Reply: “No Touch” Technique for Lip Enhancement

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We are very grateful to Dr. Kun Hwang for his inquires regarding our article.1 The standard infiltration technique we are referring to is needle injection into the lip mucosa. This technique causes immediate swelling that distorts the lip volume and can lead to asymmetries. Immediate distortion caused by edema makes it difficult to differentiate the volume enhancement for filler versus swelling from needle trauma, ultimately making it more difficult to evaluate our result. Anecdotally, we find that use of the needle is more traumatic compared with the cannula and that lip mucosa swells faster than the perioral skin. Thus, the no-touch technique is predicated on use of a cannula or needle without injecting directly through the mucosa.
In our treatment protocol, the Cupid’s bow and philtrum are treated with a needle because a cannula would be challenging. The Cupid’s bow has to be treated as an independent aesthetic subunit, and because of its short dimension, it is necessary to use the needle. For the remaining components of lip enhancement, we prefer using the cannula. In the no-touch technique presented, the preferred filler was hyaluronic acid. In our practice, this is an injection technique for fillers, not necessarily other injection materials. As with any procedure, our patients do have some level of posttreatment edema, but our clinical experience has demonstrated that the amount and duration of edema is less with the no-touch technique compared with standard infiltration methods.
Our rationale for the three-step analysis stems from what we have learned in lip reconstruction and cheiloplasty operations. We believe dividing the lip into three treatment areas (profile, projection, and volume augmentation) synergizes the anatomy and aesthetic subunits, yielding an optimal aesthetic result.
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