We’re going to talk about the natural fillers that are produced by a number of different companies.
So those of you who may have looked online or received brochures in the mail, or picked up brochures that some of the offices are familiar with certain names, such as Belotero, or Radiesse. You may be familiar with the Galderma family of products, which is Restylane; Restylane Lift, Restylane Kysse, Refyne, Defyne.
You also may be familiar with those products that come from the Allegan AbbVie company, such as the Juvederm family; Juvederm Ultra XC. They also have some products called, Voluma, Volbella. And then there’s another newer company to the market, which has a product called, Revanesse.
All of these products are available as bioidentical fillers, those structures that are sugars or hyaluronic acids that are degraded by the natural enzyme system in our body. That enzyme will break down the hyaluronic acid that we each produce, or the hyaluronic acid that I put in specific locations.
Now, all of the names that I’ve given you there, some may be household names to some of you, and some may be totally brand new names. But they are different, they have different characteristics, and they can be used somewhat interchangeably. But you need to see your aesthetic physician that has enough facility to be able to adjust what product is needed in which location the restoration will be placed.
So this is our discussion regarding the intermediate stage of fillers. And the intermediate stage for us is basically around the mouth or the lips. So in the beginning or basic application, we talked about treatment of the parentheses, or the nasal labial fold. We talked about the puppet lines or the melomental folds.
I’m talking about the lip area. There are good lip treatments and there are poor lip treatments. And it’s important that when you see your aesthetic physician, that you actually review your history, including your ethnic background. Because our ethnic heritage, our genetics determines the ratios, the proportions, and the amount of volume that is used.
Certainly, you can go in and have an idea of what you’d like to be able to produce when you have your lip filler placed. But you also want to have a picture of your youthful face, where we can actually measure the proportions, the relationships, and the alignment, and the curvature of what is naturally you.
There’s a lot of science that goes into the science of doing your fillers. And it has to do with not just chemistry and the products, but also with physics, relationships, measurements, and mathematics. And that’s why it’s important that you have your photograph taken before and after. And that’s why it’s important to bring your picture of your favorite face.
So when we talk about the perioral, the mouth area, we actually look at a number of structures. And if you look at someone who’s youthful, healthy, without a disease, without bone loss, without fat loss, without trauma, and without surgery, there are very specific proportions from the upper lip relative to the nose, from the columns that come down from the nose to the lip.
The shape of the lip, it should be basically a gullwing shape, a shape with a lip that actually has normal smooth contours. In the youthful lip, the corner of the mouth doesn’t go down. And as we age, as we get older, as we lose volume, as we lose tooth height, and as we lose bone, the amount of curvature of the corner of mouth will get progressively lower and lower, and lower, creating those puppet lines.
But the puppet lines are also relative to the shape of the lips, the amount of projection off of the teeth, and we can change that with our fillers. So the fillers that I mentioned at the start of our discussion are all available, potentially to be used around the mouth. Be careful though, we have very specific ways that we teach.
When I’m teaching the doctors how to do fillers in this intermediate stage, there are different planes of the lip and how do we fill it. We look and see what the relationship is to the underlying teeth. And so there may be times that if you have not a beautifully symmetrical tooth alignment, we may place more fill on one side to give a very smooth outer appearance to the lip.
There are people who want very protuberant lips. Remember that you will actually change your ethnic background, depending upon the ratio of the fill and the angles of the lips. But you want to make sure that number one, your aesthetic physician is making sure that the proportions are correct, that the architecture is correct. These are all things that I teach when I’m teaching the physicians how to do beautiful lips.
Remember that we want to literally resolve, erase, remove, or restore a good balance. We develop imbalances in our facial features, because we can have illness, we’ve had more birthdays, because there’s aging, even from the sun.