Clinical Anatomy of the Lower Face for Filler Injection
Jisoo Kim, MD, MS, Hong-Ki Lee, MD, PhD, and Hee-Jin Kim, DDS, PhD (Illustrated by Kwan-Hyun Youn)
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Clinical Anatomy of the Lower Face for Filler Injection
Jisoo Kim, MD, MS, Hong-Ki Lee, MD, PhD, and Hee-Jin Kim, DDS, PhD (Illustrated by Kwan-Hyun Youn)
© Springer Science+Business Media Singapore 2016 H.-J. Kim et al., Clinical Anatomy of the Face for Filler and Botulinum Toxin Injection, DOI 10.1007/978-981-10-0240-3_5
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5.1
Lip
Filler injection on the lips is often conducted to reduce, to refine the contour, and to have voluptuous lip. More specifically, filler treatment can reduce the presence of vertical lip wrinkles (smoker lines) that start on the vermilion border as an aging.
5.1.1
Clinical Anatomy
The vermilion border is the red border marking the periphery of the lip. The cupid bow is the heart-shaped dimple centrally located above the upper lip. The vertical groove between the nose and the mouth is called the philtrum. The oral commissure (cheilion) is located at the corner of the mouth where the upper lip and the lower lip meet (Fig. 5.1). With age, the vermilion border becomes dimmer, while the smoker lines become more pronounced. Overall, aging leads to a reduction of lip volume resulting in the appearance of a thinner, flaccid lip. A frontal view of the lip shows that the lip is composed of an intermediate zone—red portion—that lies between the cutaneous portion and the mucous portion. The vermilion border can also be defined as the region between the cutaneous portion and the intermediate zone. The mucous portion can be further divided into the dry mucosa and the wet mucosa with the junction between the two being defined as the dry-wet mucosal junction. Located directly below the
Cupid’s bow
Oral commissure (cheilion)
Clinical Anatomy of the Lower Face for Filler Injection
mucous portion are the superior labial a., the inferior labial a., the mental n., and the labial gland. They are located on the deeper layer than the orbicularis oris m. (Figs. 5.2 and 5.3).
5.1.2
Injection Points and Methods
The lip is highly sensitive to pain; therefore, the use of nerve block anesthesia is recommended when a topical anesthetic ointment does not suffice. The infraorbital n. and the mental n. innervate the upper and lower lip, respectively. A definitive knowledge of the nerve pathways and branching points must accompany the anesthetic procedure (Fig. 5.3). The use of a hard filler on the lips leads to visible irregularity of the lips and irritation to the patient; therefore, the use of soft fillers is advised. If the goal of filler injections is to accentuate the contour of the lip, the treatment should proceed with injecting the filler along the vermilion border into the dermal and subdermal layer. When trying to increase volume, the filler should be injected into the submucosal or intramuscular layer below the mucous portion of the lip (Fig. 5.4). Injecting the filler into the drywet mucosa junction can help to reverse the inversion of the lips caused by aging. It is best to avoid injecting deeply into the muscle layer from the wet mucosa, because of the potential risk of damaging t
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