Strong mimic muscles and gravity are the main causes of deep wrinkles. Therefore, patients should be always seen in an upright position. An injection administered to a patient in a prone position might lead to insufficient correction. Always inject a bit medially to avoid an increase in the depth of the treated folds.
With repeated injections comes an increased risk of bruising. When the filler is injected into different levels of the dermis (the multilevel injection technique) some physicians recommend
Fig. 5.33 Deep nasolabial folds treated with polylac-tic acid prior to (a), immediately after 1.4 ml (b), and 3 months later after a total of 4.3 ml (c)
Fig. 5.34 Superficial nasolabial lines in a patient pre-treated with polylactic acid for deep nasolabial folds before and 3 months after the superficial injection of a total of 1.4 ml hyaluronic acid
5.6 The Upper and Lower Lips
BoNT-A, although sometimes quite helpful, may lead to asymmetries and temporary loss of function. Fillers, on the other hand, are highly suitable for both lip augmentation and improvement of perioral wrinkles.
The lips are very important for social interaction. A wide spectrum of emotions is represented by the lips, from happiness to sadness and sorrow. It also plays an important role in the expression of sensuality and sexuality. When the sphincter mechanism is intact normal lip function promotes a competent oral seal for liquids and solids, especially the lower lip. The free movable nature of the vermillion and cutaneous skin makes this area quite suitable for distortion. The use of
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