Dr. Tom van Eijk: The next model is Anita, and she came to me to have a little bit more elevation of the top lip, and what you see is that the show of red is diminished, especially at this section on both sides. I think symmetry is very good at the moment. We are going to try and inject her without the numbing injection, without any anaesthesia. She had had some Lidocaine cream about 10 minutes ago, so if you’re ready and it’s ok, let’s start.
Dr. Tapan Patel: So, Tom, talk me through the product you’re going to use now.
Dr. Tom van Eijk: This is a different family within the Restylane range, this is Kiss, from the old Emervel group, which resembles Juvederm more than Restylane does. She is young, and you see that the envelope of the lip is perfect so we don’t need a lot of restoration there. We want some fullness here, so if you want to add more volume and less strength, less skin enhancement, I think that the Restylane Kiss is excellent.
Dr. Tapan Patel: Wonderful, let’s see. So, you’ve finished the upper right side and I already can see from here, it looks fantastic. If you had only Restylane in your range, could you have got a similar result? How do you think the result would have looked any different?
Dr. Tom van Eijk: I think the edge would look sharper with the Restylane and the fullness would be less in comparison.
Dr. Tapan Patel: Understood, so you would get more definition, but less fullness?
Dr. Tom van Eijk: Absolutely.
Dr. Tapan Patel: It’s interesting, it’s exactly why Tijion and I like the Vycross range, as it behaves more like a gel than a particulate product so we are getting that fullness.
Dr. Tijion Esho: It’s surprising to me, seeing you inject, that there’s not that massive extrusion force being seen in the product, and I think from dabbling in Emervel a long time ago I found it harder but that’s not what I’m seeing here.
Dr. Tapan Patel: I think it comes back to what we were saying, you know, in the right hands an experienced practitioner can probably work with most products, so then it just boils down to knowing the personality of the product that we’re talking about. That was going to be my question to Tom, about why you would choose Emervel over Restylane, and I think that’s a great choice when you want volume but maybe you don’t want to over define, then you’re using a slightly softer gel.
Dr. Tom van Eijk: You can see one drop, a little tear drop from her eye, and a bit of blood, and this is why next time I would use an Amsterdam intraoral block, to avoid both the bleeding and the pain.
Dr. Tapan Patel: Absolutely.
Dr. Tom van Eijk: How are you?
Patient: I’m fine.
Dr. Tapan Patel: How did that feel, Anita?
Patient: Yes, it was fine, I was trying to stop myself from sneezing!
Dr. Tapan Patel: I think we do sometimes see those little beads of tears coming out of the corners of the eyes, but I’m not always sure it’s just pain. I think, especially when you are treating noses and so forth, it can often be a reflex tear.
Dr. Tijion Esho: Completely, I have patients do it all the time, even when you just brush the area.
Dr. Tom van Eijk: I’m just going to add a little extra here.
Dr. Tijion Esho: I was going to say, there was a slight thing there.
Dr. Tapan Patel: I spotted that too, I was going to ask you about it Tom.
Dr. Tom van Eijk: I beat you to it!
Dr. Tapan Patel: You certainly did! Now this is a technique very similar to mine, Tom, I think I might start doing a bit more tenting!
Dr. Tijion Esho: And that’s sometimes slightly informative, you know when we were talking about dentistry and potentially having a rotated tooth, you’ll see that the lips sit that way, with the actual pink of the lip almost hitched up at that point, which can become problematic when you’re treating the lip.
Dr. Tapan Patel: You didn’t massage when you use the Restylane, and I understand why, because you were using the personality of the gel. You’ve used a softer gel now, will you massage this or still not?
Dr. Tom van Eijk: No, because it’s all small amounts, I believe that massaging will not give any benefit for me. I do massage in the cheek, because that can often make sense.
Dr. Tapan Patel: What’s been interesting for me is that a lot of our techniques are very similar, and then there’s things where we are completely different as well.
Dr. Tom van Eijk: All good, we’re done!
Dr. Tom van Eijk: So now you see more fullness in the upper lip, whereas before one of her upper teeth was showing through the hole. Now, it’s more even and closed.
Dr. Tapan Patel: I love this result, this is exactly the kind of results we give the patients we see for the first time who have never had a lip filler, who want some impact but also want to keep it very natural, and I think it does look very natural. It’s very important to understand that you’ve matched the product to the patient very nicely here. Any thoughts from you TJ?
Dr. Tijion Esho: I completely agree, I think we both spotted that small area where tooth was showing in that upper part of the lip and wondered how you were going to approach that with that particular product, but it just shows how being experienced with the product and selecting the right one for the patient can get you a great result.
Dr. Tapan Patel: I think it’s interesting to me that a lot of courses and training providers put lip treatment as something for beginners. To me, I think it’s actually the hardest one to treat on the face and to do well. Anyone can inject a lip and make it bigger, but to keep the anatomy, the shape, the form, the function, and the expression, I think it’s harder than tear troughs, noses, and other things we do. I think Tom has made it look easy, especially with that technique, but it is something that takes a bit of practice, making sure you’re not overinjecting in any one point, and obeying the anatomy and the architecture of the lip.
Dr. Tijion Esho: I think the key here is taking it slow, being superficial, and using small amounts of product. All of those things come together and you get a great result like this.
Dr. Tapan Patel: Let’s show you, Anita, and you can tell us what you think.
Patient: Yes, it’s nice, very natural, just what I was looking for so I have a little bit more on the top.
Dr. Tapan Patel: Perfect! Thank you very much!