Acquaderm Blog

The quintessential guide to state-of-the-art cosmetic injection approaches, from two renowned experts! This revised and updated second edition of Cosmetic Injection Techniques: A Text and Video Guide to Neurotoxins and Fillers by esteemed facial plastic surgeons Theda Kontis and Victor Lacombe builds on their bestselling first edition.

At the time this video is being recorded, we currently have three neurotoxins approved for cosmetic use by the FDA; Botox, Dysport and Xeomin. The basic techniques for reconstitution are essentially the same for all three with the only difference being the amount of diluent, which is largely determined by injector preference but the diluent itself is the same. Its 0.9% normal bacteriostatic saline. It should be noted that along with diluent volume recommendations, the package inserts for all three recommend reconstitution with preservative free normal saline. And that's because all three manufacturers use preservative free saline in their clinical trials and then in the data which they presented to the FDA for approval. So, therefore, legally, these companies can only tell you to use preservative free saline and they're bound by their FDA approval.

So, as usual, you have to assess the dynamic of the smile, it’s very important, and with this lovely lady, we gotta have a surprise, in fact, that's what I discovered a few minutes ago, in fact. The fact is, normally when you smile, as we say, we have the bone and the gum, so the upper lip is leaning on the teeth and on the gum and the upper lip is reversing naturally, increasing the volume when you smile.

This is an image of anatomy for lips for sculptors, it's very relevant as an injector, we are essentially sculpting the lip shape using fillers. It's important to be aware of the different three-dimensional shapes of the separate regions or subunits of the lips. The upper lip has three central bumps and they can vary in size; in some patients, the central one is larger and the two on either side are smaller; in some patients, the two just lateral to midline of the upper lip are larger and the central one is smaller. In the lower lip, there were two large midline bumps that comprise roughly the central two-thirds of the lower lip. The lateral edges of both the upper and lower lip are flatter than the midline portion and the border of the upper lip tends to be a sharp edge.