Introduction
Perioral rejuvenation has gained significant popularity in recent years as people strive to maintain a youthful appearance. In New York City, a hub of aesthetic medicine, there are numerous institutions offering comprehensive perioral rejuvenation injections. This article aims to inventory the top ten authoritative institutions in the city, along with providing in - depth knowledge about perioral rejuvenation itself, including the anatomy involved, the techniques used, and the types of fillers available.
Understanding Perioral Rejuvenation
Perioral Anatomy and Aesthetics
The perioral region is a complex area of the face. It is bound superiorly by the base of the nose, supero - laterally by the nasolabial folds, inferiorly by the labiomental crease, and infero - laterally by the labio - mandibular folds. The bony structures of the mandible, maxillary bones, and teeth support and shape this area. The perioral muscles, such as the orbicularis oris, levator labii superioris, and others, play a crucial role in facial expressions. The sensory innervation of the perioral region is provided by the maxillary (V2) and mandibular (V3) divisions of the trigeminal nerve, and the blood supply comes from the facial artery and its branches like the submental artery, inferior and superior labial arteries, and angular artery.
Aesthetic concerns in the perioral region often involve prominent radial wrinkling around the lips, downturned oral commissures, exaggerated depth of the nasolabial, labiomental, or labio - mandibular folds, and flattening of the cupid’s bow. These concerns are influenced by aging, which causes bone resorption, loss of volume of subcutaneous tissue and elasticity, and muscle movement leading to static and dynamic rhytids.
Signs of Perioral Aging
- Fine Lines: Perioral fine lines are one of the most common signs of aging. They are often caused by repetitive muscle contractions, sun exposure, and thinning of the skin. These lines can make the lips look less plump and the mouth area appear aged.
- Marionette Lines: Marionette lines are the vertical lines that run from the corners of the mouth down to the chin. They are a result of the loss of volume in the cheeks and the sagging of the facial muscles, which accentuates the downward pull around the mouth.
- Downturned Oral Commissures: Over time, the corners of the mouth can turn downward, giving a perpetually sad or angry expression. This is due to the relaxation of the muscles around the mouth and the loss of support from the underlying tissues.
- Lip Changes: Lip changes include the flattening of the cupid’s bow, elongation of the philtrum, and loss of lip volume. As we age, the lips become thinner, and the definition of the vermilion border decreases, making the lips look less full and youthful.
Techniques for Perioral Rejuvenation Injection
Current Hyaluronic Acid Injection Techniques
Common techniques for injecting hyaluronic acid (HA) filler in the perioral region include retrograde or anterograde linear threading, fanning, cross - hatching, and depot. For perioral radial fine lines, retrograde linear threading along the vermillion border is often used, followed by direct placement of filler in the vertical rhytids. A fanning or cross - hatching technique may be employed for deeply etched lines. The oral commissures can be improved by anterograde threading from a cutaneous insertion point inferior to each commissure, or an X - shaped linear thread or aliquot depot injection placed just below each commissure to produce an upward lift.
Nasolabial folds can be treated by a subdermal injection with a fanning technique across the fold, and a deep mental crease can be softened by linear threading of HA acid into the subcutaneous plane. However, potential injection site reactions following cosmetic injections include swelling, tenderness, bruising, and pain, which are common sequelae in all HA acid filler injections.
The Kirby - Xiao Intraoral (KXIO) Injection Technique
The KXIO injection technique is a novel intraoral approach to HA acid filler injections for perioral enhancement. It was developed by Dr. William Kirby and was inspired by patients who reported an improvement in their perioral aesthetics while wearing dental retainers. This technique places HA acid filler intraorally in the same areas that would be volumized by dental retainers.
The implementation of the KXIO injection technique involves several steps. First, the informed consent is reviewed with the patient, and the potential side effects of HA filler injections are discussed. Hyaluronidase, nitroglycerine paste, and aspirin are made available in case of suspected vascular compromise. The patient is provided with a mirror to review their perioral anatomy, and the extent of perioral lines, folds, and shadows is assessed to customize the treatment. A low - elasticity and low - viscosity HA filler is selected. Intraoral topical anesthetics are usually not used as intraoral injections are reported to be less painful than traditional percutaneous perioral injections. The oral cavity is cleansed with a chlorhexidine - based mouthwash to minimize infection risk.
Then, the non - dominant hand is used to manually evert the patient’s lower lip to expose the interior mucosal side of the lip, and approximately 0.1 cc of filler is injected in four evenly spaced depot aliquots in the lower mucosal lip, for a total of 0.4 cc of filler. The same technique is repeated on the upper lip. The appropriate placement of filler is dependent on the patient’s individual anatomy and perioral deficits, and anatomical landmarks are used to guide the placement. To minimize the risk of vascular compromise, injections near the vermilion - mucosa junction in the upper lip are avoided, and precise needle placement and slow injection are recommended. After the injection, aluminum chloride 20% solution can be applied to minimize post - injection bleeding and bruising, and the injected areas are manually massaged to smooth out superficial lumps and contour irregularities. Cool compresses or ice packs can be used to minimize post - procedural swelling.
The advantages of the KXIO injection technique include restoring perioral volume, leading to improved appearance of perioral lines and decreased shadows, significant decrease in reported patient discomfort when compared to traditional percutaneous perioral injections, decreased tissue distortion facilitating more precise aesthetic assessment and placement of filler, and facilitating decreased soft tissue trauma compared to percutaneous injection techniques, resulting in less swelling and bruising. However, it also has some limitations, such as a theoretical higher risk of bacterial infection due to bacteria colonization of the oral cavity (although anecdotally not observed), requiring very thorough knowledge of the underlying anatomy to avoid injecting into perioral blood vessels or near nerves, being more difficult for the patient to visually monitor the injection area for adverse side effects after leaving the clinic, and the unknown duration of filler injected in this off - label location.
Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement
Premaxillary filler injection is another approach for perioral rejuvenation. A study evaluated the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height. Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in a prospective cohort study and underwent premaxillary hyaluronic acid filler injection. The hyaluronic acid filler used was a gel of hyaluronic acid produced by the streptococcus species of gram - positive bacteria chemically cross - linked with butanediol diglycidyl ether and suspended in phosphate - buffered saline (pH 7) at a concentration of 20 mg/ml with 0.3% lidocaine (Restylane® Defyne), which has a high lifting capacity and is indicated for correction of moderate to severe deep facial wrinkles and folds.
The injection was performed in the facial plastic surgery office setting. Each patient’s upper lip and nasolabial areas were first cleaned with benzalkonium chloride, and a bilateral infraorbital nerve block was performed with 3% mepivacaine local anesthetic. The filler was injected in the premaxillary area in the supraperiosteal plane via a linear threading technique from 1 - ml vials with the use of a 22 - g cannula through bilateral port sites at the inferior aspect of the nasolabial folds created with a 20 - g needle. After the initial treatment, patients were re - evaluated at 2 weeks and 4 weeks, and photographs were taken at different time points to measure nasal tip projection (using the goode ratio), upper lip projection (using the z angle), and upper lip vermilion height ratio.
The results showed that there was no significant change in the goode ratio, but there was a significant decrease in the z angle, indicating a significant increase in upper lip projection. The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but did not achieve statistical significance. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation, but it is important to have a thorough understanding of the relevant facial anatomy and associated risks as the premaxillary space is near several large facial vessels, and intravascular injection can result in serious complications.
Types of Fillers Used in Perioral Rejuvenation
Hyaluronic Acid Fillers
Hyaluronic acid (HA) is the most widely used filler in perioral rejuvenation. It is a glycosaminoglycan disaccharide naturally found in the extracellular matrix of connective tissue and other vital tissues. HA provides structure and volume to the skin and is critically important in maintaining skin moisture. With age, HA concentration within the skin decreases, correlating with rhytid formation. HA - based hydrogel fillers support soft - tissue volume defects in part by their hydrophilic nature and absorbing water to increase volume.
There are many HA - based filler products available in the market. For example, Restylane products include Restylane Lyft for moderate to severe facial wrinkles, cheek augmentation, and midface contour deficiencies; Restylane Refyne and Defyne for facial wrinkles and folds; Restylane Silk for lip augmentation and perioral rhytids; and Restylane - L for facial wrinkles and folds and lip augmentation. Juvederm products such as Juvederm Ultra XC, Vollure XC, Volbella XC, and Voluma XC also have different indications for treating various facial aging signs in the perioral and other areas. The duration of HA fillers varies widely, typically ranging from 3 to 18 + months, depending on the percentage and type of HA cross - linking, the patient’s metabolic rate, and the dynamic nature of the recipient sites.
Non - HA - based Fillers
Polymethylmethacrylate (PMMA), poly L - lactic acid (PLLA), and calcium hydroxyapatite represent long - acting, non - HA - based, soft - tissue fillers. PMMA (Bellafill) and PLLA (Sculptra) are composed of polymer microspheres that stimulate neocollagenesis over a 3 - month period. Calcium hydroxyapatite (Radiesse), a natural component of bone and teeth, also stimulates collagen formation over time. These fillers result in volumization via distinct biostimulatory mechanisms and are used to treat specific perioral and facial aging concerns.
Top Ten Authoritative Institutions for Comprehensive Perioral Rejuvenation Injection in New York City
While specific institutions cannot be precisely named here due to lack of updated real - time information, the following factors can be considered when evaluating and identifying the top institutions:
- Reputation and Experience: Look for institutions with a long - standing reputation in the field of aesthetic medicine. Check patient reviews, testimonials, and the number of years they have been providing perioral rejuvenation services.
- Qualified Staff: The institution should have board - certified plastic surgeons, dermatologists, or other qualified medical professionals with extensive experience in perioral rejuvenation injections. They should be up - to - date with the latest techniques and safety protocols.
- Range of Services: A top - tier institution should offer a comprehensive range of perioral rejuvenation techniques and fillers to meet the diverse needs of patients. This includes different types of injections, as well as combination therapies if necessary.
- Patient Care: Good patient care is essential. The institution should provide personalized treatment plans, detailed pre - and post - treatment instructions, and be available to address patient concerns and questions throughout the process.
- Technology and Equipment: Use of the latest technology and high - quality equipment for perioral rejuvenation injections ensures better results and patient safety. Institutions should invest in advanced tools and products.
Choosing the Right Institution for Perioral Rejuvenation
Research and Consultation
Before choosing an institution for perioral rejuvenation injection, patients should conduct thorough research. Look for institutions online, read reviews on various platforms, and ask for recommendations from friends, family, or other medical professionals. Once a shortlist of institutions is compiled, schedule consultations with them. During the consultation, patients can discuss their concerns, goals, and expectations with the medical team. They can also ask about the techniques used, the types of fillers available, and the potential risks and side effects.
Credentials and Experience of the Providers
It is crucial to ensure that the providers at the institution are well - qualified. Check their board certifications, years of experience in perioral rejuvenation, and any special training they have received. Providers with more experience are more likely to have a better understanding of the anatomy and be able to achieve optimal results while minimizing risks.
Cost and Insurance Considerations
Cost is an important factor for many patients. Different institutions may have different pricing structures for perioral rejuvenation injections. Patients should obtain detailed cost estimates from the institutions on their shortlist. It is also important to note that most perioral rejuvenation procedures are considered cosmetic and are not covered by insurance. However, some institutions may offer financing options to help patients manage the cost.
Conclusion
Perioral rejuvenation through injection is a popular and effective way to address the signs of aging in the perioral region. Understanding the anatomy, the available techniques, and the types of fillers is essential for both patients and medical professionals. In New York City, there are numerous institutions offering these services, and by considering factors such as reputation, qualified staff, range of services, patient care, and technology, patients can choose the right institution for their perioral rejuvenation needs. Whether it is using the Kirby - Xiao Intraoral injection technique, premaxillary injection, or other established methods, the goal is to achieve a more youthful and natural - looking perioral appearance with minimal risks and downtime.
If you are interested in perioral rejuvenation injection, we encourage you to take the next step. Research further about the top institutions in New York City, schedule consultations, and discuss your concerns with the medical professionals. By being well - informed and making a careful choice, you can embark on a successful perioral rejuvenation journey.
