Valentine’s Day evokes many images, one of which is juicy full lips. While once only achievable by genetics, plumper and more full lips can be obtained by almost anyone thanks to a variety of cosmetic procedures and products that are available today. Between celebrity news and photos, endless models in magazines and a plethora of plumper and lipstick products, lip augmentation has become one of the most sought after office procedures for women.
By far the most common method of lip augmentation is injectable fillers. While they are fairly quick and easy to do (notice I didn’t say completely painless), and effective for the majority of patients, they are several insights for a successful outcome and a satisfying experience.
While there are over a dozen commercially-available injectable filler products in the U.S., not all are appropriate for injection into the lip. The only ones that should be used are those composed of hyaluronic acid or hyaluron. These natural sugar products flow evenly and smoothly and have the less chance of causing problematic nodules and lumps afterwards. Many such options exist (e.g., Juvederm, Restylanse) and the fundamental difference between them is how much they cost and how long do they last. Currently only Restylane is formally FDA-approved for use in lip augmentation but all other similar hyalurons can be safely used off-label. Though they may last lomger, avoid fillers that contain granules or crystals as they are more prone to foreign-body type reactions.
Not every lip can be made beautifully plump and full. As fillers work by expanding the size of the vermilion (pink part of the lip), one has to have enough of it to be expanded to create a fuller lip appearance. Very fine and thin lips simply can not be made two to three times their size to create a sensually full appearance. Trying to do so will make the vermilion expansion more horizontal than vertical, creating the classic and well recognized ‘duck lip’ appearance. Quite frankly, the most ideal and sensuous lip augmentation results occur in those women who already have what many people would consider good-sized lips. This doesn’t mean thin lips shouldn’t undergo a trial of lip injections to determine the results as some women will find the outcome acceptable. (anything is better than what I have concept) But if unsatisfactory results are obtained, it is time to consider surgical enhancement methods.
Lip injections are done by placing linear fills at either the vermilion-skin junction, into the body of the lip, or both. Most lips benefit by increasing the size of the white roll of the lips (vermilion-cutaneous junction) which creates a natural highlight. This is always good place to start. But size increase may also require direct vermilion body injection as well as augmenting the central pout of the vermilion or even the philtral columns of the skin of the upper lip. Good outcomes are a function of the skill and artistry of the injector as much, if not more, than the type of injectable filler product used. All lip augmentation results and injectors are not the same.
No matter how good a lip augmentation result can be, one will not be tempted to repeat it if the experience was uncomfortable. While there is no way to make lip injections pain-free, there are methods to make it more tolerable. Much is made today of some injectable fillers containing the local anesthetic lidocaine. While this does make the lip numb once it is injected with it, it is still necessary to get it in there in the first place. The choices are to either take a few injections directly into the lip to start to get it numb or to have a dental block done first. A recent innovation, known as a blunt-tipped cannula (e.g., Dermasculpt), is the best way in my opinion as it truly feels more comfortable than a beveled sharp needle of the same gauge (30 gauge) inside the lip.
Lip augmentation with fillers can have very a highly satisfying result and experience if one understands these basic concepts.
Dr. Barry Eppley
Indianapolis, Indiana