For this week’s Tweak of the Week, I went to Loughton in Essex to visit Dr Munir Somji at his clinic DrMediSpa, to talk to him about a new injectable hyaluronic acid based filler called MaiLi, and to try it out – in my lips. But what’s new?
Well, with most hyaluronic acid fillers you’ve got this kind of compromise between how much stretch-ability you get and how long they’ll last. The softer kinds of fillers, for example, don’t tend to last very well, but MaiLi is quite different. It’s made differently, as well. To find out more, you can watch the video below, or read the transcript of my chat with Dr Somji.
What this new injectable MaiLi is and why is it different?
Alice Hart-Davis: So Dr Somji, can you tell me what this new injectable MaiLi is and why is it different to others?
Dr Munir Somji: Well, it’s similar to others in that it’s made of hyaluronic acid, but each hyaluronic acid filler is very different in its makeup. This uses something called “Smart Spring technology”.
AHD: Smart spring technology?
MS: Absolutely. So you can think about it essentially as one of those modern mattresses. It’s highly flexible but it still retains its shape, so it’s got a great lifting capacity. That basically means – if you translate it into real life, when you’re injecting filler – that it doesn’t stay in one place. So, for example, if you smile, it doesn’t stay still, it moves with your body and with your animation. If you’ve got areas which are highly mobile i.e. around the mouth or cheek area, it moves exactly like your normal tissue.
AHD: Okay, but it’s largely staying where it’s put, it’s not like moving around your face?
MS: It will never migrate. It’s got a high lifting capacity, so it stays together, but the crucial thing is, it’s highly elastic, so it will always snap back into shape.
AHD: Right, now that’s really unusual isn’t it because, usually, if you have a filler that’s going to give you more projection or definition, it tends to be a bit stiffer.
AHD: And so it becomes more obvious and bunchy when the face moves – but this has got the ability to kind of go with the tissues?
MS: Absolutely, yeah, and it reforms back into its shape, which means that you can get really nice contour, but you don’t have to limit the amount of naturalness that you have post-injection.
AHD: Okay. And how long does it last? Because usually when you’ve got a more flexible kind of filler, it doesn’t last very long.
MS: That’s a good question. Well, there’s something else that’s unique to MaiLi, that’s not there with other hyaluronic acids. When they’re actually engineering the product, they engineer it without any oxygen, which basically means that there’s less breakdown of that structure. People think oxygen’s good, but actually oxygen within any kind of biochemical engineering is actually quite reactive, so it will break things down. If you actually build these building blocks of hyaluronic acid without any oxygen, it will stay in a nice lattice, so when it’s injected, it’s more of a controlled structure. It will therefore (theoretically) break down less than other fillers.
AHD: Right! And that’s very new, isn’t it?
MS: It is very new, yes.
AHD: There’s nothing else like this.
MS: Nothing else like this around. The other crucial thing, which it lends itself to, is that, normally, when we inject subconsciously, without even knowing about it, we probably inject a little bit more than we need to, knowing that the filler’s going to break down. So, like you said, if something’s a lot more flexible, we know as injectors that we need to inject a little bit more filler. But with MiaLi, because we know that it doesn’t break down as quickly as other products, you actually need to inject less.
MS: And that’s crucial, over a long period of time, because it not only improves longevity, but, if you need less product to get the same effect, after years of treatment, you’re still going to look quite natural.
AHD: That is truly crucial isn’t it. I have stepped up and volunteered my lips to be done for this treatment but of course I walked in here saying the very tiresome thing that I don’t want to look over enhanced, too obvious. I’m obviously very happy to look like I’ve had lip treatment done because actually I’ve got lipstick on, which I should get rid of, but I feel my lips look quite flat, quite old, that kind of collapsed-ness you get. There’s some reasonable shape to them, but they need a lot of hydration. I don’t know what you’d say as the doctor.
MS: I think, if we look at the science of ageing, one of the things that we all know about now is that your collagen goes down and with your decrease in collagen you get a break of the trans epidermal water barrier, so hydration’s going to lack. So you replace that with a nice hyaluronic acid that’s elastic, especially in the lip barrier, which is probably the most unforgiving area, then you’re going to attract a lot more water. You have that natural plumpness, you’re happy with the shape, so there’s ways of injecting this so you don’t disturb the shape and just have that slight enhancement rather than filling.
AHD: This is where your skill as an injector comes in, isn’t it, to know what’s going to be right. We were chatting about this a bit earlier and I said I want it to look natural etc and you said something which made me laugh which was, “Oh you want a placebo lip treatment”. So what do you mean by that?
MS: Well, I think this is something that I’ve had requests for over the years is saying, look, Dr Somji, I want to have my lips done, but I also don’t want anyone else to notice, but I want to notice myself. Okay? And that puts me in a conundrum, but that’s what I’m known for I guess. What we want is that subtle, subtle treatment, so you basically say, well, I’m happy with it, but I want a little bit more. Can I get a bit more? No. Go home. And that’s all we’re going to do.
AHD: Okay. And how is the swelling with MaiLi compared to other fillers, is it much the same? You don’t need to use anaesthetic with this, do you, because it’s got anaesthetic in the product.
MS: It’s got anaesthetic in the product, yes. Sometimes you can use some topical anaesthetic just around some of the entry points, but the crucial thing as with any hyaluronic acid filler, is understanding the rheology and what we’ve talked about and how it applies in practice. So let’s just split it down for a second, because it’s really important and I think a lot of people don’t understand this and it’s really important for a natural result.
AHD: Thank you, so when you say the rheology?
MS: Yes, so what we’ve talked about – a high elastic, but also very good lifting capacity, and within the MaiLi range then you’ve also got different variances of that, on a little slack chart like this.
AHD: Sure, for different areas of the face.
MS: For different areas. We’re not going to inject something with a great, really high lifting capacity, in the lip – the highest one. I mean that’s going to look too crazy, we’re going to probably get a lot more softer than that. And, if you’ve got an elastic product, we want to get the most from an elastic product that we can. So you’ve probably seen these filler injecting techniques where people put microdroplets in? If we used that technique with MaiLi filler, that’s not going to be too great, because you’re not going to be using that elastic nature of the filler. We want to put very thin strips, because when you smile, we want it to stretch, and you need more of it to have that, rather than having lumps and bumps. It’s got a higher lifting capacity, so you don’t need to use that technique in the face. In fact, that’s why you can actually accurately put the filler within the right layers and also use less product.
MS: And less trauma. So less trauma means not as much swelling.
AHD: Fine and I must get all my questions in now because I know when you’re treating me I shall have to keep still and not talk.
MS: It’s fine, everyone talks! You can do that! It’s fine!
How much does MiaLi lip filler treatment cost?
AHD: Roughly what price does a lip treatment like the one you’re going to give me start at?
MS: It starts at around £500 I’d say. We need less product and, as you know, and as probably most of the people that follow you know, it’s not just about the lips sometimes. Sometimes you have to look around the lip as well, and that’s why we call it perioral treatment, so around the mouth. If you can put less product in the actual lip then maybe we’ve got enough to touch up around the lips as well.
AHD: Great. Okay, right, well. Let’s go!
What’s it like to have MaiLi lip fillers?
MS: There’s a number of things that happen during ageing. We start with the bone in the lower face. If you look at the chin over here, there’s two things that happen, it shortens with age, so you start seeing this labiomental crease that starts appearing, so that comes upwards, and also the bone in general within this region also goes further back as well and if we turn the face to the side you can actually see that both of the lips go inwards.
So, we want to make sure that we replace some of that volume. We have to be careful of course because you don’t want to be going to a room thinking, “Oh my god my lips are going to come out”. But you want to softly replace this. So this is where when I talked earlier on about perioral treatment, you actually think, okay she’s had some of this replaced quite nicely, you can see her jawline looks nice and straight, because you’ve had a previous fat transfer within that region. And that’s helped out, but this probably accentuates the fat that you’ve got a lack of volume within the lip.
Here we are on a soft tissue level, if you just whistle for us, you can see that you’ve got these vertical lines just above and that’s all to do with lack of volume as well as structure within this region. It’s very tempting, very tempting, to have filler injected directly into those lines but it is not a good idea.
AHD: Glad to hear you say that, yeah.
MS: Because what happens with ageing is there’s an elongation of this upper lip anyway.
MS: So, what do we want in a nice lip? You want a ski slope. You want a nice convexity, not a concavity, that will probably age you a little bit more, so you say, okay, the lines are gone, but actually the whole lip and its structure looks old then and we don’t want to lend to that process, we want to stay away.
So what do we want to do? We want to shorten this gap between the end of the nose and the top of the lip. We want to actually replace within the red lip and if you do that then you’re going to get that little lift over there. No-one’s made symmetrically, so there’s small asymmetries. If you think you can make the lips completely symmetrical, it can’t happen, because there’s a number of things happening. You’ve got some muscles that are attached to the top of the lip and they’re stronger on one side than the other and, as you know, on the left side on yourself, it’s a little bit stronger. So we’re going to inject and make sure it’s nice and symmetrical at rest, and the rest your muscles take care of. Alright?
AHD: Thank you.
MS: Simply speaking, the volume you have in your lips means absolutely nothing. Because it’s all about the rheology of the product and how viscous the filler is, so 0.5ml of a high-voluminous viscous product is probably going to be the equivalent of 2ml of a very light, fluffy product. So, therefore, the amount of filler that you have in the lip means absolutely nothing. It’s about choosing the right product rather than choosing the amount of filler that you have.
There’s a golden plane that you want to sit in and it’s right there. So this is subdermal, but what we want to do is inject just in a nice controlled fashion like we said, one strip, and you can see the lip just lift naturally. And now smile for us? You can see it’s completely natural. No lumps and bumps.
I am pretty much done, I’m just going to touch up now.
AHD: Wow. So you have literally put a thread around the top
MS: Yeah so you have had, if we’re talking about millilitres, you’ve had 0.6ml. So just relax for us now, we’re just going to look at slight asymmetries and balance that. But you can see already, it’s probably good for you to have a look. I’m going to put a secondary strip just in the top lip, just for perfection, but you can see you know there’s hardly any swelling.
AHD: Fantastic, thank you so much!
MS: No problem.
AHD: So that was this week’s tweak of the week, thank you very much for watching.
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