Gabriel Siquier, MD, of Dameto Clinics describes how to achieve the best results on perioral wrinkle correction with the Blanching Evolution technique and biorevitalization

The perioral area is one of the most important areas for a youthful appearance and is frequently viewed by injectors as difficult to treat cosmetically. It is affected by both intrinsic (changes in volume, boney support, skin elasticity) and extrinsic (smoking, straw use, sun exposure) factors and is highly dynamic, making correction with dermal filler challenging. Attaining soft, full and natural-looking results with fillers is crucial for success, but difficult to achieve with the products and techniques currently available.

Traditional approaches to cosmetic correction have included the use of both low-dose botulinum toxin and fillers. Dermal fillers may be injected along the vermillion border (white roll) to restore volume and improve perioral wrinkling. However, many products that are widely available are too stiff, resulting in a heavy appearance. Lastly, correct placement of traditional cross-linked hyaluronic acid fillers for perioral rejuvenation is difficult, as it requires a high degree of injector expertise and familiarity with each individual product.

To fill this aesthetic niche, a biorevitalizant such as Apriline® Hydro by Suisselle Laboratories is ideally suited for this purpose. It’s non-crosslinked structure and high degree of dermal integration allow for placement in the superficial dermis making it an excellent choice for correction of mild to moderate perioral wrinkles. Additionally, with a biorevitalizant there is no risk of Tyndall effect, lumpiness and ‘blebbing’ of product allowing for superficial placement both parallel and perpendicular to vertical perioral lines, a technique necessary for optimal correction.

There are additional benefits of superficial placement of a non-crosslinked biorevitalizant (stabilized with glycerol) such as Apriline® Hydro. The structural integrity of the skin itself is improved as new collagen is stimulated, a process that decreases with age. The high concentration of hyaluronic acid imparts a stable, long-lasting source of hydration as it attracts water. This will improve the look of fine lines and replenish the skin’s youthful glow, further enhancing the injection results.

The author has developed the most optimal and effective injection technique for biorevitalization, called Blanching Evolution.  This proprietary technique can be used for a comprehensive facial rejuvenation, crow’s feet, forehead and glabellar lines. It is particularly well suited and recommended for the perioral area.

Blanching Evolution involves the use of a TSK Invisible needle supported above the skin at a 45-degree angle. Vertical pressure is applied, producing a slight bend in the needle prior to advancing it into the tissue. Without applying excessive force on the plunger, a small amount of product is injected as the needle is advanced into the superficial dermis. Constant pressure should be used until the skin is visibly saturated with the product.

An immediate ‘blanching effect’ (whitening of the skin) will occur. The smaller gauged needle drastically reduces product waste as well as the risk of bruising. The product must be cautiously massaged after injection to ensure it spreads evenly. It is important to note there will be a visible ‘ridge’ of product that resolves within 24 to 36 hours of treatment, and there may be transient swelling for 1 to 2 days post injection. Treatment may be repeated in 2 weeks and full improvement may be apparent in 2 to 3 weeks.

The use of cross-linked hyaluronic acid fillers with this technique is contraindicated. Unlike injection techniques used with these fillers, Blanching Evolution does not require determination of product-specific needle placement within the dermis. Instead, this technique allows for instant visualization of success, and thus is less reliant on physician expertise, product and needle familiarity.

Using the Blanching Evolution injection technique with a none cross-linked hyaluronic acid biorevitalizant such as Apriline® Hydro will help practitioners more easily achieve optimal correction of the perioral area while preserving the necessary subtlety of movements, such as speaking and smiling, that are critical to maintain for successful, natural-looking perioral rejuvenation.

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