Features
Lip tenting
The goal of the lip-tenting technique is to control both shape and volume during the procedure by adjusting the pressure on the syringe, writes Dr Tom van Eijk
Augmenting lips aesthetically is gaining popularity. But with this higher demand comes a growing resistance among the general public against the obviously artificial aspect that can arise from this procedure. Most patients and doctors alike are searching for a more natural alternative to the “duck-lip”.
One aspect that needs consideration before the treatment is the proportion of the upper lip in comparison with the lower lip. In most races the upper lip is slightly smaller than the lower lip. In mammals, in general, a narrow upper lip is associated with an aggressive facial expression. This “mean” look is mentioned by many of my patients who notice their lips shrink over the years.
All this leads to a much higher demand of upper lip augmentations than lower lip augmentations. It is obvious, though, that filling the smallest upper lip can give a disproportional result when exceeding the size of the lower lip. The patient's peers will immediately recognise the lip is artificially enhanced.
Left-right asymmetries need to be noticed, photographed and pointed out before applying anaesthesia, which can cause the lips to swell.
Canine arc
A detail in the shape of the lip that is much appreciated (and asked for in my clinics) is the curve of the white roll at the level of the canine tooth. We call this the canine arc. It is a shape prominent only in humans, both male and female, when we are at our reproductive age. It is noticeable that most archetypical beautiful faces such as those of actors and models are blessed with a striking canine arc.
Of course, the aesthetic goal of the patient needs to be realistic, which is dictated by technical possibilities and limitations. Sufficient local infiltration anaesthesia of the lips is essential for almost all patients undergoing the treatment, because the lips are highly sensitive. The most comfortable for the patients is to inject Xylocaïne/adrenaline superficially underneath the mucosa, in a fashion that combines the dental block and the field block (see YouTube, “Amsterdam Block”). In contrast with the dental block this block works immediately and brings adrenaline close to the treatment site, hence diminishing bruising afterwards.
The goal of this lip-tenting technique is to control both shape and volume of the lip during the procedure, lifting the white roll to optimise the canine arc projection. The needle is inserted multiple times, hitting the white roll towards the centre of the lip.
As the needle is withdrawn, the hyaluronic acid is injected to give volume inside the muscular part of the lip and to form pillar-like structures that project the white roll. It is important to do so without filling the actual white roll itself to avoid a plump aspect of the lip border.
In the upper lip, the white roll is injected about every 3mm from the mouth corner towards the beginning of the philtrum. This will strengthen the canine arc and will enhance the shape of the philtrum by simply not touching it.
In the lower lip, to obtain a natural result it is advisable to start injecting approximately 5mm away from the mouth corner, all the way to the centre of the lip to define a nice contour.
This technique will give ample opportunity to control the volume and shape of the lips by adjusting the pressure on the syringe, always keeping an eye on the position of the needle tip. Generally, young lips will need more volume in the central body of the lip to obtain a result in accordance with fashion.
Older patients may seek reconstruction of the lip contour. Moreover, because of the multiple injections, risks of large single volumes of gel giving rise to palpable or even visible lumps are minimal.
Dr Tom van Eijk is a cosmetic doctor who practises in The Netherlands. E: tom@tomvaneijk.nl; T: (+31) 6-4225-0664;
W: www.tomvaneijk.nl
