Dr. Shervin Naderi: So, we've had enough time for the dental block to work. She's numb. We're going to start with the Juvederm injection. All I have to do is take an alcohol wipe and just basically wipe the lips, take any lipstick or anything else off. You can't really sterilize the lips, but the alcohol does help remove any extra stuff that is sitting on the surface. Now, this is Juvederm Ultra. There's also an ultra plus, which is thicker. It's more similar to Perlane, which we'll be doing next. Juvederm Ultra is a clear syringe, and it's a clear hyaluronic acid gel.

Okay. So, we're going to start. I like to kind of keep the patient's mouth slightly open, not wide open, just slightly open. What it does . . . I start penetrating the needle, and uniformly injecting. I like to inject as I'm entering, to push away any small blood vessels. That decreases the chance of bleeding and bruising. It's very common to bleed and bruise from the lips. They're very vascular. But doing the technique, there's a little nice modification, which actually lessens the chance of bleeding and bruising.

So, the penetration and filling is from both sides, as you enter and as I pull back. Now, as you can see, with her, she has a very nice lip roll, which means I really see her red lip nicely. This is partially because I've actually injected her before, in the last few months. But with this type of lip, I don't need to inject the vermillion border, which is the border between the red and white. If I wanted to get more of a roll, I would do it slightly differently. The take-home message is every lip is different, and the injection has to be done differently.

As I've said before, if you fill the lips like a sausage link, they'll look like sausage links. Open your mouth just a little bit. A lot of times, patients will not have sensation or control over their lips. So, they may think that the mouth is open when it's not. You just have to gently remind them.

After I fill the first round, I do two things with my hands. One is I feel how much filler I have on each side. The tactile sensation definitely helps, making sure we have a symmetric fill. The second thing it does, as you fill the lips, by smoothing it out, you don't have any lumps or bumps or nodules. Doing okay? [inaudible:00:02:59].

We're going to go through the bottom lips, same thing. Penetrating, filling as I penetrate, avoiding the labial artery, and also filling as I pull back. You can see, with her so far, we haven't encountered any major vessels. So, she hasn't had any major bleeding, which means she won't really have any major bruising, so far. We're not quite done yet.

After I smooth it out, I have them hold their lip together. I take a step back to get a better look. They look very symmetric. I like to overfill it just a little bit, because it loses its volume. Just two little areas that I see a slight little shadow. Filling goes up, and you can see this is a different technique. It's a perpendicular injection. Put the lips together again. Her right side is naturally a little bit less full than the left side, a little more on this side. And we're done with the lips.

That took about 3/4 of a syringe of Juvederm, and we had done about a CC just a few months ago. So, this is just adding up on top of that. What I like to do next is . . . I have this extra Juvederm. I definitely don't want to waste it. So, we have injected the nasal labial folds in the past for her, and we're going to do the same thing here with the remainder of this. This is a fantastic injection for that purpose.

What I'll do is take a little alcohol wipe against her [inaudible:00:05:09] area. You don't have to follow me.

Female Voice: This is exactly what I wanted. Yay.

Dr. Shervin Naderi: What I did is I changed the needle to a fresh needle. It's sharp, and it also doesn't have the bacteria from the lips on it. What I do is I, again, penetrate straight in to the high nasal labial fold. This technique is different than the filling technique of this method, and I use both, basically push up and volumize the tissue.

Do the same thing on this side. She doesn't need a lower down. After I inject it, I massage it, smooth it out. And as I feel it right now, there's absolutely no lumpy bumpiness. That's the beauty of Juvederm.

So, that concludes that injection of Juvederm Ultra to the lips and the nasal labial folds. There's a little bit of point bleeding. It will not bruise. It's very minor. And essentially holding pressure for about just two minutes, tops. I'll have you hold this there. And she's lucky that there was no blood vessels in the way for the lips. So, essentially the lips are done. She shouldn't have any major bruising. She can cover it with lipstick, and she'll be ready to go out tonight.

Lip Augmention and Wrinkle Reduction Using Restylane Filler

Dr. Shervin Naderi demonstrates a liquid lip augmentation as well as a nasal fold touch up using Restylane.