The ideal lip, like other ideals involving the body, is often discussed but difficult to ascertain. Reasons for this include the fact that lips, like noses, are wildly variable among individuals, and what looks good on one person may not fit another.
Things to Consider
Anatomic variance significantly figures into determining just how to proceed. For example, some people have linear vermilions while others have perfect Cupid’s bows. Injecting these different anatomic variants with the same cookbook formula may result in an unnatural appearance and an unhappy patient.
The patient’s goals, too, must be carefully considered in terms of what is attainable and ultimately pleasing to the patient. Desired outcomes range from augmentation of the size of the lips while maintaining the existing shape, minimizing the perioral lines, or changing the shape of the lips to attain a more aesthetically pleasing appearance. Patients frequently present with a mix of such goals, which may be attainable.
Things to Discuss
Informed Consent
Prior to injecting the lips, a discussion about possible complications, including swelling, lumps and bumps is warranted. During the discussion, it is wise to hand the patient a mirror so that he or she can demonstrate the desired outcome.
Risks, Benefits and Alternatives
It is essential that the preoperative conversation regarding risks, benefits and alternatives be documented. Following this discussion, informed consent should be obtained and photographs must be taken. A careful history regarding potential herpes simplex outbreaks is required, and for patients who have this history, treatment with an antiviral is appropriate.
Material Selection for Lip Injections
This could be the subject of its own article, but for the sake of completeness, we shall provide some guidelines.
• Cosmoderm or Cosmoplast is appropriate for patients who do not want a long-term correction.
• Evolence, a porcine collagen approved in Canada and Europe, offers a collagen that is durable, with expected persistence of 6 to 9 months
• Hyaluronic acids have become the mainstay of lip injections with Restylane, Juvéderm and Perlane being used for different patient populations. Dedicated hyaluronic acid products designed for lip injection are being used in Europe (Restylane Lipp and Juvéderm Lip), and these are smoother materials that should do well when introduced into U.S. markets.
• Microdroplet silicone injections are also used to treat lips, but this should be reserved for a small niche of patients and smaller niche of physicians.
Warning: Sculptra and Radiesse, despite early reports touting them, are not appropriate materials for injections into the lip.
Pain Control
In order to create an ideal lip, it is helpful to have the patient adequately anesthetized and comfortable. A gingival mini-block using 1% lidocaine with epinephrine or septicaine is useful. Alternatively, topical anesthetic may be used, but requires a long period of application and will not provide the typically required deep anesthesia.
Note that although they contain lidocaine, Cosmoderm and Cosmoplast should not be used as an anesthetic platform for thicker products, as this does the patient a disservice by not providing thorough anesthesia, increasing the cost of the procedure and masking the appearance of the lip when the second product is injected. Product can be used together or separately, depending on the patient’s goals and anatomy.
Approaches to Take
Increasing Volume
Injections for increasing the volume of the lip should strive to increase the “show” of the vermillion. This is accomplished by injections into the vermilion, and needle placement for this should be at the “wet-dry” junction, which is the edge of the Fordyce glands — which should be pointed out to patients who will suddenly notice them after injection and frequently believe that they are injection-related.
Grasping the lip in one’s fingers and everting it will help to produce a more pronounced lip with volume and eversion, which is the goal of the procedure.
Figure 1 is a good example of a woman with perfect shape who desired more volume. The anatomy did not need to be changed, just augmented This was accomplished using hyaluronic acid, with nice results (Figure 2).
Lip Definition without Augmentation
Patients who want lip definition without significant augmentation typically require injections into the rolled border of the lip.
This is an injection that may be accomplished by introducing the needle into the potential space of the rolled border and injecting a small amount of material. Note that the injection may proceed only if the material flows. When it does not flow, another injection site should be tried. In most instances, the material will flow across the lips and provide the anatomic barrier that is the desired goal.
Serial punctures are the best way to obtain a homogenous appearance. However, I believe that this technique also produces much of the swelling associated with lip injections; therefore, I try to apply ice immediately following the procedures.
Injecting the Cupid’s Bow
Special attention should be paid to the Cupid’s bow in most patients. Frequently, the injection of a small amount of material (from 0.05 to 0.1 ml of Juvéderm, Restylane or Perlane) will provide a more youthful and attractive appearance.
To accomplish this, I place the needle into the vermilion approximately 1 mm inferior to the superior border, and I inject the material in a cephalad direction. This may be performed on patients who are having other areas of the face injected and is a wonderful means to introduce them to rejuvenation of other facial areas.
Injecting Perioral Lines
The most difficult lip patients to satisfy are those with etched-in perioral lines. These patients are typically smokers or former smokers, and their expectations are for the lines to disappear with no lumps or bumps resulting from the treatment.
Perioral rhytids are frequently best treated with combination modalities, and this may involve fractional or ablative lasers combined with fillers and toxins. The full spectrum of options must be discussed during the patient consultation.
Hyperdynamic orbicularis muscles, which are common among such patients, are best treated with injections of botulinum toxins.
Patients who require volume to correct their perioral rhytids are best treated with a soft collagen or a hyaluronic acid. When injecting these lines, I inject them by grasping the rhytids between my thumb and forefinger and guiding the product into place. Using a 32-gauge needle may help and is frequently the best option for fine lines. Specific materials designed for this are used now in other countries, and it is likely that they will make it to the United States.
Using Cosmoderm or Cosmoplast
These products are easy to inject, contain anesthetic, and have great flow characteristics. They must be over-injected, and the degree to which this should occur varies depending on the product.
Adhering to Each Patient’s Goals
Lip injections are among the most technically demanding, and most of us have seen ample evidence of how they looks when incorrectly performed.
To obtain great results, it is essential to realize that each person has unique anatomic realities that mandate an individualized approach. As it is also important to have an understanding of the patient’s goals, a discussion of whether or not these goals are realistic is essential.
Specialists who have not treated the lips should be aware that it is an area that can produce immense patient satisfaction. My advice to those currently using cookbook formulas to inject the lips is to appreciate the individual variations and goals of each patient to produce consistently good outcomes.
The ideal lip, like other ideals involving the body, is often discussed but difficult to ascertain. Reasons for this include the fact that lips, like noses, are wildly variable among individuals, and what looks good on one person may not fit another.
Things to Consider
Anatomic variance significantly figures into determining just how to proceed. For example, some people have linear vermilions while others have perfect Cupid’s bows. Injecting these different anatomic variants with the same cookbook formula may result in an unnatural appearance and an unhappy patient.
The patient’s goals, too, must be carefully considered in terms of what is attainable and ultimately pleasing to the patient. Desired outcomes range from augmentation of the size of the lips while maintaining the existing shape, minimizing the perioral lines, or changing the shape of the lips to attain a more aesthetically pleasing appearance. Patients frequently present with a mix of such goals, which may be attainable.
Things to Discuss
Informed Consent
Prior to injecting the lips, a discussion about possible complications, including swelling, lumps and bumps is warranted. During the discussion, it is wise to hand the patient a mirror so that he or she can demonstrate the desired outcome.
Risks, Benefits and Alternatives
It is essential that the preoperative conversation regarding risks, benefits and alternatives be documented. Following this discussion, informed consent should be obtained and photographs must be taken. A careful history regarding potential herpes simplex outbreaks is required, and for patients who have this history, treatment with an antiviral is appropriate.
Material Selection for Lip Injections
This could be the subject of its own article, but for the sake of completeness, we shall provide some guidelines.
• Cosmoderm or Cosmoplast is appropriate for patients who do not want a long-term correction.
• Evolence, a porcine collagen approved in Canada and Europe, offers a collagen that is durable, with expected persistence of 6 to 9 months
• Hyaluronic acids have become the mainstay of lip injections with Restylane, Juvéderm and Perlane being used for different patient populations. Dedicated hyaluronic acid products designed for lip injection are being used in Europe (Restylane Lipp and Juvéderm Lip), and these are smoother materials that should do well when introduced into U.S. markets.
• Microdroplet silicone injections are also used to treat lips, but this should be reserved for a small niche of patients and smaller niche of physicians.
Warning: Sculptra and Radiesse, despite early reports touting them, are not appropriate materials for injections into the lip.
Pain Control
In order to create an ideal lip, it is helpful to have the patient adequately anesthetized and comfortable. A gingival mini-block using 1% lidocaine with epinephrine or septicaine is useful. Alternatively, topical anesthetic may be used, but requires a long period of application and will not provide the typically required deep anesthesia.
Note that although they contain lidocaine, Cosmoderm and Cosmoplast should not be used as an anesthetic platform for thicker products, as this does the patient a disservice by not providing thorough anesthesia, increasing the cost of the procedure and masking the appearance of the lip when the second product is injected. Product can be used together or separately, depending on the patient’s goals and anatomy.
Approaches to Take
Increasing Volume
Injections for increasing the volume of the lip should strive to increase the “show” of the vermillion. This is accomplished by injections into the vermilion, and needle placement for this should be at the “wet-dry” junction, which is the edge of the Fordyce glands — which should be pointed out to patients who will suddenly notice them after injection and frequently believe that they are injection-related.
Grasping the lip in one’s fingers and everting it will help to produce a more pronounced lip with volume and eversion, which is the goal of the procedure.
Figure 1 is a good example of a woman with perfect shape who desired more volume. The anatomy did not need to be changed, just augmented This was accomplished using hyaluronic acid, with nice results (Figure 2).
Lip Definition without Augmentation
Patients who want lip definition without significant augmentation typically require injections into the rolled border of the lip.
This is an injection that may be accomplished by introducing the needle into the potential space of the rolled border and injecting a small amount of material. Note that the injection may proceed only if the material flows. When it does not flow, another injection site should be tried. In most instances, the material will flow across the lips and provide the anatomic barrier that is the desired goal.
Serial punctures are the best way to obtain a homogenous appearance. However, I believe that this technique also produces much of the swelling associated with lip injections; therefore, I try to apply ice immediately following the procedures.
Injecting the Cupid’s Bow
Special attention should be paid to the Cupid’s bow in most patients. Frequently, the injection of a small amount of material (from 0.05 to 0.1 ml of Juvéderm, Restylane or Perlane) will provide a more youthful and attractive appearance.
To accomplish this, I place the needle into the vermilion approximately 1 mm inferior to the superior border, and I inject the material in a cephalad direction. This may be performed on patients who are having other areas of the face injected and is a wonderful means to introduce them to rejuvenation of other facial areas.
Injecting Perioral Lines
The most difficult lip patients to satisfy are those with etched-in perioral lines. These patients are typically smokers or former smokers, and their expectations are for the lines to disappear with no lumps or bumps resulting from the treatment.
Perioral rhytids are frequently best treated with combination modalities, and this may involve fractional or ablative lasers combined with fillers and toxins. The full spectrum of options must be discussed during the patient consultation.
Hyperdynamic orbicularis muscles, which are common among such patients, are best treated with injections of botulinum toxins.
Patients who require volume to correct their perioral rhytids are best treated with a soft collagen or a hyaluronic acid. When injecting these lines, I inject them by grasping the rhytids between my thumb and forefinger and guiding the product into place. Using a 32-gauge needle may help and is frequently the best option for fine lines. Specific materials designed for this are used now in other countries, and it is likely that they will make it to the United States.
Using Cosmoderm or Cosmoplast
These products are easy to inject, contain anesthetic, and have great flow characteristics. They must be over-injected, and the degree to which this should occur varies depending on the product.
Adhering to Each Patient’s Goals
Lip injections are among the most technically demanding, and most of us have seen ample evidence of how they looks when incorrectly performed.
To obtain great results, it is essential to realize that each person has unique anatomic realities that mandate an individualized approach. As it is also important to have an understanding of the patient’s goals, a discussion of whether or not these goals are realistic is essential.
Specialists who have not treated the lips should be aware that it is an area that can produce immense patient satisfaction. My advice to those currently using cookbook formulas to inject the lips is to appreciate the individual variations and goals of each patient to produce consistently good outcomes.
The ideal lip, like other ideals involving the body, is often discussed but difficult to ascertain. Reasons for this include the fact that lips, like noses, are wildly variable among individuals, and what looks good on one person may not fit another.
Things to Consider
Anatomic variance significantly figures into determining just how to proceed. For example, some people have linear vermilions while others have perfect Cupid’s bows. Injecting these different anatomic variants with the same cookbook formula may result in an unnatural appearance and an unhappy patient.
The patient’s goals, too, must be carefully considered in terms of what is attainable and ultimately pleasing to the patient. Desired outcomes range from augmentation of the size of the lips while maintaining the existing shape, minimizing the perioral lines, or changing the shape of the lips to attain a more aesthetically pleasing appearance. Patients frequently present with a mix of such goals, which may be attainable.
Things to Discuss
Informed Consent
Prior to injecting the lips, a discussion about possible complications, including swelling, lumps and bumps is warranted. During the discussion, it is wise to hand the patient a mirror so that he or she can demonstrate the desired outcome.
Risks, Benefits and Alternatives
It is essential that the preoperative conversation regarding risks, benefits and alternatives be documented. Following this discussion, informed consent should be obtained and photographs must be taken. A careful history regarding potential herpes simplex outbreaks is required, and for patients who have this history, treatment with an antiviral is appropriate.
Material Selection for Lip Injections
This could be the subject of its own article, but for the sake of completeness, we shall provide some guidelines.
• Cosmoderm or Cosmoplast is appropriate for patients who do not want a long-term correction.
• Evolence, a porcine collagen approved in Canada and Europe, offers a collagen that is durable, with expected persistence of 6 to 9 months
• Hyaluronic acids have become the mainstay of lip injections with Restylane, Juvéderm and Perlane being used for different patient populations. Dedicated hyaluronic acid products designed for lip injection are being used in Europe (Restylane Lipp and Juvéderm Lip), and these are smoother materials that should do well when introduced into U.S. markets.
• Microdroplet silicone injections are also used to treat lips, but this should be reserved for a small niche of patients and smaller niche of physicians.
Warning: Sculptra and Radiesse, despite early reports touting them, are not appropriate materials for injections into the lip.
Pain Control
In order to create an ideal lip, it is helpful to have the patient adequately anesthetized and comfortable. A gingival mini-block using 1% lidocaine with epinephrine or septicaine is useful. Alternatively, topical anesthetic may be used, but requires a long period of application and will not provide the typically required deep anesthesia.
Note that although they contain lidocaine, Cosmoderm and Cosmoplast should not be used as an anesthetic platform for thicker products, as this does the patient a disservice by not providing thorough anesthesia, increasing the cost of the procedure and masking the appearance of the lip when the second product is injected. Product can be used together or separately, depending on the patient’s goals and anatomy.
Approaches to Take
Increasing Volume
Injections for increasing the volume of the lip should strive to increase the “show” of the vermillion. This is accomplished by injections into the vermilion, and needle placement for this should be at the “wet-dry” junction, which is the edge of the Fordyce glands — which should be pointed out to patients who will suddenly notice them after injection and frequently believe that they are injection-related.
Grasping the lip in one’s fingers and everting it will help to produce a more pronounced lip with volume and eversion, which is the goal of the procedure.
Figure 1 is a good example of a woman with perfect shape who desired more volume. The anatomy did not need to be changed, just augmented This was accomplished using hyaluronic acid, with nice results (Figure 2).
Lip Definition without Augmentation
Patients who want lip definition without significant augmentation typically require injections into the rolled border of the lip.
This is an injection that may be accomplished by introducing the needle into the potential space of the rolled border and injecting a small amount of material. Note that the injection may proceed only if the material flows. When it does not flow, another injection site should be tried. In most instances, the material will flow across the lips and provide the anatomic barrier that is the desired goal.
Serial punctures are the best way to obtain a homogenous appearance. However, I believe that this technique also produces much of the swelling associated with lip injections; therefore, I try to apply ice immediately following the procedures.
Injecting the Cupid’s Bow
Special attention should be paid to the Cupid’s bow in most patients. Frequently, the injection of a small amount of material (from 0.05 to 0.1 ml of Juvéderm, Restylane or Perlane) will provide a more youthful and attractive appearance.
To accomplish this, I place the needle into the vermilion approximately 1 mm inferior to the superior border, and I inject the material in a cephalad direction. This may be performed on patients who are having other areas of the face injected and is a wonderful means to introduce them to rejuvenation of other facial areas.
Injecting Perioral Lines
The most difficult lip patients to satisfy are those with etched-in perioral lines. These patients are typically smokers or former smokers, and their expectations are for the lines to disappear with no lumps or bumps resulting from the treatment.
Perioral rhytids are frequently best treated with combination modalities, and this may involve fractional or ablative lasers combined with fillers and toxins. The full spectrum of options must be discussed during the patient consultation.
Hyperdynamic orbicularis muscles, which are common among such patients, are best treated with injections of botulinum toxins.
Patients who require volume to correct their perioral rhytids are best treated with a soft collagen or a hyaluronic acid. When injecting these lines, I inject them by grasping the rhytids between my thumb and forefinger and guiding the product into place. Using a 32-gauge needle may help and is frequently the best option for fine lines. Specific materials designed for this are used now in other countries, and it is likely that they will make it to the United States.
Using Cosmoderm or Cosmoplast
These products are easy to inject, contain anesthetic, and have great flow characteristics. They must be over-injected, and the degree to which this should occur varies depending on the product.
Adhering to Each Patient’s Goals
Lip injections are among the most technically demanding, and most of us have seen ample evidence of how they looks when incorrectly performed.
To obtain great results, it is essential to realize that each person has unique anatomic realities that mandate an individualized approach. As it is also important to have an understanding of the patient’s goals, a discussion of whether or not these goals are realistic is essential.
Specialists who have not treated the lips should be aware that it is an area that can produce immense patient satisfaction. My advice to those currently using cookbook formulas to inject the lips is to appreciate the individual variations and goals of each patient to produce consistently good outcomes.
