FPSAM - Roundtable 2021 - 5

EXPERT PANEL DISCUSSION
Dr. Dayan: Dr. Fabi, there are many different
techniques for treating the lip, from crosshatching
to vertical threading, to linear retrograde, anterograde.
Now I know you wrote the article on cannula
for Silk, so can you comment a little bit about
your techniques, both with needles and with cannula,
and when and why you use each technique.
Dr. Fabi: It depends on what my intention is with the
lip. With evenly revolumization of the lip, I might use
the cannula first, to evenly distribute the product
throughout. Silk is approved with a 25-gauge cannula.
In some people, they do not need to revolumize the
entire lip, but rather need to restore a more youthful
feminine shape to the lip. In such cases, I'll use a
needle to accentuate the tubercles. If they are bothered
by their perioral wrinkles, because the orbicularis
oris muscle is flattening from age-related
atrophy, I will put product along the vermilion border
with a needle to support and indirectly improve the
perioral wrinkles. Again, it depends on what my intention
is with the lip.
Dr. Dayan: Dr. Durairaj, can you comment a little
bit about perioral lines and your approach to getting
those as well as the philtral columns/cupid's
bow area. Do you treat that as well?
Dr. Durairaj: Yes, I do. In fact, I will not perform a
single lip injection without treating the philtral columns
because I think that the turgor and water pressure
that we create by instilling these fillers needs to sort of
look globally placed. I will not treat just the upper
lip-I must give a little bit of that same level of hydration
to the lower lip with a touch of that same filler.
I also think that we need to see highlight points of the
philtrum, it is a nice way of pulling up, giving a thin
upper lip more height and more definition, and definitely
this is one of the areas where we stretch and age
the most, the philtral distance, try to keep that right
around the 13mmmark if possible, and I can often do a
good job with filler just creating those little buttresses
of philtral support.
Perioral lines are difficult challenges for all injectors;
one must be careful not to use too much filler in
the philtrum and perioral area because it gives so much
cutaneous thickness of the lip, which can look artificial
and stiff. This is what I do with thin retrograde linear
threads, and I take care to massage it thoroughly once
applied to make sure it is distributed throughout the
body of the cutaneous lip to distribute it evenly to the
perioral areas.
Dr. Dayan: Dr. Rosengaus, can you comment on
your technique with cannulas or needles and what
do you do first? The perioral rhytides or do you do
the vermilion?
ª 2021 by American Academy of Facial Plastic and Reconstructive Surgery, Inc.
Dr. Rosengaus: My approach is needle based, precisely
because I do not want the product to go everywhere.
I want the product to be exactly where I am
choosing it to be. Now, having said that, it is normally
retrograde, and for safety, any amount that you put in
must be in very small quantities. It should be a slow
injection. For me, it is a very careful step-by-step procedure
to achieve harmony, symmetry, and balance.
Dr. Dayan: Dr. Cotofana, what are your thoughts
about cannula versus needle and accuracy of
placement of product?
Dr. Cotofana: It all depends. If you want to have a
little bit of more contour, then of course you can use a
cannula and the product would stay exactly along
the pathway. If you want to have a little bit more of the
volumizing effect, you just go with a needle to the
respective mid area and then you will have the local
volumizing effect coming from the needle. And, of
course, this will influence the safety aspect.
Dr. Dayan: Dr. Durairaj, what about treating men?
Can you share the percentage of your lip patients
who are male?
Dr. Durairaj: My lip patients are roughly 90% women
and about 10% men; the men that visit my practice
are of all ages and all orientations. Men are
coming in with more confidence and demand, definitely
with the millennial and the younger generations.
I think the male lip filler is slowly becoming a new
trend.
Dr. Dayan: Dr. Fabi, have you ever seen male lips
that are done well with filler?
Dr. Fabi: If they are done well, I am probably not
noticing them! Indeed, roughly 10% of my patient
population is male, but lips are not the first thing that
men are coming in for, at least the men who come to
my office.
Dr. Dayan: Dr. Fabi, you mentioned earlier Defyne
just recently got approved for the chin. We have
been using a lot of it in my own practice. Can you
tell me a little bit about your technique with the
chin and how you are approaching it?
Dr. Fabi: Yes, of course. When approaching the chin,
I like to use a needle. Along the mandibular symphysis,
I will inject on bone along the pogonion, if projection
along the sagittal plane is needed, or along the
menton, if elongation of the face is needed and there is
not a 1/3 to 2/3 ratio between the base of the nose and
the lower aspect of the upper lip and the upper aspect
of the lower lip and menton (most inferior point of the
5
FPSAM - Roundtable 2021

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