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

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A Novel Injection Method to Improve Perioral Cosmesis with Hyaluronic Acid Filler 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 rejuvena3on have become one of the most This intraoral perioral injec3on technique was developed by Dr. Will Kirby and inspired by mul3ple pa3ents who reported an trauma compared to bacterial infection due to frequently performed nonsurgical cosme3c procedures in the U.S.1 improvement in their perioral aesthe3cs while wearing dental retainers. As such, this technique is designed to place HA filler intraorally percutaneous injection bacteria colonization of Perioral aesthe3cs play an integral role in maintaining a youthful in the same areas that would be volumized by dental retainers. While previous intraoral injec3on techniques have been described for techniques, resulting in oral cavity, although appearance. Aging of the perioral area may result from repe33ve correc3on 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 contrac3on of the perioral muscles, sun exposure, thinning of the skin, restore volume in the malar cheeks6,7, this injec3on technique is a new applica3on of the intraoral injec3on approach specifically atrophy of subcutaneous fat, ptosis of the malar fat pads and loss of designed for perioral aesthe3c rejuvena3on. Decreased tissue Requires very thorough structural bone support.2 Volume loss from the nasolabial and 1. Review informed consent with pa3ent, including poten3al side effects of any HA filler injec3ons, 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 defini3on in the vermilion border and 2. Provide the pa3ent with a mirror and review their perioral anatomy to discuss goals and realis3c expecta3ons. Assess the extent of perioral lines, folds, and shadows to customize treatment to each pa3ent. 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 elas3city and low viscosity will be used for injec3on. wrinkles from repe33ve orbicularis oris contrac3on.2 Injec3ons of the appropriate 4. Cleanse the oral cavity with a chlorhexidine-based mouthwash and cleanse the perioral skin with chlorhexidine solu3on. 7 hyaluronic acid (HA) filler can address many of these concerns in the anatomical locations. 5. U3lize non-dominant hand to manually evert the pa3ent’s lower lip with to expose the interior mucosal side of the lip. Figure 3 perioral region to provide op3mal facial harmony and rejuvena3on. Significant decrease in May be more difficult for 6. Inject approximately 0.1 cc aliquots of filler in four evenly spaced depot injec3ons in the lower mucosal lip, approximately halfway reported patient patient to visually PERIORAL ANATOMY down the ver3cal 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 pa3ent’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 pa3ent’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 injec3ons in the upper mucosal lip, approximately halfway up CONCLUSION the ver3cal length of the superior mucosal lip, with each aliquot directly opposing one of the four maxillary incisors. Figure 7-8 9. Avoid injec3ng too close to the vermilion-mucosa junc3on in the superior labial mucosa to minimize the risk of injury to the This intraoral perioral injec3on technique anastomo3c arch of the superior labial arteries.. Tansa3t et al described the typical posi3on 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 junc3on.8 As with all filler less discomfort, leading to high pa3ent sa3sfac3on coupled with minimal and predictable side effects. injec3ons, intravascular injec3on risk can be minimized by precise needle placement and injec3ng very slowly.5 The technique can be customized to each pa3ent 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 effec3vely correct volume deficiencies and external cutaneous lip. Apply gentle to moderate pressure to smooth out superficial lumps and contour irregulari3es. enhance perioral aesthe3cs to maintain a youthful 11. Cool compresses/ice packs can be u3lized 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 pa3ent selec3on, realis3c pa3ent expecta3ons, and a precise evalua3on of a pa3ent’s personal correc3ve needs are paramount for op3mal outcomes. Figure 2. Surface anatomy REFERENCES CONVENTIONAL TECHNIQUES FOR PERIORAL HA FILLER 1. Ibrahim O, Berson DS, Rohrer TE. Trends in Dermatologic Surgery: Results of the American Society for Dermatologic Surgery Procedure 3-5 and Consumer Surveys. Dermatologic Surgery. 2019 Feb 1;45(2): Percutaneous injec3on techniques and indica3ons : 303-6. • Retrograde linear threading: Needle is withdrawn as filler is injected like 2. Ponsky D, Guyuron B. Comprehensive surgical aesthetic enhancement Figure 8a. Before intraoral HA filler Figure 3. Manual eversion of lower liP Figure 4. Intraoral injecXon of lower Figure 5. Intraoral injecXon of lower liP and rejuvenation of the perioral region. Aesthetic surgery journal. a thread 2011 May 1;31(4):382-91. injecXon to exPose injecXon sites lip • Labiomandibular folds, labiomental crease, nasolabial folds, perioral 3. Klein AW. Techniques for soft tissue augmentation. American journal ver3cal rhy3ds, oral commissures of clinical dermatology. 2006 Apr 1;7(2):107-20. 4. Buckingham ED, Glasgold R, Kontis T, Smith Jr SP, Dolev Y, Fitzgerald R, • Anterograde linear threading: Filler is injected like a thread ahead of the Lam SM, Williams EF, Pollei TR. Volume rejuvenation of the lower advancing needle third, perioral, and jawline. Facial Plastic Surgery. 2015 Feb;31(01): 070-9. • Oral commissures, perioral ver3cal rhy3ds 5. Chiu A, Fabi S, Dayan S, Nogueira A. Lip Injection Techniques Using • Fanning: Retrograde linear threading as the needle is withdrawn but Small-Particle Hyaluronic Acid Dermal Filler. Journal of drugs in dermatology: JDD. 2016 Sep;15(9):1076- 82. changing direc3on prior to being removed, producing a wheel spoke 6. Dayan SH, Bassichis BA. Facial dermal fillers: selection of appropriate palern products and techniques. Aesthetic surgery journal. 2008 May 1;28(3): 335-47. • Labiomandibular folds, nasolabial folds, deeply etched lines 7. Anand CV. Intraoral approach: A newer technique for filler injection. • Cross-hatching: Retrograde or anterograde linear threads are injected in Journal of cutaneous and aesthetic surgery. 2010 Jan;3(1):23. 8. Tansatit T, Apinuntrum P, Phetudom T. A typical pattern of the labial perpendicular lines arteries with implication for lip augmentation with injectable fillers. • Nasolabial folds, Perioral ver3cal rhy3ds, deeply etched lines Aesthetic plastic surgery. 2014 Dec 1;38(6):1083-9. • Depot: Needle remains sta3c while an aliquot of filler is injected 9. Sito G. Transoral injection of Restylane SubQ for aesthetic contouring Figure 6. Manual eversion of uPPer liP Figure 7. Intraoral injecXon of uPPer Figure 6b. Intraoral injecXon of medial Figure 8b. Aer intraoral Perioral HA filler of the cheeks. Aesthetic surgery journal. 2006 Jan • Oral commissures to exPose injecXon sites lip upper lip injecXon 1;26(1_Supplement):S22-7. RESEARCH POSTER PRESENTATION DESIGN © 2015 www.PosterPresentations.com.
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