Lip filler injections are among the most popular procedures performed in the United States now, at this moment in time.
You can see the before and afters of filler injections to the lips everywhere, from on TV –especially the “reality shows” and on social media, from Facebook to TikTok. You see it on the news, from ESPN to Bloomberg, from MSNBC to FOX. Big lips transcend political affiliations; it’s our culture. Lip fillers and big lips are in.
A variety of fillers enhance the beauty of the lip, and each has a specific use and benefit.
Lip filler is typically performed in the office using a topical anesthetic, and in our practice, we may also use a local nerve block for added comfort. With techniques we’ve published in the plastic surgery literature, we’re able to make the treatment significantly more comfortable for patients.
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What makes a pretty lip?
A pretty lip varies based on your taste, but there are basics that transcend time, race, and culture.
- A pretty lip should have a gentle concave slope from the nasal base to the vermilion border.
- The lower lip should be about 1.66 times the size of the upper lip.
- From the front, the upper lip should have a defined cupid’s bow that forms a distinct M with the points of the M pointing towards the columella (see the illustration)
- The upper lip in many people has three defining points (tubercles) and the lower lip two tubercles, but in a Julia Roberts-type lip, these defining points are blurred (and still look attractive!)
- The upper lip projects more than the lower lip.
- The distance from the nasal base to the upper vermilion should be .66 times the distance from the lower lip vermilion to the chin.
- The outer corners of the mouth should not turn down and should be about as wide as the distance between the pupils of the eyes. If the corners turn up, that creates the infamous and now very commonly seen “Joker’s mouth”.
- At rest, the bottoms of the incisors should show, and with smiling, more incisors should be displayed. With a smile, the lips thin, and these natural and beautiful anatomic landmarks disappear, hopefully revealing beautiful, white, aligned teeth.
How does filler help around the mouth & lips?
No question about it, hyaluronic acid (HA) fillers have revolutionized in-office aesthetic care. From smoothing the nasolabial folds to plumping cheeks to filler rhinoplasty, these naturally occurring, synthetically derived compounds are used in conjunction with neurotoxins to smooth and shape.
Nowhere are they more useful than in the lips. Almost all HAs feel soft, like what you’d expect if you were introducing them into a lip.
HA fillers can be used and are most useful for defining the vermilion border, enhancing lip effect and projection, and providing a lip liner effect.
HA fillers can plump the lips to give them a fuller appearance and enhance the tubercles. Too much filler makes the teeth disappear under its weight.
Filler can also be used to eliminate fine lines or so-called bar codes (a.k.a. smoker’s lines) around the lip.
Deeper, thicker fillers can be used to restructure the lip, giving the illusion of elevation at the mouth corners and balancing the areas around the lip, treating the chin (including weak chins!) and the so-called jowl sulcus, making the entire mouth more beautiful.
*Real Patient Results - Lip Fillers
8 types of lip filler:
1. Juvéderm
This product can be used around the lips in two different formulations. Juvéderm, approved in the United States in June 2006, is produced by Allergan (now AbbVie), the same company that has popularized Botox worldwide.
Juvéderm plumps the lips and projects the vermilion. If desired, Juvéderm can be diluted off-label and can be used with a local anesthetic to improve fine lines. Generally, Juvéderm lasts 6 to 9 months and contains a local anesthetic to make it more comfortable. To achieve benefits, lip injections with Juvéderm need to be repeated approximately once a year. If you are afraid of lips that are too big, you can supplement Juvéderm a little at a time to achieve your desired benefit over time.
Juvéderm is a great product, but in my view, it produces more edema than some of the other products. I have seen it move over time. It needs to be removed if one decides to undergo a procedure around the mouth, like a lip lift, because it tends to cause more postoperative swelling.
2. Restylane
Restylane and Refyne are commonly used around the lips, both to enhance the projection of the lip and to plump the lips. Restylane, in our view, is more capable of producing definition and sculpture of the lips and is a slightly harder product. This isn’t something that you feel when it is injected, but something that can be used as a sculptural tool by your doctor or injection provider.
It’s sort of like the difference between watercolor and oil: an oil painting has dimension to it and thickness that can be layered onto a canvas, and Restylane has similar merits to its use. It is effective at turning up the corners of the lip and contains lidocaine in most products, though it can be ordered without lidocaine for those who are allergic.
Refyne is a product also from the same company and is intended more for fine lines, but it is also enjoyed frequently on the lips.
3. Belotero
Belotero is a product made by Merz, a hyaluronic acid-based product specific for fine lines. A Swiss physician described injecting wrinkles till they turn white and, in so doing, watching them disappear. Ordinarily, when tissue turns white, physicians are afraid that they’ve created tissue ischemia, in other words, a precursor to skin loss, and get alarmed. But with Belotero, it’s a sign that you’ve hit the endpoint. One of the advantages of Belotero is that even when introduced into the very superficial skin, it doesn’t cause any telltale signs of bluish discoloration, which you sometimes see with denser fillers.
We’ve used Belotero since its introduction in the U.S. in 2011. It seems slightly shorter acting in our hands.
4. Teosyal Products
RHA-2 and Redensity are both beautiful products made by Teoxane, a Swiss company. These products are reported to move better, so they don’t carry the same weight and affect facial expression to the same degree as other fillers do. Even plump lips move naturally with this product. It is administered in a similar fashion to the other products with a topical or a local block.
5. Silicone Fillers
Although silicone fillers do exist, we here at W Cosmetics do not use them in this practice or lip implants, both of which we feel can cause permanent disfigurement and scarring, and don’t produce a natural-looking or pretty lip.
6. Fat Injections
We perform fat injections with almost every cosmetic surgery, but don’t advise them for the lip. We feel they are unpredictable in their response in this area and, when overcorrected, cause tremendous amounts of unnatural swelling when injected. We feel this is due to all the movement that occurs with facial expressions and eating.
Fat is difficult to remove if you are not happy with the results. As a consequence, when we perform facial fat liposculpture with your own fat, we generally augment and beautify the lips with one of the fillers listed above.
7. Collagen Fillers
Collagen has not enjoyed the same success that it did in the past, primarily because it requires skin testing and can cause an allergic reaction. It is made from bovine collagen (cows) and can produce allergies. The duration is unpredictable. Hyaluronic acids, which are naturally derived and present in our bodies in great quantity, have been favored for the past 20 years.
8. Other Fillers (Radiesse & Sculptra)
These fillers are very useful for augmenting the face in other locations. We don’t advocate their use around the mouth for a variety of reasons, primarily because they don’t produce the same excellent results as quickly and can cause lumps. However, if you are interested, a few examples of these include Radiesse and Sculptra.
Is there any downtime associated with fillers?
In general, most patients leave the office delighted with their appearance. Swelling and bruising are possible and generally appear the worst on the first day after the injection. Pain post-injection can be managed with over-the-counter pain medications
We have multiple ways in our practice of reducing bruising, beginning with our injection technique. We will discuss post-treatment bruising reduction with you during your consultation. Bruising-reduction treatments from the injections we perform are provided at no charge. Makeup easily covers most bruising so that you can return to normal social activities within a few days.
When will I be able to exercise and wear makeup?
We generally recommend waiting 24 hours before wearing makeup and exercising after a lip filler procedure.
I’m interested in getting lip fillers. Where do I start?
The most important factor is choosing the right person to inject these products, and ensuring they are comfortable with each of them! You can see before-and-after photos of some of our real patients (such as the one below) and judge for yourself. We’d be happy to come up with the perfect plan to get you the fuller lips you’ve been dreaming about.
