THE

LIP
DR TRACEY BELL BDS (HONS) MA –GDL (LAW)
ANATOMY OF THE LIP

• Do you Believe all lips are the same ?

• Do you know the 15 Anatomical zones which are important in respect to
Dental Filling
• Know your arterial and venous Reply
• Volunteer for facial marking
ARTERIAL SUPPLY

• In Depth Discussion re
anatomy

• Upper and Lower Lip

• Literature research and Provide

students with Handouts

• Marking of the arterial supply

• Importance of anatomy in
relation to complications and
Vascular Occlusion
ASSESSMENT OF THE LIP

• What should we consider ?

• Dental issues
• Competency of Lip
• Animation and at rest
• Autonomy of the Patient – what doe the
patient want to achieve ?
CONSULTATION / ETHICS / CONSENT

• JCCP
• Photographs
• Consent – particular to them Verbal
and Written
• Suitability – Can dermal fillers provide
what the patient wants
• Autonomy and Paternalism - do you
understand what these are ?
DERMAL FILLER PRODUCT

• RHEOLOGY
• ELASTICITY
• GPRIME
• CROSS LINKING
• BRANDS – Juverderm , Teosyal , Belotero
• FDA approval
TECHNIQUES OF LIP FILLING

• Retrograde Threading

• Anterograde Threading

• Tenting

• Bolus

• MD CODES
ALLERGAN – MD CODES

• What I use in New Patients

• Guides
• Allergan
• Easy to re produce
• Safety Zones
MD CODES

• MD Codes™ is a newer technique in facial rejuvenation that promises to revolutionize how dermal fillers are injected.

• Dr. Maurizio De Maio, a Brazilian Plastic Surgeon, originally developed the 8 Point Lift which identified 8 key areas for lifting and rejuvenating the face with dermal
fillers.

• Dr. De Maio has since developed an innovative technique known as MD Codes. MD Codes is a revolutionary step by step approach of predefined and precise
injection points on the face where dermal fillers can be injected to elevate, rejuvenate and enhance the face, giving it a natural non-surgical face lift.

• Up until recently, dermal fillers were commonly injected wherever individual practitioners saw hollows and wrinkles. This type of treatment added weight and
volume and thus resulted in additional sagging, drooping and puffiness. The true cause of the aging process was not being addressed.

• MD Codes targets the source of the issues instead of focusing directly on the problem areas. Based on a deeper understanding of facial anatomy, MD Codes
outlines a series of injection points for facial fillers that address the cause, and not just the symptoms of facial aging.

• There are 75 different MD Codes. The MD codes injection points include cheeks, temples, around the eyes, chin, jawline, forehead, brow and lips. New clinical
studies and research suggests that MD Codes are more beneficial for patients, since it treats the source, and not just the issue. Taking this approach leads to
higher patient satisfaction as well as some outstanding natural results.

• Not all patients require having all the MD Codes injected. Since everyone’s face and motivation for treatment are unique, the treatment approach will be adjusted
to each person’s needs and personal desires.
BEFORE AND AFTER
COMPLICATIONS

• Ace Guidelines
• Consent essential
• Bruising
• Bleeding
• Infection
• Poor aesthetic outcome
• Vascular Occlusions
• Delayed Onset Nodules
REFERENCES
REFERENCES

• Albornoz, C., Jhawar, N., Durso, T., Hazan, E., Wang, J., & Saedi, N. (2020). Preinjection aspiration for injectable fillers in aesthetic dermatology: Trust or bust?. Journal Of
Cosmetic Dermatology. DOI: 10.1111/jocd.13377

• Allergan. (2015). Unlocking the code to facial revitalisation: A step-by-step approach to using injectables in the lower face. Allergan.

• Allergan. (2019). “Webinar – Beneath the Skin: Anatomy and Physiology of the Face”. https://eu.allerganspark.com/s/
Astner, S., & Rox Anderson, R. (2004). Skin Phototypes 2003. Journal Of Investigative Dermatology, 122(2), xxx-xxxi. DOI: 10.1046/j.1523-1747.2003.22251.x

• Beleznay, K., Carruthers, J., Humphrey, S., Carruthers, A., & Jones, D. (2019). Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World
Literature. Aesthetic Surgery Journal, 39(6), 662-674. DOI: 10.1093/as/sjz053
Consent: patients and doctors making decisions together. (2008). from https://www.gmc-uk.org/-/media/documents/consent---english-0617_pdf-
48903482.pdf?la=en&hash=C77983ADC0B63D655CC6BCFA89209B9C1A3D86A2
De Boulle, K., & Heydenrych, I. (2015). Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clinical, Cosmetic And
Investigational Dermatology, 205. DOI: 10.2147/ccid.s80446
DeLorenzi, C. (2014). Complications of Injectable Fillers, Part 2: Vascular Complications. Aesthetic Surgery Journal, 34(4), 584-600. DOI: 10.1177/1090820x14525035

• Goodman, G., Magnusson, M., Callan, P., Roberts, S., Hart, S., & McDonald, C. et al. (2019). A Consensus on Minimizing the Risk of Hyaluronic Acid Embolic Visual Loss
and Suggestions for Immediate Bedside Management. Aesthetic Surgery Journal. DOI: 10.1093/asj/sjz312
REFERENCES

• Koziej, M., Trybus, M., Hołda, M., Polak, J., Wnuk, J., & Brzegowy, P. et al. (2019). Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic
Procedures. Aesthetic Surgery Journal, 39(11), 1151-1162. doi: 10.1093/asj/sjz028

• Lee, H., Won, S., O, J., Hu, K., Mun, S., Yang, H., & Kim, H. (2017). The facial artery. Clinical Anatomy, 31(1), 99-108. doi: 10.1002/ca.23007

• Lee, J., Lee, K., Jung, W., Youn, K., Hu, K., & Tansatit, T. et al. (2019). A novel anatomical consideration on the exposed segment of the facial artery. Clinical Anatomy,
33(2), 257-264. doi: 10.1002/ca.23495

• Lee, K., Lee, H., Youn, K., & Kim, H. (2019). The positional relationship of superior and inferior labial artery by ultrasonography image analysis for safe lip augmentation
procedures. Clinical Anatomy, 33(2), 158-164. doi: 10.1002/ca.23379

• Pavicic, T., & Funt, D. (2013). Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clinical, Cosmetic And Investigational Dermatology,
295. doi: 10.2147/ccid.s50546

• Sansone, C., Prendin, F., Giordano, G., Casati, P., Destrebecq, A., & Terzoni, S. (2017). Relationship between Capillary Refill Time at Triage and Abnormal Clinical
Condition: A Prospective Study. The Open Nursing Journal, 11(1), 84-90. doi: 10.2174/1874434601711010084

• Signorini, M., Liew, S., Sundaram, H., De Boulle, K., Goodman, G., & Monheit, G. et al. (2016). Global Aesthetics Consensus: Avoidance and Management of Complications
from Hyaluronic Acid Fillers—Evidence- and Opinion-Based Review and Consensus Recommendations. Plastic And Reconstructive Surgery, 137(6), 961e-971e. Doi:
10.1097/prs.0000000000002184
REFERENCES

• Snell, R. (1995). Clinical anatomy for medical students (5th ed., pp. 664-665). Boston: Little, Brown.
Tansatit, T., Apinuntrum, P., & Phetudom, T. (2014). A Typical Pattern of the Labial Arteries with Implication for Lip Augmentation with Injectable Fillers. Aesthetic Plastic
Surgery

• Tansatit, T., Apinuntrum, P., & Phetudom, T. (2016). Cadaveric Assessment of Lip Injections: Locating the Serious Threats. Aesthetic Plastic Surgery, 41(2), 430-440. doi:
10.1007/s00266-016-0755-1
Urdiales-Gálvez, F., Delgado, N., Figueiredo, V., Lajo-Plaza, J., Mira, M., & Moreno, A. et al. (2018). Treatment of Soft Tissue Filler Complications: Expert Consensus
Recommendations. Aesthetic Plastic Surgery,

• Van Loghem, J., Fouché, J., & Thuis, J. (2017). Sensitivity of aspiration as a safety test before injection of soft tissue fillers. Journal Of Cosmetic Dermatology,