The lips are one of the most unique areas of the face to be treated by injectable fillers. The lips are extremely soft and supple, have a high number of nerve endings and are the most frequently touched part of the entire face. They also have a somewhat complex shape to them and undergo a lot of different types of muscular movements. Therefore, injectable filler techniques are the most challenging to perform in the lips to get good results as well as to limit any potential complications.
While there are a large number of injectable filler types available today, when it comes to the lips, hyaluronic acid-based types have the highest safety profile. Semi-permanent fillers such as Radiesse, Artefill and Sculptra should be avoided since the muscular movement of the lips can cause clumping and potential nodule formation. But because of the water-absorbing properties of hyaluronic acid fillers, undercorrection at the time of treatment is preferred to avoid prolonged swelling or ultimate overcorrection.
Injections of the lips should be principally done by small gauge microcannulas. They limit the amount of swelling and bruising because they do not cut through the sensitive lip tissues with their blunt tips. They are also more flexible than rigid needles. Through entrance sites in the corners of the mouth, microcannulas can be used to contour and lift lips that would otherwise need multiple puncture sites by a needle. The lack of tissue trauma by the blunt nature of the microcannula makes treatments bloodless and much more comfortable than needles.
The only thing a microcannula can not do is touch-up or fine tune small areas of the lips. This is where the use of a small 30 gauge needle can be beneficial to get to where a microcannula can not. But with today’s fillers that contain lidocaine, the use of a needle to touch up lip areas can be done painlessly since they will usually be numb from the initial layer of filler laid down by the microcannula injection.
Microcannulas for injectable fillers are available in different small diameters (down to as small as 30 gauge) and in different lengths. But the lips are best treated by using long 1’ 1/2” lengths of 27 gauge diameters. They can reach to the cupid’s bow on each side of the lip and can out a layer of material back down to the corners in one smooth pass.
Dr. Barry Eppley
Indianapolis, Indiana