Chapter 119 Achieving Beautiful Lip Augmentation 361
Before and 2 weeks after Hylaform 1cc
Figure 119.2. Injection of 1 ml of hyaluronate filler along the vermillion border and red upper lip. Avoiding injection of the cupid’s blow narrowed its width.
References
1. Niamtu J. Simple technique for lip and nasolabial fold anesthesia for injectable llers. Dermatol Surg 2005;31(10):1330–1332.
2.Smith KC, Melnychuk M. Five percent lidocaine cream applied simultaneously to the skin and mucosa of the lips dreates excellent anesthesia for filler lnjections. Dermatol Surg 2005;31(11):1635–1637.
3.Klein AW. In search of the perfect lip. Dermatol Surg 2005;31(11): 1599–1603.
4.Carruthers J, Carruthers A. Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg 2003;29(05):468–476.
120
Restylane Injection for the Lower Eyelid Tear Trough
R. Jeffrey Hofmann
Injecting Restylane into the lower eyelid (to correct a tear trough or orbitomalar groove) is fraught with potential complications, such as bruising, lumpiness, and contour irregularities. Nonetheless, it can be done and good results can be achieved.
Adjust patients’ expectations and tell them that they will most likely have some bruising, even though they do not have bruising in the lower face with Restylane.
I only use a topical anesthetic—usually ELA-Max cream. I always inject very deep along the inferior orbital rim. Inject very small aliquots (0.02 ml). While injecting, keep one finger pressed inside the inferior orbital rim to prevent the Restylane from traveling superior to the orbital rim. After each injection, apply pressure to the area to tamponade bleeding and prevent bruising. I inject greater volumes into the cheek (inferior to the orbitomalar groove or tear trough) because expanding the cheek will “push” fat superiorly toward the lid area. This treatment is much more time-consuming than Restylane injections in the nasolabial folds or marionette lines.
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Chapter 120 Restylane Injection for the Lower Eyelid Tear Trough 363
A
B
Figure 120.1. (A) Patient post lower blepharoplasty with fat repositioning. The patient declined midfacial liposculpture. Note significant midface volume loss and prominent residual tear trough. (B) Following three sessions of midfacial llers and tear trough treatment spread over months (most recently with 4 vials of Restylane), the patient achieves appropriate facial volumization and correc-
tion of the tear trough.