Lip augmentation is one of the most sought-after non-invasive cosmetic procedures. Clients often seek treatment for age-related concerns, such as thinning lips, vertical wrinkles above the upper lip (known as smoker’s lines or barcode lines), flattening of the Cupid’s bow, and loss of volume. This area poses a unique challenge due to its high mobility, which often results in a decreased duration of action for non-permanent fillers compared to other facial areas.
Traditionally, lip enhancement involved invasive surgery and the use of synthetic or autologous materials. While these methods offer long-lasting effects, often up to five years, they come with high costs and risks of severe complications, including scarring and asymmetry. Permanent fillers like polytetrafluoroethylene semisolid fillers are another option but pose significant drawbacks if the results are not as desired, as removal is difficult and sometimes impossible. Therefore, an ideal lip augmentation procedure would use a soft tissue volumizing agent that is non-invasive and offers semi-permanent results.
The use of calcium hydroxylapatite filler, marketed as Radiesse, in lip augmentation is controversial. Some practitioners discourage its use due to a reported high risk of nodularity in areas with high muscular activity, such as the lips. However, other researchers dispute these claims, attributing nodules to improper injection techniques rather than the filler itself.
To minimise the risk of nodule formation, practitioners should follow specific steps: place the product sufficiently deep, avoid overcorrection, and treat any nodules or granulomas with triamcinolone via local injections or, if persistent, through a small incision.
Before treating the lips, it is recommended to use anaesthesia, either infraorbital nerve or mental nerve blocks, due to the sensitivity of this facial region. Radiesse can be administered with a 27- or 25-gauge, one-inch needle to minimise punctures. The filler should be injected between the orbicularis oris muscle and the mucosal border, with two punctures for each side.
For additional volume and vermillion enhancement, a second, deeper injection line can be added. A separate 27-gauge needle is required for treating the philtrum columns. For smoker’s lines, avoid direct filling to prevent bumps and unevenness; instead, use the linear threading technique for fine perioral lines.
Radiesse is an effective soft-tissue filler suitable for various clinical applications. However, its use in lip augmentation comes with an increased risk of nodularity, which must be carefully considered against its benefits, including the longevity of results. Practitioners should weigh these factors to determine the best treatment approach for their clients.
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