(Magazine L’OFFICIEL CHIRURGIE ESTHÉTIQUE)

A beautiful mouth has a nice contour, nicely shaped vermilion borders, the lips are plump but not excessively big, adapted to the shape of the face and the personality. Reshaping the lip line, correcting the Cupid’s bow, enhancingthe lips volume involves the proper know-how and a certain aesthetic sense. Here is how Dr. Hervé Raspaldo explains it (he is a plastic surgeon specializing in the face and neck surgery).

How do you properly reshape a mouth?
Dr. Hervé Raspaldo:

First of all, we establish a precise physiological and psychological diagnosis before any procedure concerning the lips enhancement and reshaping.

Just like before any other surgical procedure, I will carefully observe the patient’s face, take note of any possible issues. I will not only examine the mouth andthe lips, but also the teeth and their position, the bone structure of the face, the nasolabial folds. I will also ask questions to determine the patient’s social environment. Knowing a few things about my patient’s psycho-sociological environment is important, it helps me understand whether she wants an aesthetic improvement or a transformation, whether she aims for a subtle improvementor a rejuvenation.

Do you say no to certain procedures?
Yes, when a patient wants a full, plump mouth and sexy lips but such a correction is not fitting the patient’s face or style.

How do you conceive the corrections? As global procedures or small successive steps?
Each case is unique. In some cases I wouldonly rehydratethe mucous membrane, if the lips are thin and the patient is no longer very young. In other cases I would work on the mouth contour and enhance thevolume.

Do you have your own specific techniques?
I focus on perfecting my gestures, choosing the right injectables (Juvederm Volbella®, the new hyaluronic acid of the Allergan Laboratory), and the injecting process, during which the product is properly and evenly spread under the mucosa. This is essential for a correct procedure if you want to leave no place for bad surprises, and preservethe natural appearance of the lips as well as a nice, soft touch.

Is there something particular about this injectable gel?
This special lip product is based on the Vycross ™ technology (patented by Allergan), based on the combination of hyaluronic acids of low and high molecular weight,which produce a fluid and cohesive gel, with increased correction comfort. It allows to reshape the lipsandthe mouth in a more precise and less painful way (because it’s more fluid and it contains anesthetics). We only need one injecting point to hydrate and reshape contours at the same time. You can see the effect immediatelyand there is norisk of over-correction,because the product will not absorb water after the injection. There will be no edema during the procedure. It gives the practitioner more accuracy. The effect lasts up to twelve months.

Do you have to use local anesthesia?
No, the product is fluid and flexible, and it already contains anesthetics, so there is no need for another anesthetic technique nor creams before the procedure.

What do you work on first ? Lip line, volume, hydration? How to you make the injections in these cases?
I always start by reshaping the vermilion border, including the Cupid’s bow, then I proceed to the hydration of the lipsif necessary. Since the gel is soft and contains lidocaine (an anesthetic), it’s a painless procedure.

How do you avoid overcorrections?
This is a key feature of this new filler. You get no surprise, no edema during the procedure, so no overcorrection, no risk of unnatural, ”duck lips” appearance.

How do you correct a mouth that has suffered from over-injecting?
If the problem is the over-injection with fillers, we must wait for about oneyear beforethe product disappears. Only then can I inject again, and reshape the mouth. If we inject too soon, the two products combined can trigger inflammatory reactions in the form of granuloma.

If the problem is due to a permanent product, only surgery will solve it. In this case, I perform a procedure on the inside of the mouth, removing what needs to be removed and reshaping the lips. After a month of edema, the lips will pressent a nice shape again.

Do you treat drooping mouth corners?
Yes, I perform vertical and horizontal injections in order to lift the lip corners and reshape a nice smile, like Mona Lisa’s legendary smile.

How do you treat the fine lines on the upper lip (the so-called ”barcode”?)
I proceed by crossed intra dermal injection. The product isfluid, so there is no risk of irregularity or bulging effect.

How do you avoid pain?
The idea is to perform anterograde and retrograde injections in a smooth way, using very fine needles (32 gauges). These are the needles used for newborns. Another technique consists in  injecting an area where fillers have juste been injected. The anesthetic contained in the product is already active in this area.

Are there any postoperative measures?
In the following 24 hours, it is recommended to putice on the lips in order to prevent edema. Exercising should be banned, as it can increases the edema risk. If you have a tendency to develop herpes, you should take an antiviral.

When can you see the results?
The effect is immediate. I very rarely re-inject fillers during the first month after the procedure. In some cases, small injections may be needed again after 3 months. Depending on the volume injected, the results last up to twelve months.