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Lippen en mondregio
We hebben de tools, maar wat doen we ermee?
SAMENVATTING
• Wat is schoonheid
• Veroudering gezicht
• Lippen
• Behandelingen
VAAK ZIE IK DIT
DIT ZOUDEN WE MOETEN NASTREVEN
Ondertussen wil de patient dit
Is het onredelijk om hoge verwachtingen te hebben?
MATIG RESULTAAT
Courtney love
35 jaar 40 jaar
MOOI RESULTAAT
Caroline de Bruijn39 jaar 51 jaar
WAT IS SCHOONHEID?
• Evolutionair gezien staan symmetrie en
jeugdigheid voor
– Gezondheid
– Vruchtbaarheid
– Kracht
1 : 1,6
De ouder grieken wisten het al: PHI
WAT IS SCHOONHEID?
WAT IS SCHOONHEID?
OORZAKEN VEROUDERING GEZICHT
Aging of the facial skeleton, Shaw et al,
Journal of Plastic and Reconstructive Surgery (2010, 125: 332-342)
VERANDERING BOTSTRUCTUUR
MOND EN LIPPEN
DE MOND
• De mondregio bestaat uit
• lippen, kin, filtrum, onderste deel wangen kaaklijn.
Oral commissuur
Vermilion border
Labium superius oris
Mentolabial sulcus –
Labium inferius oris
Vermilion
Cupid’s bow
Philtrum
Drake RL et al. Gray’s Anatomy for Students. Churchill Livingstone; 2005.
BENAMING STRUCTUREN
ANATOMIE VAN DE LIPPEN
Overzicht anatomie
Orbicularis oris
Mucosa
huid
Hair follicles
Gekeratiniseerd
squameus epitheel
Vermillion border
Mucosal-epidermal
junction (red area)
Bloedvaten
Niet gekeratiniseerd
squameus epithelium
Lamina propria
Vet
Lip kliertjes
• De lippen sluiten de mond af
• Lippenvorm door complex samenspel:
• support (tanden, kaakweefsel)
• spieren
• mucosa en huid
• vet
Draelos ZD, Editor. Cosmetic Dermatology: Products and Procedures, 1st edn, Chichester, West Sussex: Wiley-Blackwell; 2010.
DE LIPPEN
• De tanden en het kaakbot zijn de basis voor de
vorm van de lippen en het peri-orale gebied
TANDEN
Zygomaticus minor –
trekt de bovenlip
omhoog
Zygomaticus major–
trekt de mondhoek
omhoog en opzij
Modiolus
Mentalis
Heft de onderlip
Speeksel afdrijven
Depressor labii inferior
– trekt de onderlip naar
beneden
Depressor anguli oris –
trekt de monhoek
omlaag en opzij
Orbicularis oris
sluiten van lippen
samenknijpen lippen
spreken
Levator labii superioris
trekt de bovenlip omhoog
Levator anguli oris
trekt de mondhoek
omhoog en opzij
Drake RL et al. Gray’s Anatomy for Students. Churchill Livingstone; 2005.
SPIEREN
• Vermillion border = overgang huid – muceus
• Vermillion:
– droog gedeelte (zichtbaar bij monddicht)
– nat gedeelte (zichtbaar bij open mond)
HUID
• De huid van de lippen
– is erg dun: 3−5 lagen vs 16 lagen bij de normale huid
– geen zweetklieren
– Houdt zeer slecht vocht vast
• Lippenkleur
– Hoe minder melanocyten, hoe roder de lippen
HUID
VEROUDERING VAN LIPPEN
VEROUDERING LIPPEN
Lip volume vermindert
Minder support
Minder vet
Spieren kleiner
Lippenhuid wordt dunner
De vermilion border wordt
langer, dikker en groter
De philtral columns worden
slapper
Cupid’s bow platter
Draelos ZD, Editor. Cosmetic Dermatology: Products and Procedures, 1st edn, Chichester, West Sussex: Wiley-Blackwell; 2010.
Rimpels rond de lippen
De lippen worden platter
Mondhoeken zakken
Langere bovenlip
verminderde projectie
Hamsterwangen
VEROUDERING LIPPEN
Belhaouari L. How to enhance lips with hyaluronic acid. PRIME 2011; 1: 14-22.
VEROUDERING LIPPEN
BEHANDELING LIPPEN
• De lippen zijn moeilijk te behandelen:
– Zeer bewegelijk
– Gevoelig
– Goed doorbloed
– Elke kleine fout (overcorrectie) direct zichtbaar
• Zwellen gemakkelijk op
• Orbicularis oris bepaald voor groot gedeelte de vorm
DE LIPPEN
3
0LIPAUGMENTATIE
LIPPENROOD
• Injecteer op de grens van dermis en mucosa
• Linear threading
• Insertie 45 graden hoek
• 4-6 injectiepunten in de lip
• Onderlip groter dan bovenlip
• MINDER = MEER
3
1
VERMILLION BORDER
• Bij mondhoek vermillion border ingaan
• Tot hoogste punt cupidoboog
• Linear threading
• Pas op voor duck lips bij dunne lippen
• 4-6 injectiepunten in de lip
• MINDER = MEER
LIPAUGMENTATIE
•Juvederm Volbella: 1cc
LIPAUGMENTATIE
LIPAUGMENTATIE
Voor
•Juvederm Volbella: 2cc
LIPAUGMENTATIE
Voor Na
LIPAUGMENTATIE
Hoog moleculair gewicht
effective ineffective
Laag moleculair gewicht
viscosity
Voor Na
Crosslinking
Voor Na
Crosslinking
water water
Mate van crosslinking hoger met laag MG HA
Effectief
Niet effectief
JUVEDERM VYCROSS TECHNOLOGIE
Veilig
Effectief
Natuurlijk
Weinig reactie
Duurzaam
Injectable hyaluronic acid gel for soft tissue augmentation: a clinical and histo
Duranti et al, dermatol Surg, 1998
JUVEDERM: DE IDEALE FILLER

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Presentatie over de behandeling van lippen met juvederm volbella

Editor's Notes

  1. Dit is een bekend postkantoor in Praag, Veel mensen vinden dit een mooi gebouw, maar als ik er naar kijk, vind ik het geen geheel. de voorgevel lijkt er tegenaan geplakt te zitten Soms komen er patienten bij mij die er uitzien zoals dit gebouw hierboven. Het lijkt erop dat enkele van mijn mede collega’s geen duidelijk, helder beeld hebben van wat ze willen bereiken met hun behandelingen.
  2. Op dit filmpje zie je een vrouw langzaam ouder worden van 25 jaar tot 75 jaar. Een van de dingen die er gebeuren bij het ouder worden, is het minder worden van het volume op de jukbeenderen en het verplaatsen van de focus/ apex van het jukbeen naar voren en naar beneden. Hierdoor ‘draait’ uiteindelijk de triangle of youth om in een piramidevorm, zoals je op deze video kunt zien.
  3. The lips are divided into three main sections, the cutaneous, vermilion and mucosal lips. They have a distinct histology compared to other facial areas, and are structurally complex. The upper and lower lips are known as the labium superior oris and labium inferior oris respectively. The skin of the lip is much thinner than normal skin, containing just 3–5 layers compared with 12–16 layers in the face. Lips contain fewer melanocytes, leading to their reddish appearance as blood vessels below the surface are more readily visible. The lips are highly vascularised, and blood is supplied via the facial artery. The lips are also highly innervated by the facial nerve, making them highly sensitive to touch. They are acutely sensitive to intervention, constantly moving and vulnerable to ageing. They are also a key feature in sexual attraction, as fuller lips can be indicative of increased oestrogen levels, and therefore increased fertility. The lips are therefore a popular choice for cosmetic enhancement; consumers desire a soft and natural look to their lips, with lips that look naturally plump, symmetrical and in harmony with their face. Maintaining function and cosmetic integrity is important following an enhancement procedure, as any asymmetry in the lips can be highly visible.
  4. Op dit filmpje zie je een vrouw langzaam ouder worden van 25 jaar tot 75 jaar. Een van de dingen die er gebeuren bij het ouder worden, is het minder worden van het volume op de jukbeenderen en het verplaatsen van de focus/ apex van het jukbeen naar voren en naar beneden. Hierdoor ‘draait’ uiteindelijk de triangle of youth om in een piramidevorm, zoals je op deze video kunt zien.