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The most popular non-surgical procedures continue to be injectables with hyaluronic acid ranking at number two, including lip augmentation which is gaining in interest and represents a large portion of cosmetic medicine practice in recent years. Although it is considered a simple technique, we often observe poor quality results. Many Authors in the literature have published the rate of side effects like pain, post treatment discomfort, bruising, swelling and asymmetries in lip injection with hyaluronic acid considered common or very common in their experience. A cosmetic improvement of the lips involves many precautionary considerations. In this study we examine our single accredited outpatient cosmetic medicine and surgery center experience transitioning from the use of traditional injection technique to the use of Boodless Atraumatic Technique (BAT). Methods: We performed a retrospective analysis of all lip injection cases performed over a 1-year period from January 2017 to December 2017 by multiple physicians and surgeons in the practice. During the 1-year period, there were 360 lip enhancement with filler performed by three attending doctors. Post-treatment follow-up length and complications including swelling, bruising, long lasting edema (more than 14 days), infection, seroma, granuloma, skin necrosis and need for revision were noted. Results: Three of the most interesting findings were a significantly decreased pain level and discomfort, bruising and swelling in the BAT group (258 patients) where no pain occurred in 43.02%, light pain in 42.24%, moderate pain in 14.72%, intense or serious pain in 0%. Whereas serious pain occurred in the Traditional Infiltration Technique (TIT) group (102 patients) in 25.49%, intense pain in 68.62%, moderate pain in 5.88%, light or no pain in 0%. We found in the BAT group that bruising occurred in 3.87% vs 25.49% in the TIT group and swelling in 4.65% vs 29.41%. Other sensitive element was the decrease rate of long lasting edema (more than 14 days) with 0.77% in the BAT patients and 5.88% in the TIT group. Discussion: Pain level and discomfort in the Bloodless Atraumatic Technique Lip Injection Group were much lighter than that in the Traditional Infiltration Technique Group, which demonstrated that BAT significantly reduced post treatment pain and discomfort. Improvement of facial harmony requires a strong knowledge of the anatomy. Most lip injections are performed without a clear understanding of the underlying oral and perioral anatomy. Conclusions: The Bloodless Atraumatic Technique allows to enhance the lip with control and precision without violating important and sensitive anatomical structure like mucosa, labial arteries and orbicularis oris muscle which reduces pain, postoperative discomfort, swelling, bruising, long lasting edema and the possibility of infection. Bloodless Atraumatic Technique Lip Injection offers objective improvements in side effects and complications, recovery and the overall patient experience, but do not happen in a predictable manner without substantial commitment of the medical staff and effort primarily of the aesthetic physician.

journal of medical-clinical research and reviews

Decrease in Side Effects Rate after Adopting Bloodless Atraumatic Technique (BAT) - A Single Cosmetic Surgery Center Experience of 360 Lip Injections Over One Year