VERTICAL LIP TECHNIQUE: Is it more dangerous than horizontal? [Aesthetics Mastery Show]

[@caseyprice543]

I’d love to have a video dedicated more to “older lips” specifically. I get a lot of requests for them and just feel they are challenging because there is so little to work with.

[@talithakeating5255]

Thanx for great educational videos Tim. I particulary prefer your 'age gracefully' approach to aesthetic medicine. I have been doing aesthetic for about 11 years and try to keep up with new approaches and injecting methods with emphasis on safety. As I am still practicing paeds I do not always have time to go to workshops to keep up to date, thus watching your videos is great!!!

[@DrTimPearce]

kzbin.info/www/bejne/gquao5qMm7Wpb5o Have a look at this one.

[@laurencushley8428]

This was brilliant. Never crossed my mind about the artery taking up more space in the older persons lips. Great content. Love these videos ❤️

[@Viewlaser]

I use both vertical and horizontal. More important than needle or canula, horizontal or vertical is the depth and plane of injection relative to the muscle. I will use vertical for the central volume and structure, horizontal for the lateral 1/3 finishing with a bolus below the oral commissure. I will normally use BD needle for patient comfort and accuracy. Canula has its place for safety, comfort and results. Understanding the rheology of products is also important. What are your go to lip dermal fillers for specific lip types and desired results?

[@revivemedicalspas]

Depends on the lip and the goal. One thing I do that you don’t discuss in lip injections is to change the needle often (at least once per area) and to not prime it. More comfort, less bruising, better assessment of what is in that area.

[@skinsister5691]

I agree with your reasoning. I like the way you explained if you were actually trying to cannulate a vessel, of course you could go horizontally, so that does make sense. I think Ultrasound would be very helpful to assess patients before injecting to visualise where the artery runs and we can adapt our techniques accordingly :)

[@01maggie]

As a Nurse I love it!!

[@davidvandam2405]

I use horizontal 99% of time but 90% of my lip augmentation are performed using a 25 Ga., 1 1/2" cannula. A very small injection of lidocaine with epi is placed 3-4 mm lateral to the oral commissure and a 23 Ga. needle is use to create an adit. Through this opening, the cannula is gradually passed to the center of the lip vermilion within the superficial plane and with the opening oriented outward, directed toward the vermilion.. Injection is slow and retrograde. two to three passes may be necessary for each side of the upper and lower lip. My goal is a natural-looking lip. It is most common to use less than 0.5 ml (total) to treat upper and lower lip. Patients who have had both needle and cannula treatments generally comment that the cannula is less painful. Topical anesthetic ointment for 20-30 minutes prior to lip augmentation does help. It is not difficult to produce nicely shaped lips by varying the rate of injection during withdrawal of the cannula. Rarely ever does this method cause bruising and there is only one, tiny 30 Ga. needle-mark at the corner of the mouth that is invisible in 1-2 days.

[@Peter-ol9bt]

David, I use the exact same technique

[@leiyashim5999]

Thanks it's worth reading

[@just.jaimie.]

If you want to add fullness and also definition do you do this and then use a small needle at the vermilion border?

[@davidvandam2405]

@@just.jaimie. yes

[@just.jaimie.]

@@davidvandam2405 thanks for the reply!

[@microbladingbrowartmba5132]

Both. Good point about artery not getting smaller and occupying more space 👏

[@jeanshannontoth9466]

I just love how dedicated you are ensuring the proper advice is given its very helpful to me. Thank you very much. 💝

[@ShredderTainment]

Thank you for making these videos!

[@onurege6755]

I follow you form Turkey. Thank you for information.💐

[@shelbylane3441]

Vertical w/ some horizontal. Could you expand on what you believe is best technique for older women w/ inverted lips? I find these a struggle and would love to hear more about your technique recommendations!

[@dawnengaas8834]

Yes, this is also my biggest struggle.

[@meliroca]

Vertical injector here 🙋🏿‍♀️ Thank you for explaining so good always!!! 🤗 I follow you from Monterrey, Mexico 🇲🇽

[@spentonbargains1]

Great video. I usually inject horizontally, starting with the wet-dry border, but some clients want the "Russian lip" (which I do not encourage, but they are the customer). Then I do some of the vertical technique. This video was helpful in teaching the starting point inside the vermillion border, and not going too deep.

[@janedapeg5906]

I agree with you DR TIM PEARCE

[@Miramani]

I love anatomy!!!

[@Mrnaitsircsbg]

What do you think about labial artery transilumination for locating the arteries before your technique? Thank you Dr. Pearce

[@jacquihesher5424]

I’m looking into getting lip filler for the first time and doing research 🧐 so I have no opinion on vertical versus horizontal injection but found this video informational thank you ☺️

[@sassy7506]

My dermatologist used horizontal on my 50 yr old lips. Zero bruising, very minimal swelling. It's a very natural look without duck lips.

[@jennacorvan6633]

I usually inject horizontal but really want to try vertical, so glad I saw this, very informative, thank u

[@JoBisbee]

I am an older lady with thin lips thinking about a little work to give me back a bit of lips. Thank you for your kindness and expertise Dr. Pearce.

[@fluffykittens4090]

Both depending on need to accomplish goal. Great point about the artery taking up greater percent of area as volume decreases. Love your videos!

[@FioreAesthetics]

Great video Dr Tim , Love to see a continuation part 2 on Bottom Lip anatomy Vertical Vs Horizontal .

[@lexi03gabby]

My anatomy specifically is very superficial. If I am injected laterally or the corners of my upper lip my superior labial artery becomes prominent, palpable and you can visualize it pulsing. After my first ever injection I requested the corners to be dissolved and it resolved the issue. I now request to never be injected in the corners and focus on the medial lip.

[@rezpakzad7016]

Dear Dr Tim, I think it would be better if you could explain on a model.

[@hosseinkaramsima8176]

tnx for your comprehensive explanation

[@katrinacanning4640]

I njoy your videos must say Dr Tim. I'm an linear injector always along the lip

[@crystalstarr6196]

I just came across one of your videos by accident I was only 8 minutes into it and I stopped watching to make a comment that is very impressed in what you had to say and then I read my comment over and I had to edit and I lost it and I lost the video but anyway I subscribed I didn't realize there's so many different things vertical injections horizontal injections different things to put in your lips I love learning new things anyway glad I found you

[@Davytron]

This was a great thought experiment. Thank you!

[@Gounesh]

My man explains lips with particle physics, now that's another level.

[@DrTimPearce]

😂😂 thanks that made me laugh at myself, which is always good 😂😂

[@nancyarcuri5857]

Love your videos!! I was a horizontal injector because that is how it was taught 10 plus years ago. But now I am more of a vertical injector unless it is the older or smaller lip then I oftentimes use the horizontal technique to avoid VO but also to get a better result giving the lips the structure they need.

[@bibinek9950]

What is VO?

[@peacefullyme848]

@@bibinek9950 It stands for vascular occlusion.

[@الملكةفرح-ت9ع]

Very useful vedio❤😍😍😍

[@clairewood9905]

50-50 depending on where volume or definition and section of lip you want to work on - interesting re:artery size -so obvious but didn't cross my mind!

[@runningdoctor]

i use more often vertical injection for young and filled lips patients, but with older and thinner ones lips it’s more safe to use horizontal injection. And it is physically more inconvenient to inject vertically thin lips and much more likely to leave the visualized filler on the mucous membrane

[@melaniecheung4125]

I think the more I inject the more I’m aware , or maybe come across the arteries .. I do a combination of Vertical and horizontal.. yes younger more vertical.. it’s very difficult to even try with and inverted/ small lip vertically .I think I attempt structure building with the VB and go from there. Very interesting convo, I think I started horizontal, I do remember the through the white lip to pink phase. Didn’t care much for that with the bruising. This closer to vessels would make a lot of sense! Thanks for verbalizing though or questions we may have! 👏🏻👏🏻👏🏻👏🏻

[@a.evansrn107]

It would be great if you actually pointed out the anatomy of the lip on a person. Also, I liked the slide on where the artery is located. Part of learning is visual demonstration. Maybe you could draw the artery (s) on a model and discuss the anatomy that way paired with an actual injection. Than talk about what regions to avoid and show through demonstration where you inject.

[@DrTimPearce]

Thank you for your feedback. I have a variety of different free videos available online that are accessible on KZbin that discuss anatomy of the lip. But further more if you’d like to get in touch regarding further face to face or e- learning please reach out and one of my team can send you details.

[@innasmirnova9055]

Thank you for this information!

[@joannelira9978]

I just loved the video! 😍😍

[@Ophieknits]

Thank you. Very informative. It got me wondering about threads and how they are applied horizontally right on the vermillion border. Couldn’t they cause a vascular occlusion, and is it a risk that they could be inserted into an artery and through it?

[@wendypickett8653]

PDO threads are placed very superficially in the v border.

[@brezbrez7845]

Grateful for your superb work. Do you have any experience with the use of a near infra-red light torches/devices to highlight the non-visible skin vessels which can then be marked out for avoidance prior to filler injection? They can supposedly detect to a 5.5mm depth but I've heard mixed accounts on the few reviews that I've come across.

[@smu23749]

Youre amazing! Both.

[@juancarlosguerrerovelasque8139]

Excelente video, muy ilustrativo y enriquecedor! Gracias!

[@amimontague]

Another great talk! I use both techniques!

[@Aimeeevps]

I go with horizontal I believe with older lips. It’s best that way. They just pull back on plunger to determine if they hit a bein

[@elizabethtodd2567]

Thank you for the info on lip enhancements

[@elainekupconsultorio5157]

Horizontal with some vertical ( w/canula). It will depend on what I am trying to achieve ( hight, projection, volume..) and where. Very good post and discussion! 👏🏻👏🏻👏🏻Appreciate ! ( from Brasil ). Waiting for your next pic ( on inf.lip! )

[@andrewmirfield9253]

Horizontal majority of time. Thanks for your excellent insight and pictures are great.

[@alicianovotny4559]

Both! And this was great thank you!

[@wmschweitzer]

Excellent discussion about lip injection risk. Very informative. Thank you.

[@Paul-ph7kg]

Hello! Where can i find the first picture with the lip anatomy?

[@africantigress876]

Would you ever run a clinic here in Bristol, Dr Pearce? That would be absolutely awesome 👌. I watch many of your videos and used to self-treat but now realise I have clearly been very lucky indeed not having any issues. I am now reluctant to ever self-inject again and given your knowledge, expertise and experience feel you are the only injector I would put my faith in to treat me. I would be over-the-moon with joy if you would consider running clinics here in Bristol and would be the first to book. Please consider this seriously. Many thanks.

[@Labbepus]

I used to do horizontal. Results are better now.

[@ebe68164]

I love your video!

[@johnlekkas2682]

the way i see it its about goals...vertical might have an advantage in opening the lip (eg "russian lips") and the horizontal in defining the border and probably making a more natural lip....im horizontal so far but i will adjust depending on the case from now on. About complications since there are probabilities this discussion is not very important as you have to be prepared in any technique and for any complication as long as there is even a small chance....High quality fillers, slow retrograde injections and massage right after really help.

[@DrTimPearce]

Agreed! 🙂

[@carmelitagibbons9801]

Really helpful Dr Tim, thank you 😊

[@CatherineChangchangstkdamerica]

Balance is key…not one or the other.

[@robinpower4699]

Both, depending on the lip. What are your thoughts Dr. Tim, re cannula for restoration on older, or very small lips, and safety/efficacy, as per MD Codes technique? (I saw a pic of you and Dr. Mauricio de Maio, so assume you are familiar). Thanks--love your show. And Miranda too. :)

[@sarafigini589]

Hi doctor! Thank you for all your helpful teachings! I’m an regenerative aesthetic doctor too, practicing in Portugal. Generally I use 30g blunt cannula for lips. Most my patients are over 45, and prefer a natural look, so I tend to use Restylane kiss and both techniques ⬆️⬅️. Also use prp growth factors for rebuilding and rejuvenation. Now appreciating results from Endolaser lifting. Appreciate your work!

[@الملكةفرح-ت9ع]

Thank u I wish the best 4u🎉❤😍😍😍😍💰

[@RG-bd5fy]

Possible patient for lip filler - I didn’t know about the arterial risk. Thanks!

[@julietastes181]

How would you suggest to treat such patients with the arterie lays very superficial? I prefer vertical injections to get a high lip and volume all over, to sculpture the lip.

[@katlyndsummers5863]

You said the artery naturally loops in and out of these layers, Do they sometimes wiggle In and out of the superficial layer you would inject in? Love your channel btw Thank you 😊

[@DrTimPearce]

1% of the time yes- but there are signs a good injector should see first before injecting.

[@doctorjarrett]

Primarily vertical with a few Horizontal threads. Also you didn’t mention the bottom lip. Was your research just regarding the top lip? Great content. Appreciate you!

[@elizabethpawlowski2673]

Same here

[@DrTimPearce]

yes it was getting overwhelming doing both, perhaps in another video!

[@SimplyFitLondonAlbinaSafarova]

Great video, 👌... Could you do similar video on PDO threads, pls? Thank you

[@DrTimPearce]

I’m afraid we don’t offer this service so we can’t really comment. Kind regards Mary. Clinical advisor for Dr Tim

[@hajranoorkhan64]

Thanks 👍

[@Maxine-ho3jc]

Verticle injections left lumpy lines for weeks on my lips. It didn't make them look plump or nicely shaped.

[@الملكةفرح-ت9ع]

Thank u u r the best🎉🎉🎉❤

[@PRCLEVER1974]

Well, I do it horizontally, but using a cannula.

[@yousifmq]

Vertical technique tends to flip the lip upwards, changing the form of the lip (when looked at from the front) Horizontal technique doesn't do that, but it changes the volume of the lips (when looked at from the side)

[@DrTimPearce]

I broadly agree :-)

[@yousifmq]

@@DrTimPearce this is how we have been doing it, but I would like to hear your opinion about it and would appreciate any additions/corrections :) If possible, please cover it in a video, would be very interesting to hear your thoughts about it

[@mariannebotha5543]

I love your videos.

[@mizravenkustoms]

Not really related to the video but if anyone here is a professional wind player - you can still play with injected lips - i took a big risk and so far so good no major problems just had to adjust my embouchure.

[@tulliapannozzi1422]

Personalmente io faccio sempre un po' di eversione del labbro (arco di cupido soprattutto) con tecnica verticale, ma poi per dare volume vado con tecnica orizzontale.

[@leecottrill6142]

Love seeing all these positive comments on how people have enjoyed this video :-))

[@katiasaul8232]

Why not to use a cannula to avoid artery perforation?

[@alexandraw887]

Ok, so how do you feel abt injecting vertically in the wet dry border on the bottom lip??? I'm curious abt this due to the fact that i was injected in this area and ended up with a vascular occlusion. It was quite painful (pain was immediate), looked horrible and only got worse, he refused to fix it/help me (i had no idea what was going on), told me to wait 2 weeks and after 1 week i just couldn't take the pain anymore (i have a high pain tolerance in general) plus my lip was changing colors. At my appointment he told me i had an extra muscle in my lower lip, and that I caused this to happen because i probably had too much filler. So, he injected my lip (both sides) with botox, and banned me from the practice which wasn't his in the first place. I ended up going to a second plastic surgeon who had to reverse (hyaluronidase) in that specific area of my lip. He also shocked by the botox injection to the left and right side of my lip. What is your take on this?

[@alexandraw887]

Dr Tim Pearce

[@DrTimPearce]

I’m sorry you had to go through that. It must have been a very scary situation for you. Unfortunately I can’t give an explanation as to what this practitioners rationale was to treat you how he did. I’m glad you found a practioner that correctly diagnosed and treated your problem. Vertical lip injections, even in the bottom lip have a place and when injected at the right plain and angle of trajectory they can achieve a great result. But no injectable treatment comes without risk. Clinical advisor for Dr Tim Pearce

[@tamborambo2957]

That is horrifying. I’m so sorry it happened to you.😢

[@bibinek9950]

I got horizontal and got so beautiful lips. Then this new trend Russian lips came and everyone does the vertical technique and this technique makes the lips full at the vermillion border and empty in the middle of the lips and this cause a duck lip and also it migrates easier

[@anayarey]

Is one technique more likely to cause migration?

[@krystledillon4123]

Vertical injector primarily, with horizontal as well

[@beabeckers]

I inyect my own lips, always horizontal

[@Tracy_555]

Can you see the artery if u shine a light thru the lip?

[@DrTimPearce]

It’s usually too deep and thin to see but it could be a possibility. I wouldn’t use this as a clinical test though prior to treatment. Feeling for pulsation in the under side of the lip is more sensitive. But remember vessels snake in and out of the layers of this lip too. Kind regards Mary. Clinical advisor for Dr Tim

[@elliebarr6902]

Can you please give your opinion on the Russian lip technique. Im not a fan but i see so many clinics offering this look. Thank u

[@hanakhourydamouny8106]

What do you mean with getting the needle into the actuall lumen? what is the actuall lumen?

[@DrTimPearce]

The space within an artery is the lumen, the most dangerous place to be.

[@JennMartinello]

Wouldn't the best thing to aspirate especially going vertical of the vermillion and thin. One other thing is to absolutely know if someone is on ketogenic diet, or blood thinners, herbs, and so on for bleeders... Lord knows the ketogenic effect on thinning the blood is tricky. Just another idea to think about.

[@DrTimPearce]

We are keen fans of aspirating on every injection yes.

[@DrTimPearce]

That's a new idea for me-I aim for keto myself- I don't bruise easily at all. Is the idea that the blood is less viscous or slower to clot? I could imagine the former.

[@bethmccracken4641]

I’m 60 blessed with thick lips, however my upper lip needs a little injection, any recommendations ?

[@DrTimPearce]

Have a good search in your local area for medical practitioners trained in aesthetics. Visit a couple and see who you feel most at ease with. A Perioral treatment using a fine filler around the borders to replace the crisp edge is a beautiful treatment for a lady in her 60’s. Clinical advisor for Dr Tim

[@lancale]

I disagree with your theory about pirecing the artery being more likely with the horizontal approach. If you have ever done a radial arterial blood gas, the approach is to insert the needle perpendicular to the artery. This technique is most likely to fix and pierce the artery. Cannulating a radial artery for an arterial line has a bit more horizontal approach and is more difficult because all arteries and veins tend to roll away from a needle inserted horizontally, especially the thicker walled arteries. I believe the vertical injecters, who are doing mutiple stabbing injections, multiply by several factors their chances of piercing the arterey.

[@DrTimPearce]

Thank you for sharing your rationale and not just your conclusion. I agree that if you are comparing one horizontal with 40 vertical injections trauma is more likely. In the very precise comparison of one vertical injection compared with one horizontal in the exact same plane in the same patient both Injections would pierce the artery at the point closer to entry, but the horizontal would more likely stay in the lumen.

[@reneearriaga7485]

Horizontal, always using a cannula.

[@pokee1854]

I do not understand the terms "pink lip" and white lip. The lip is pink and if it is not pink, is not lip. Don you refer to the wet dry border and white lip. Or is the skin surrounding the lip the white lip?

[@DrTimPearce]

It is as it suggests. The red/ pink lip is the coloured lips. Wet dry border is where the lips meet (wet side is the inner side of the lip) white lip is the skin surrounding the lips (Perioral region). Hope that helps. Kind regards Mary. Clinical advisor for Dr Tim

[@milayalyuda1]

Wise

[@gokcekaya2494]

Bu konuyu çok merak ettim videolarinizi izlemek isterim keşke farklı dillerde alt yazı olsa tam olarak anlayamıyorum söylediklerinizi (Türkçe)

[@krisztianegyed6566]

Hi there, I don’t understand why you don’t mention aspirating the plunger to test if there is an artery in order to avoid canulating it. For me, it would be common sense to test it with this simple way… Thank you for your answer.

[@DrTimPearce]

I'm a big proponent of aspirating- sorry if I didn't say in this video.

[@krisztianegyed6566]

@@DrTimPearce thank you Sir :)

[@davelandy1503]

both

[@janelouise7585]

Both vertical and horizontal, depends on the shape of lips ❤

[@margaretmorris-calderon2826]

I don’t like the way woman’s lips look like with vertical injections. The trim stays extended after the inspection wears off. They have a rim lift left over. It’s really unnatural looking. Given the choice I’d choose horizontally.

[@BOOK-PHILOSOPHY]

Radial artery on the back of the wrist???? Omgosh

[@DrTimPearce]

We are all unique. Some more than others ! Mary - Clinical advisor for Dr Tim

[@Labbepus]

Vertical!

[@susanfrenz6653]

Horizontal

[@hajranoorkhan64]

I am horizontal injector

[@verreal]

Darn. I thought you were going to tell me The Answer, so I could look for the appropriate doctor. Instead, it's a rousing debate on both sides of the question. I mean aren't there some statistics for adverse outcomes so that we could come to a reasonable conclusion? Btw, did you lift your own brows a little? Men hardly have an arch like that. It's a bit nosey, but it is your area of expertise. I want to know what you're willing to do on yourself (and all other doctors speaking about these issues as well.)

[@DrTimPearce]

I’m afraid this is incredibly true analysis of the video and of the data that is available to us. But what is evident is that every technique whether it vertical or horizontal can be made more safe or more risky by the hands that wield the needle. Depth is the true main factor that makes any of the injections safe/ risky and knowing the anatomy for that accompanying depth. I don’t believe Dr Tim has a toxin lift. But that’s for him to discuss :) Kind regards Mary. Clinical advisor for Dr Tim

[@janedapeg5906]

For me the more i like horizontal

[@dhlavelle]

Horizontal more than vertical