"No-Touch" Technique for Lip Enhancement.
BACKGROUND
The purpose of this study was to examine the anatomical principles of lip structure as they relate to individualized lip enhancement procedures and to describe a technique that does not violate lip mucosa during injection.


METHODS
A retrospective analysis of patients undergoing lip enhancement procedures between 2001 and 2014 was performed. Preprocedural and postprocedural photographs were analyzed for lip subunit changes. A stepwise treatment algorithm targeting specific anatomical subunits of lip is described.


RESULTS
Four hundred ten patients were treated with a "no-touch" technique for lip enhancement. Lip profile is determined by the position of the white roll. The white roll is accessed by a 30-gauge needle at a point 5 mm lateral to the oral commissure and at the base of the philtral columns. Lip projection is established by vermilion formation contributing to the arc of the Cupid's bow. To improve projection, the labial commissure is entered with a 25-gauge cannula and tunneled 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.


CONCLUSIONS
Accurate assessment of the white and red rolls, arc of Cupid's bow, philtrum, and gingival show can guide the injector on the proper enhancement that individual patients require. The no-touch technique minimizes mucosal trauma. Tailoring treatment toward lip profile, projection, and/or augmentation can yield predictable and reproducible outcomes in this commonly performed cosmetic procedure.
Kansas City, Kan.; Barcelona and Palma de Mallorca, Spain; Kansas City, Mo.; and New York, N.Y.|From the Department of Plastic Surgery, University of Kansas Medical Center; Plastic Surgery Department, Hospital of Terrassa; Department of Anatomy, Kansas City University; Plastic and Reconstructive Surgery, New York University; and the Instituto Dr. Beut.
Christopher C
CC
Surek
Kansas City, Kan.; Barcelona and Palma de Mallorca, Spain; Kansas City, Mo.; and New York, N.Y.|From the Department of Plastic Surgery, University of Kansas Medical Center; Plastic Surgery Department, Hospital of Terrassa; Department of Anatomy, Kansas City University; Plastic and Reconstructive Surgery, New York University; and the Instituto Dr. Beut.
Eva
E
Guisantes
Kansas City, Kan.; Barcelona and Palma de Mallorca, Spain; Kansas City, Mo.; and New York, N.Y.|From the Department of Plastic Surgery, University of Kansas Medical Center; Plastic Surgery Department, Hospital of Terrassa; Department of Anatomy, Kansas City University; Plastic and Reconstructive Surgery, New York University; and the Instituto Dr. Beut.
Kenna
K
Schnarr
Kansas City, Kan.; Barcelona and Palma de Mallorca, Spain; Kansas City, Mo.; and New York, N.Y.|From the Department of Plastic Surgery, University of Kansas Medical Center; Plastic Surgery Department, Hospital of Terrassa; Department of Anatomy, Kansas City University; Plastic and Reconstructive Surgery, New York University; and the Instituto Dr. Beut.
Glenn
G
Jelks
Kansas City, Kan.; Barcelona and Palma de Mallorca, Spain; Kansas City, Mo.; and New York, N.Y.|From the Department of Plastic Surgery, University of Kansas Medical Center; Plastic Surgery Department, Hospital of Terrassa; Department of Anatomy, Kansas City University; Plastic and Reconstructive Surgery, New York University; and the Instituto Dr. Beut.
Javier
J
Beut
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003357:Cosmetic Techniques; D000067548:Dermal Fillers / Q000008:administration & dosage*; D004954:Esthetics; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D007279:Injections, Subcutaneous; D008046:Lip / Q000033:anatomy & histology*; D008875:Middle Aged; D009061:Mouth Mucosa; D010781:Photography; D012189:Retrospective Studies; D012904:Smiling; D055815:Young Adult
D000067548:Dermal Fillers; D006820:Hyaluronic Acid; C445361:Restylane
Beut FJ.Cirujanos Plastikos Mundi: CPM First East Indian International Cleft Surgery Workshop; Cleft Lip & Palate Manual. Bathalapali, India; CPM & Smile Train.
Caruthers A, Caruthers J. Nonanimal based hyaluronic acid fillers: Scientific and technical considerations. Plast Reconstr Surg. 2007;120:33S40S.
Jansen DA, Graivier MH. Evaluation of a calcium hydroxyapatite-based implant (Radiesse) for facial soft-tissue augmentation. Plast Reconstr Surg. 2006;118:22S30S.
Carruthers J, Matarasso S, Jewell M. Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane). Plast Reconstr Surg. 2006;117(Suppl):3S34S; discussion 35S–43S.
Fagien S, Fitzgerald R, Matarasso A. Introduction to “soft-tissue fillers and neuromodulators: International and multidisciplinary perspectives”. Plast Reconstr Surg. 2015;136(Suppl):9S10S.
Medicis Aesthetics, Inc. Restylane injectable gel (nonanimal stabilized hyaluronic acid; NASHA) (package Insert). Scottsdale, Ariz: Medicis Aesthetics; 2008.
Baumann L. Replacing dermal constituents lost through aging with dermal fillers. Semin Cutan Med Surg. 2004;23:160166.
Duranti F, Salti G, Bovani B, Calandra M, Rosati ML. Injectable hyaluronic acid gel for soft tissue augmentation: A clinical and histological study. Dermatol Surg. 1998;24:13171325.
Matarasso SL. Injectable collagens: Lost but not forgotten. Review of products, indications, and injection techniques. Plast Reconstr Surg. 2007;120:17S26S.
Friedman PM, Mafong EA, Kauvar AN, Geronemus RG. Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation. Dermatol Surg. 2002;28:491494.
Fagien S, Klein AW. A brief overview and history of temporary fillers: Evolution, advantages, and limitations. Plast Reconstr Surg. 2007;120(Suppl):8S16S.
Fagien S. Putterman AM. Facial soft tissue augmentation with autologous injectable collagen. Cosmetic Oculoplastic Surgery: Eyelid, Forehead, and Facial Techniques. 1998:3rd ed. Philadelphia: Saunders; 367375.
Henly DR, Barrett DM, Weiland TL, O’Connor MK, Malizia AA, Wein AJ. Particulate silicone for use in periurethral injections: Local tissue effects and search for migration. J Urol. 1995;153:20392043.
Dewan PA, Hoebeke PE, Hall H, Chow CW, Edwards GA, Terlet J. Migration of particulate silicone after ureteric injection of silicone. BJU Int. 2000;85:557.
Dolwick MF, Aufdemorte TB. Silicone-induced foreign body reaction and lymphadenopathy after temporomandibular joint arthroplasty. Oral Surg Oral Med Oral Pathol. 1985;59:449452.
Hatanaka S, Oneda S, Okazaki K, et al. Induction of malignant fibrous histiocytoma in female Fisher rats by implantation of cyanoacrylate, zirconia, polyvinyl chloride or silicone. In Vivo 1993;7:111115.
Lee SH, Gil YC, Choi YJ, Tansatit T, Kim HJ, Hu KS. Topographic anatomy of the superior labial artery for dermal filler injection. Plast Reconstr Surg. 2015;135:445450.
Tansatit T, Apinuntrum P, Phetudom T. A typical pattern of the labial arteries with implication for lip augmentation with injectable fillers. Aesthetic Plast Surg. 2014;38:10381089.
Nakajima H, Imanishi N, Aiso S. Facial artery in the upper lip and nose: Anatomy and a clinical application. Plast Reconstr Surg. 2002;109:855861; discussion 862.
Matsson L, Goldberg P. Gingival inflammation at deciduous and permanent teeth: An intra-individual comparison. J Clin Periodontol. 1986;13:740742.
The Burton Goldbery Group. Alternative Medicine: The Definitive Guide. 1995.Tiburon, Calif: Future Medicine Publishing.
Goldberg PV, Higgijnbottom FL, Wilson TG. Periodontal considerations in restorative and implant therapy. Periodontal 2000 2001;25:100109.
Lip enhancement, the no touch technique. 2010.Presented at: Beut Jelks Symposium.
Beut J. The no touch technique, master class. 2008.Presented at: International Master Course on Aging Skin; Palma De Mallorca;.
The no touch technique for lip enhancement. 2011.Presented at: Vallex Symposium.
Hilinski JM, Cohen SR. Volumetric use of injectable fillers in the face. 2007:Amsterdam: Elsevier Health; 117.
Fledman J. Secondary repair of the burned upper lip. Perspect Plast Surg. 1987;1:3167.
Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg. 2009;124:266271.
Flowers R. Blepharoplasty and peri-orbital surgery. Clin Plast Surg. 1993.
Rumyantsev E, Beut J, Dyachencko Y. What’s new in lip injection. Plast Aesthet Med. 2012;8090.