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 FB 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 exist to enhance the beauty of the lip, and each one of these has a specific use and benefit.
Lip filler is done in the office often with a topical anesthetic –and sometimes in our practice– with a local block to completely abolish the pain. The procedure –which we hear about as the most excruciating of someone’s life—can be made comfortable using means that we’ve published on in the plastic surgery literature.
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 side from the nasal base to the actual 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 smiling, the lips thin and these natural and beautiful anatomic landmarks disappear, hopefully to show 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 natural 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 actually most useful–to define the vermilion border – which enhances the effect and projection of the lip, giving a lip liner effect.
HA fillers can be used plump the lips to give them a fuller appearance and to enhance the tubercles. Too much filler makes the teeth disappear under the weight of the filler.
Filler can also be used to eliminate fine lines or so-called bar codes (a.k.a. smoker’s lines) around the lip.
Deeper and thicker fillers can be used to restructure the lip to give the illusion of elevation of the mouth corners and to balance the areas around the lip –treating the chin (including weak chins!) and the so-called jowl sulcus–making the entire mouth more beautiful.
This product can be used around the lips in two different formulations. Juvéderm– approved in the United States initially in June of 2006– is produced by Allergan, now AbbVie, the same company that has popularized Botox throughout the world.
Juvéderm plumps the lips and projects the vermilion. If desired, Juvéderm can be diluted off label and can be used with local anesthetic to improve fine lines. Generally, Juvéderm lasts 6 to 9 months and has a local anesthetic in it to make it more comfortable. In order to achieve benefit, lip injections with Juvéderm need to be repeated approximately on a yearly basis. 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 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.
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 water color 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 has lidocaine in most of the 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 enjoys frequent use in the lip.
Belotero is a product made by Merz, which is also hyaluronic acid and is specific for fine lines. A Swiss physician described injecting wrinkles till they turn white and in so doing, watch them disappear. Ordinarily, when tissue turns white, physicians are afraid that they’ve created tissue ischemia—in other words, 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 tell tale signs of bluish discoloration which you sometimes see with denser fillers.
We’ve used Belotero since it was introduced in the U.S. in 2011. It seems slightly shorter acting in our hands.
RHA-2 and Redensity both are 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 topical or a local block.
We do not use silicone fillers 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 the lip.
We perform fat injections with almost every cosmetic surgery, but don’t advise them for the lip. We feel that they are unpredictable in their take in this area and when over-corrected cause tremendous amounts of unnatural swelling when injected. We feel this is because of all the movement that occurs with facial expression and with eating.
Fat is difficult to remove in the instance that 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.
Collagen has not enjoyed the same success that it did in the past primarily because it requires skin testing and can be allergic. 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 really for the past 20 years.
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.
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 at the time of your consult. Bruising reduction treatments from injections that we perform are done 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 advocate waiting 24 hours before wearing makeup and exercising after taking part in 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 their comfort level with each of them! You can see the 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.