Before Lip injection – answer this one question

The one thing I need to know before doing your lip injection

So the topic today is: The one thing I need to know before doing your lip filler injections with Juvederm or Restylane.

Have you ever had cold sores on the outside of your lips?

What is a cold sore? It is caused by the herpes simplex virus.  I know now we’re all worried about some other virus right now – the coronavirus, but I still worry about an “older” virus.  Cold sores are caused by the herpes simplex virus.  There are 2 types and type 1 is the usual cause of the cold sores around the mouth.  At least half of all adults are infected with herpes simplex virus type 1 which spreads easily from person to person.  Once you have the infection, you have it permanently.  The virus lies dormant inside the nerves causing no symptoms most of the time.  But it can be woken up by triggers such as stress, sunburn, hormonal changes, exhaustion, fever – this is why they are sometimes called fever blisters, and any trauma around the area where the herpes simplex virus lives.  An example of trauma would be needle trauma from lip injection procedure.

By knowing your history of cold sores and how easily you get them, we can have a plan of possibly pre-treating your risk of a flare up by having you take a prescription medication called acyclovir right before your lip procedure or even a few days before your procedure if you are really prone to cold sores.  I have pills of acyclovir available in my office and you can take a tablet right before your procedure while numbing up those lips with topical numbing cream.  Totally optional and we offer it for free.    I joke with my patients when they try to chug down the pill of acyclovir while their lips are getting numb from my special formula numbing cream.  When the water drips down the floor because you can’t feel your lips, I pretty much will say, “I see you have a drinking problem!”

I would also write you a prescription for acyclovir tablets to take at home to prevent the flare up.

On another note, cannulas for lip augmentation is something I also do if the risk of swelling and cold sores is severe.

The risk of flare ups with patients who have had previous coldsores is relatively low, but I think it may be 1 in 5 procedures and with pretreatment, perhaps we lower that risk to 1 in 20 procedures.  So I would rather have a lower risk, because cold sores are unsightly and can lead sometimes to scars, and sometimes it can even push our lip filler off to the side.

The lip filler experience can be a bit of a roller coaster ride afterwards because of the swelling, and if we can eliminate the added aggravation of having a cold sore – that would be a good thing.

Also if you have a history of swelling a lot with hyaluronic acid fillers such as Juvederm and Restylane, it would be good for me to know too because we can consider an antihistamines or a prescription prednisone series of pills.  Prednisone is a steroid which is like a big “off” switch for the body and part of what it can do is turn off the swelling mechanisms. So prednisone, antihistamine (like Zyrtec), and cannulas are options for patients with extreme risk of swelling and cold sores.

But in summary, I will ask before your filler appointment if you have a history of cold sores – mainly because it’s somewhat of a risk with lip fillers, but we can lessen that risk by being prepared. Come visit me for lip fillers in Modesto, CA.

Lip Augmentation Technique

Sometimes I’m asked about my favorite lip augmentation technique.

I have about 15 different techniques I like to use for injecting lips with filler such as Juvederm. Thus I have 15 favorites which I like to combine! These include retrograde, anterograde, perpendicular injections (lip tenting), serial puncture, fanning (chicken feet), cannula, vermillion border emphasis, wet dry border emphasis, middle 2/3’s of the lips, parallel lip injections, keyhole preservation, lip tubercle preservation, starting laterally, starting medially, and our 4 hands lip technique. There is also something called the Russian Technique for lips but I’m not quite sure what that is – perhaps it is more of a white roll/vermillion border emphasis technique.

I like to have a vision in my mind for me to achieve and to maintain safety at all times. There are so many variations on what I like to do, but what I keep in mind in choosing which method I use is:

  1. physics of elasticity, viscosity, rheology, vectors.
  2. goals we have (shape, amount, symmetry, proportion)
  3. minimizing the amount of traumatic forces
  4. comfort

I’m thankful for our plastic surgery assistants at Surgical Artistry for helping me develop a 4 hands lip method.

One could also combine lip filler with Botox, but that’s for another topic. Thanks for reading my Lip technique blog.

About me: I am Dr. Calvin Lee, MD, former trauma surgeon. I have been injecting lips since around 2008. I use Allergan products: Juvederm volbella, and ultra most often for lip plumping. I also sometimes use Restylane for lips and also for tear troughs. I actually think that tear troughs and lips are some of the hardest filler procedures to do. The two procedures are quite opposite in the technique we would choose to do. I am located in Modesto, CA. Our address is 4754 Dale Road, Modesto, CA 95356. We moved in March, 2019. Hope you can visit us and give us a call at 209-551-1888.

Plumped up Cheeks with Botox or Filler?

Another Botox question in a public forum:

Fluffy cheeks with botox or filler?

Hello i am 37 years of age. I want my cheeks become fluffly as i was used to look in young age. Which treatment would b better botox or filler ? And how much is cost? Thanks.

My Botox Answer:

I get this type of question of Botox or Fillers every single day – so it’s a great question.

​BOTOX IS MORE PREVALENT

​Last month I had the honor of treating 127 patients with Botox, and 31 patients with a dermal filler.  I think 1/4 of these patients wondered about the differences between Botox and Fillers.  And in my practice, the usage of Botox is a lot more than the usage of fillers.

​BOTOX AND FILLERS EXPLAINED AS MOUNTAINS AND VALLEYS.

​I came up with this explanation for my patients and perhaps it will help others.  First imagine our face as having a landscape.  We have mountains and valleys in our face.  The valleys being the wrinkles which are usually surrounded by mountains on either side.  I have told my patients that Botox weakens muscles and thus it will give the appears of lowering the mountains on our face.  But Fillers, will help to fill up the valleys.  Thus if we want an even surface – a combination approach might be needed: we might have to lower the mountains with Botox (those bulging muscles!) and we might have to raise the level of the valleys/wrinkles with Fillers.

​WHAT IF WE WANT TO RAISE A CHEEK?

The filling/raising of a structure on the face requires a Filler.  Thus for bigger, fluffier cheeks, we need a filler.

​WHAT CHOICES OF FILLERS DO WE HAVE?

​There are many fillers.  The filler that is very popular in the cheek is Juvederm Voluma.  But I still consider off-label FDA choices of other fillers in the cheeks for my desired appearance or a combination of fillers.  I use Belotero, Juvederm ultra plus XC, Juvederm ultra XC​, and Radiesse in the cheeks.  I also use thinned out versions of Juvederm by purposely diluting the products.  All this is considered off-label FDA, but this helps me get the results I envision along with my patient’s goals.

​OTHER POSSIBILITIES – PERMANENT IMPLANTS:
​My plastic surgeon wife who is in practice with me has certain permanent implants which she can use in surgery.  But that would be a totally different topic which I’ll let her explain.

​SUMMARY:

​What is used for making bigger cheeks Filler or Botox? The answer is Filler.  I try to explain that Botox actually shaves down the appearance of bumps in the face, and filler raises lowered areas on the face.  But if we want to raise a bump (mountain) on the face – that would also be fillers.  Naturally the next question might be which filler would we choose.  I think my go-to filler right now is Voluma for the cheek.

​DISCLAIMER:
​​
​Thank you for your question. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.

​Calvin Lee, MD
​Botox and Juvederm in Modesto, California

Modesto Surgeons at work