adjusted according to the paent’s specific deficits. Figure 4-5 compared to traditional area for adverse side 7. Repeat the same technique on upper lip: Use non-dominant hand to manually evert paent’s upper lip to expose the interior mucosal percutaneous perioral effects after leaving clinic injections side of the lip. Figure 6 8. Inject approximately 0.1 cc aliquots of filler in four evenly spaced depot injecons in the upper mucosal lip, approximately halfway up CONCLUSION the vercal length of the superior mucosal lip, with each aliquot directly opposing one of the four maxillary incisors. Figure 7-8 9. Avoid injecng too close to the vermilion-mucosa juncon in the superior labial mucosa to minimize the risk of injury to the This intraoral perioral injecon technique anastomoc arch of the superior labial arteries.. Tansat et al described the typical posion of the superior labial artery 4.5mm deep facilitates more precise placement of filler with along the upper lip between the oral mucosa and the orbicularis oris muscle just above the vermilion-mucosa juncon.8 As with all filler less discomfort, leading to high paent sasfacon coupled with minimal and predictable side effects. injecons, intravascular injecon risk can be minimized by precise needle placement and injecng very slowly.5 The technique can be customized to each paent Figure 1. Musculature and arterial supply 10. Manually massage the injected areas by pinching the upper and lower lips with the index fingers intraorally and thumbs on the to effecvely correct volume deficiencies and external cutaneous lip. Apply gentle to moderate pressure to smooth out superficial lumps and contour irregularies. enhance perioral aesthecs to maintain a youthful 11. Cool compresses/ice packs can be ulized to minimize post-procedural swelling. appearance. Because the KXIO technique can be more technically challenging for novice injectors, a thorough understanding of the relevant anatomical features, proper paent selecon, realisc paent expectaons, and a precise evaluaon of a paent’s personal correcve needs are paramount for opmal outcomes.

Figure 2. Surface anatomy REFERENCES

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