PERIORAL COMBINATION technique

The first action-packed day at the injectables live demo area of Aesthetic Medicine London concluded with a revealing masterclass called Honouring identity: Individualising injectables treatments, during which Dr Yousrah Ahmed conducted a live demonstration of the perioral combination technique using Relife Definisse filler.

Since 2018, Dr Ahmed has been training other medical professionals at her clinics in London and Liverpool where she finds herself inundated with a steady stream of requests to even out or plump up the lips.

A highly experienced dental and aesthetic practitioner dedicated to delivering outstanding treatment results to her patients in a safe clinical environment, she pointed out there is a widespread problem with lip fillers: “It’s something that is often poorly treated. In the past people have treated the area with overfilling and basically using cross-linked filler which is too viscous and gives the impression of an overfilled upper lip.

“It’s a pretty painless procedure providing you prep the patient appropriately. It doesn’t take long, literally a matter of five minutes.”

As she prepped her patient, Dr Ahmed explained how the most common dermal filler used to be collagen, but that has been replaced by more sophisticated products that are widely considered to be much safer and have longer-lasting results.

ENHANCING SYMMETRY

Relife Definisse products can be used to turn up the corners of the mouth, balance top and bottom lips, correct asymmetry and gummy smiles, smooth fine lines in and around the lips, accentuate and define the lip line and increase their volume by enhancing shape and symmetry. These injectables have been specifically crafted to restore lost volume, sculpt contours and rejuvenate the appearance with immediate results and almost zero downtime.

Meticulously engineered to mimic the body’s natural substances, Relife Definisse products ensure seamless integration and long-lasting results, said Dr Ahmed prior to the demo: “This can be used in patients with multiple features requiring different outcomes.

“This patient has lost volume. As we age, we tend to get reabsorption of the bones and lose mid-face volume, which can affect the nasolabial fold, making it more heavy with fine lines around the upper and lower lip. The whole area becomes more aged, the cheeks droop down causing deep lines in the marionette area.”

Since the patient wanted to rejuvenate the whole area, including vertical lines which can give the face a sad or angry appearance, Dr Ahmed decided to use Relife Definisse Core filler, which has been designed specifically for shaping and building facial contours. “It’s a thick volumising filler to lift and support the nasolabial fold and cheek pad area, which I am injecting into the triangle next to the nostril, using a needle perpendicular to the area.”

The doctor also explained how important it is to aspirate the syringe when injecting near a facial artery: “I am being mindful and careful, making sure the needle is steady,” she said. “As you can see, I am aiming towards the nose to stay well away from the superficial artery, this is the safest place and my usual go-to area because it helps to lift the nasolabial fold, but the facial artery runs just under this fold, so it is important to use less filler.

“I will be using a cannula and going mid-depth in the lower third, and going more superficial in the upper third, it’s all about anatomy so go slow and don’t rush these types of treatments because there can be complications.”

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RESTORING VOLUME

Dr Ahmed then moved on to the cheeks, and began to inject with Relife Definisse Restore, which has been developed for the treatment of medium lines and wrinkles. She said: “This is a softer filler, gentler for dynamic areas of the face. It needs to be injected at the right depth as this is a movement area, so it is important to inject carefully, so it is not visible.

“From the same entry point, I can change position and angle the needle downwards to the corner of the lip where she had a slight depression. It is already starting to lift, showing this is the perfect way of using one injection site.”

The next area under scrutiny was the mouth. Since the patient had asked for filler in her top and bottom lips, Dr Ahmed chose Relife Definisse Touch for this stage of the treatment. Designed for lines and wrinkles, it is a finer product than the others in the range.

She explained: “The next area we are defining is the border of the top and bottom lips which lacks definition and volume. Their top lip has collapsed inwards, and when she smiles the top lip inverts. There are static lines on the upper lip, so I will be defining the border with a filler that’s a bit more flexible, more mobile and I will be using a needle just under the border. You have to bear in mind the anatomy of lips, and, if I’m not careful, I could widen the corner of the lips which will look very unattractive.

“You want to help support the loss of volume, but if you do not use a fine product and the proper needle it won’t flow properly and you end up with lumps. If you stay anterior to the muscles then the risk is very minimal.”

She went on to define the patient’s cupid’s bow, saying: “You have to be mindful that the lip moves, but still add enough to lift and support. A linear thread is not trying to change the shape of the lip in any way, I’m just trying to enhance what she naturally has, I’m following the anatomy.

“I tend to avoid using dental injections if my patient has a tendency of swelling, so instead I use topical anaesthetic for these treatments, otherwise I don’t know how the patient will look after a couple of days following the treatment.”

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BOOSTING SKIN MOISTURE

For the next step, treating the perioral lines, Dr Ahmed selected Relife Definisse Hydrobooster which has been developed especially for refreshing and boosting skin moisture: “This is fantastic in the perioral region, and with fine lines one session is enough. For deeper lines I would recommend three to four sessions spread over several weeks, and I would expect it to last, on average after three sessions, about six to nine months.

“I aim to use one ml of each Relife Definisse product, half on each side. When starting, first I treat the muscle, then wait two weeks, then treat the rest with filler when the muscle is more relaxed, and that way we get a nicer, smoother result. You can treat it all on the same day but if you are injecting the needle at ninety degrees down to the bone, ask the patient if they have a history of facial trauma, especially in the temple area – there have been cases of injecting into the brain. Medical history is extremely important.”

Finally, Dr Ahmed, who prefers to use longer cannulas for ease of manipulation, moved on to the lips, explaining: “The patient already had toxins in the upper lip to create a flip effect, so I am injecting one millimetre under the border following the anatomy of the lip, stopping a few millimetres from the border, I don’t want to widen the lips.”

Using Relife Definisse Hydrobooster she added more volume to help the rejuvenation of the entire area: “It takes Hydrobooster about two weeks to distribute and see a little bit of a result, and then I wait about four weeks to see the best results. If we need to repeat the treatment, I will do it after two weeks. If we created a large bolus, it will go down considerably within 24 hours.”

After adding a little more filler to the fine lines around the patient’s chin, she used the small amount of remaining Relife Definisse Core in the side of the jawline, then analysed the results, saying: “The nasolabial fold has reduced considerably, we have improved the fine lines and natural volume of the lips.

“There is minimal bruising, minimal trauma. I would usually use a little bit of arnica for this area and warn the patient not to go in a sauna, steam room or jacuzzi, not to take any exercise or wear makeup for 24 hours. She should also avoid touching the area to reduce the risk of infection. I do the majority of the massaging where possible so the patient shouldn’t need to do any manipulation themselves.”