|(Photo credit: beapen)|
Do you know where your fillers go? (I never did!) If you don’t, read this latest article in Dovepress on the ultrastructural investigation of the lips. Whether you use Juvederm Ultra 3, Juvederm Ultra Smile, Restylane Lipp or Restylane Refresh, you should know where your filler is going, or you may be dangerously close to disaster! (BTW one of these fillers gives terrible erythema and swelling if injected superficially)This article gives a nice overview of the surgical anatomy of the perioral region too. Carruthers lip fullness grading scale may also be useful.
However the article used ultrasonographic control to “know where the fillers go” which is neither reliable nor practical. I personally feel that impedance measurement may be a better technology to pursue for filler companies to design the next generation needles that cry out when dangerously close to disaster (large blood vessel or a nerve trunk). This 2009 article titled “Impedance-based tissue discrimination for needle guidance” shows that we are/were close.