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Male Voice: The first thing is I want to place a couple of drops of Botox. By a couple drops in her, I'm going to do seven-and-a-half units, splitting between the two sides, at the vermillion border, on the upper lip, to reduce a gummy show. When she smile, the gum shows. I'm going to reduce that by weakening the orbicularis muscle. The orbicularis goes all the way around to the sphincter muscle. But by relaxing and weakening the upper part of the lip, when she smiles it lifts up less. So, you see less of the gum under there. It's also going to mean that when she smiles, the lip is not going to thin out as much. So, more of her lip is going to show during smiling.

Now, it's important not to over-paralyze this because if you weaken it, then you can't speak. It's going to feel and look horrible. It does take some getting used to. Even slight weakness of the upper lip will make it feel a little bit stiffer. It's going to take a few days to a few weeks to get used to it, but most patients love the way it looks. It can even help upper lip vertical lines from forming.

Then, I'm going to take Juvederm Ultra XC and inject the lips, the red lip itself. She has a nice vermillion. She's young. She doesn't need much of the vermillion, but it's mostly the red lip that I'm going to do. I'm going to show you a new technique with a different type of a needle, less injection ports, less chance of bruising. It's a little bit more comfortable. It's actually a longer needle. It's a larger needle, but it hurts less when we do it. So, I'm going to do that now.

First, we're going to do the Botox. If you kind of zoom in, then you can actually see better. So, the injection . . . You're splitting between the two sides, and I'm placing it right at the vermillion on this patient. Go right there, and I'm going to put about half of this injection right there. I'm going to do the other half on the other side. That's it.

Now, this is a bigger needle, longer needle. It's a 27 gauge, one-and-one-quarter inch. The beauty of this is that you can thread it across and get a nice improvement with just one injection on each side. So, tilt your head back a little bit. Open your mouth a little bit. Leave it right there, not too far open. You can see I use my non-dominant hand to turn the lip, see my entry point. As I'm entering, you can see I'm not too superficial. You don't really see the needle through the skin, but if I actually push it up, you can feel it right there. I can tell exactly where it's going. I'm going across the lip slightly to the other side. Then, I'm going to start filling.

As I fill, I'm not distorting the lip. I actually visualize it. Now, one very important point is that as you're filling, I don't fill the exact same amount everywhere. So, as I'm pulling back, depending on how much filling I want, I'm going to actually fill a little bit less right before I pull out, like so. You can see there's no bleeding. There's no bruising. She's got the fullness on this side, and I'm going to go through the other side now.

It's really important. You don't want to put the same amount of volume all the way across. Otherwise, it's going to feel like a sausage link and look like a sausage link. So, depending on the patient, if they're too full in the middle, I'll put more on this side. If they're not full enough, and they want a heart-shaped lip, I'll put more in the middle. Then, as I'm pulling up, I'm releasing my finger's pressure on the plunger. So, I'm putting less as I'm coming out.

So, I'm rolling this back again. You can see the entry point. As I do this, try to stay out of the camera's way. Typically, I'll be standing over where the camera is right now. Go across. Then, again, I'm filling as I come across to the other side. Going to do the same thing here. You can see I use my other hand, pull this apart, go across the lip.

Incidentally, if you ever did lip implants, and we used to do quite a bit of lip implants, this is the injection pattern that replicates the entry point for the lip implant, like so. Once I'm done, I'm going to hold a little pressure at the entry points, just to make sure there's not a lot of bleeding there. I'm going to massage it. I don't feel a single lump or bump there, because it is Juvederm. It is very soft. A little bit of bleeding right at the entry point. But again, if you get the bruise right here, it's barely noticeable. Again, this is just a normal bleeding point, which will stop.

So then, I take a look at it. I'm going to evaluate it. Put your lips together for me, as much as you can, like that. Just relax it. Open your mouth a little bit. Perfect. So, what I'm going to look here now is . . . I'm going to switch to the smaller needle. This does have lidocaine. The lidocaine has kicked in now. The lips are more numb….


Botox and Juvederm Lip Injection to Minimize Gum Show

As Dr. Shervin Naderi explains, this patient wanted Botox injections to minimize gum show and lip filler to plump the lips.

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