Lip filler course: what a good first course covers
A good first lip filler course teaches how variable the lip arteries are, how to choose a product and when to use a needle or a cannula. It teaches you to recognise a vascular occlusion and treat it with hyaluronidase. Then it has you treat real patients under close supervision. It is best taken after a first course in botulinum toxin and in a simpler filler region.
The lips are among the most frequently treated sites for facial filler [2]. The most detailed public standard for such a course was written by Health Education England in 2015 [1]. It is guidance for England, not law where you work, but no other public document lists so precisely what a filler course must teach.
The lip arteries do not run in one layer
A study of 193 head specimens from Caucasian body donors, dissected in six anatomy departments, found the superior and inferior labial arteries in every lip. Most often, in 78.1 per cent of cases, the artery ran between the oral mucosa and the orbicularis oris muscle. It lay within the muscle in 17.5 per cent and between the muscle and the skin in 2.1 per cent [2].
The artery changed layer along its course in 29 per cent of upper lips and 32 per cent of lower lips. The midline was the most variable place in both lips, and there the artery was found more often in a superficial position [2]. The English standard expects an in-depth understanding of facial vessels, nerves, muscles and fat pads, and of danger zones [1]. A course should teach the lip as a set of probabilities, not as a diagram.
Product choice and needle or cannula are skills to learn
The standard asks for the pharmacology of permanent, semi-permanent and temporary fillers and the ability to choose the best product for each patient. It also asks for the advantages and drawbacks of needle and cannula, and the ability to use each appropriately [1].
A study of 370 US dermatologists, who reported 1.7 million syringes injected, shows why both belong in a course. There was one occlusion for every 6,410 syringes injected with a needle and one for every 40,882 with a cannula [3]. The authors still conclude that the right instrument may depend on the patient, the site and the defect [3]. They also note that hyaluronic acid fillers, unlike the others studied, can be dissolved with hyaluronidase [3].
Vascular occlusion happens in the lips
In the same study, 106 of the 370 dermatologists, or 28.6 per cent, reported at least one occlusion. With hyaluronic acid, the nasolabial folds and the lips accounted for almost half of all facial occlusions. Across all filler types, 85 per cent of occlusions left no long-term sequelae [3]. Blindness has also been reported after filler injected into the lips [2].
The English standard requires you to recognise vascular occlusion, which can lead to skin necrosis, scarring or permanent blindness, and to give the emergency treatment quickly. It also requires the ability to use hyaluronidase: when it is indicated, how to dilute and give it, and what complications it can cause [1].
Supervised practice on real patients
Dermatologists who had injected filler for more than 5 years had 70.7 per cent lower odds of an occlusion than less experienced colleagues [3]. A course is where that experience starts.
The English standard requires at least half of a programme to be practical skills training, 80 per cent of it normally in a real clinical setting. For dermal fillers it sets a minimum of 10 treatments observed on 10 different patients and 10 delivered under supervision on 10 more, for each treatment type [1]. For some procedures, injectables among them, it requires one trainee per supervisor. Supervisors should have at least 3 years of experience and 150 of the same procedures, and be able to manage complications [1].
Natural results start with assessment and consent
The standard expects a filler course to teach facial balance and proportion, careful assessment and a treatment plan for each patient [1]. It also expects informed consent, an agreed view of the expected result and the ability to recognise body dysmorphic disorder [1]. On a lip course, that means practising how to decline a request as well as how to inject.
Questions to ask before you book
- How many lip patients will I treat myself? Ask for a number, and whether they are real patients or models.
- Who supervises, and how many trainees each? Ask how long they have been injecting lips and whether they still treat patients.
- Will we rehearse a vascular occlusion? Ask where the hyaluronidase is kept during the course.
- Do I learn both needle and cannula? Ask how the course decides which fits which patient.
- Is competence assessed, or attendance? A certificate for attendance alone has not checked what you can do.
Before you pay, ask for the timetable with the hands-on hours marked, the number of lip patients you will treat and the name of your supervisor.
Read next
- Lip Augmentation: The Assessment That Decides the Result
- Facial Arteries Vary: Why Landmarks Are Not Guarantees
- Hyaluronidase: using it in an occlusion, and when not to