Researchers describe their experience in a new study documenting 410 patients treated with an approach they use for lip enhancement, called the “no-touch technique.”
The study’s lead author Christopher C. Surek, D.O., a plastic surgery resident at University of Kansas Medical Center, Kansas City, Kansas, tells Cosmetic Surgery Times that the no-touch technique was originally described by the study’s senior author Javier Beut, M.D.
“The ‘no-touch’ concept is rooted in avoiding any direct needle injection into the wet or dry mucosa. All facets of the technique utilize cutaneous needle and cannula insertion ports,” Dr. Surek says. “The reason for this is that the mucosa swells quickly if repeatedly violated with needle injection, and we feel that this can distort the anatomy making it more challenging to determine appropriate volume and symmetry when performing lip injection.”
Dr. Surek and colleagues retrospectively analyzed patients having lip enhancement procedures between 2001 and 2014. The researchers determined the lip profile by the position of the white roll, which they accessed with a 30-gauge needle at a point 5 mm lateral to the oral commissure and at the base of the philtral columns, according to the study’s abstract.
To enhance lip projection, they entered the labial commissure with a 25-gauge cannula, going into the submucosal space between the white and red rolls.
“Lip augmentation is a direct reflection of the prominence of the red line and can be approached in a perpendicular fashion with a needle or cannula descending to the level of the wet-dry junction,” the researchers write.
NEXT: Lip Aesthetic Components
Lip Aesthetic Components
They found that avoiding needle injection directly into the mucosa decreased swelling and bruising, during and after the procedure. This gave providers the ability to take their time and carefully analyze lip aesthetics, as they proceeded with their injections, according to Dr. Surek.
“The second key component of this technique is that we assess the lip based on anatomic subunits, and then treat the lip based on the three aesthetic components (profile, projection and augmentation), which allows us to truly customize our treatment to each individual patient,” he says.
“Profile,” Dr. Surek explains, focuses on defining or sharpening the white roll, philtral columns and cupids bow. “Projection” addresses the anterior-posterior dimension of the dry vermillion. And “augmentation” enhances the height of the lips through wet vermillion volumization.
The no-touch technique not only minimizes mucosal trauma, but also yields predictable, reproducible results, according to the study.
Dr. Surek says the study’s aim is to share an accurate, reproducible and methodical lip enhancement approach with fellow surgeons.
“We believe that proper analyzation of lip anatomy and aesthetic subunits yields a focused and customized approach to lip enhancement. We also find that performing all injections from skin insertion sites, and not directly in the mucosa, has provided improved outcomes for our patients,” he says.
According to Dr. Surek, the researchers in this study prefer to use small- or medium-particle size hyaluronic acid filler.
“We do not recommend using high G-prime or highly cohesive filler for this technique,” he says.
Fred Fedok, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), tells Cosmetic Surgery Times that the approach described is plausible and potentially minimizes trauma to the lip tissues.
“It is an attempt to describe injectable lip augmentation with an anatomically based rationale,” Dr. Fedok says. “I am in favor of using cannulas in the use of injectables. I feel that undue trauma is minimized and the risk intravascular injection in lessened. The authors report a technique that enhances lip definition, rather than only volume. This will greatly improve the aesthetics of the lip. Their description is one that should be reviewed and possibly assimilated by practitioners that perform injectable lip enhancement.”
Disclosures: Dr. Surek and Dr. Fedok report no relevant disclosures.