Title: The role of toxins and fillers in perioral rejuvenation
Abstract: Dr. Barton: The first patient is a 40-year-old woman who is looking for options to increase the fullness in her lips (Figure 1). Dr. Coleman, what would you suggest?
Figure 1
This 40-year-old woman desires more lip fullness.
Fritz E. Barton, Jr., MD
Dr. Coleman: Her lips are not as easy to improve as atrophic lips in which you simply fill in the fat, like filling an envelope. Here, the structure of the lip actually has to change. First, I would focus on flipping out the lip. Getting the vermilion to evert would be the primary focus. I would place fat under the vermilion, primarily, and the mucosa, secondarily, paying attention to eversion. Second, I would create a clear white roll by intradermal fat placement. Third, I would focus on lower lip volume enhancement more than upper lip. I think it is a common error to focus on the upper lip and forget about the lower lip; if you do not get eversion of the lower lip, you will have a very funny-looking lip.
Sydney Coleman, MD
Dr. Barton: Dr. Coleman, when you counsel a patient such as this, what do you predict will be the percentage of success or retention with the first injection? How many injections do you routinely need to do?
Dr. Coleman: In my hands, one treatment usually suffices. I prepare patients for a second treatment, but one application is usually enough, although, occasionally, patients may want further enhancement.
Dr. Barton: Approximately what volume will you use in a lip complex like this?
Dr. Coleman: I would probably use between 5 and 7 mL over the whole lower lip. I would probably use about half that amount in the upper lip, between 2.5 and, maybe, as much as 3 mL.
Dr. Barton: Dr. Graivier, what would be your …