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Stanford, Calif. - According to Andrew Menkes, M.D., it generally doesn't matter whether Restylane is injected using a threading or puncture technique or, as he prefers, a combination of the two - that is, unless you are talking about the lips.
Stanford, Calif . - According to Andrew Menkes, M.D., it generally doesn't matter whether Restylane is injected using a threading or puncture technique or, as he prefers, a combination of the two - that is, unless you are talking about the lips.
"The other common treatment areas - the glabella, nasolabial folds, and mesomental folds - are fairly simple and uniform. But the lips are totally different. That's where the variations in technique come in," he says.
Techniques For the most common areas - the glabella, nasolabial folds and mesomental folds - Dr. Menkes first applies a topical anesthetic before injecting the material into the mid or lower dermis with a 30-gauge needle.
"With the glabella, lines are sometimes there even after Botox. In that case, Botox is used to paralyze the line; then, what's left is filled in with filler. But I first need to learn which patients need both. So after treating first-time patients with Botox, I have them come back in a few weeks, at which point I touch up with Restylane if needed. Once you know what they need, you can put in the Botox and Restylane in at the same time."
He uses a combination of techniques, usually starting with the threading technique, then filling in with the serial puncture technique.
"There's no right or wrong answer; it's a matter of preference, experience and what you're comfortable with - as long as you get the Restylane in there," he says.
Lips Dr. Menkes believes that art is more important in the lips than other areas.
"When you're talking about the lip," he says, "the question is, what do you want out of it? Do you want a bigger lip? A fuller lip? Do you want to eliminate the vertical lines extending from lips upward?"
Anesthetic, too, is more important there because the procedure would otherwise be especially painful. To numb the lip without distorting it, he performs a nerve block using local anesthetic.
"You don't have to do a full maxillary nerve block, though. You can inject a small amount of local anesthetic into sulcus on the mucosal side of the upper lip just lateral to the incisors. This achieves complete numbing of the upper lip with minimal swelling," he explains.