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"We've been doing a lot of lip augmentation patients this week, and a lot of the questions that have come up about lip augmentation or strategies in both choosing where and how you're doing the lips anatomically, and then which products are the best to use for lips, and my answer is that, really it’s up to the artist, and really up to the patient as to what they're outcome desires are.
In my opinion, there are two basic anatomic areas that we want to address when we're using fillers alone. One is the lip boarder or the vermilion boarder, vermilion from the French for red, and in many patients, doing vermilion augmentation and doing it subtly and doing it appropriately will help to restore the lip role, a nice curvature as the white part of the lip meets the red lip that provides youth, it provides a slightly, a greater amount of vermilion show, and really enhances the lip a lot like a lip liner would do.
For those that have a diminished or softening or not well-defined cupids bow, where the lip comes up in the middle and makes a little bow-like shape, those areas can be specifically augmented to define or to enhance the cupids bow region.
The products that I use for that, I really like Restylane for that product or Restylane Silk, it’s a little bit stiffer g prime, that's really the stiffness of a gel, but really its ability to resist deformation or compression if you will, and in the big picture these are all very soft gels so it means very little in terms of how it feels and touches to a patient, but for us doing the augmentation its significant.
For patients that want body fullness and they already have a nicely defined lip boarder. First of all, most important is the technique, that the product chosen is not as important. Restylane or Juvederm or Belotero could all be used. Its key that is placed at the junction between where the vermilion is dry and where the vermilion is wet on the inner portion of the lip, the mucositis we call that the wet-dry boarder of the lip and if we do that right at that equator it allows for eversion of the lip and fullness to be created without too much projection of the lip and that's really the key.
The lips are like tubes and any tube that you're filling will expand circumferentially. At some level of increase in height the increase in outward projection is going to be so great that doesn't look attractive or pleasant, it gives the fish lip look, and I think everybody seen the people walking in with the "bee-stung" looking lips.
One of the reasons for "bee stung lips" is that these products hold a lot of body water so in general I think it’s better to go gradually and step up the volume so that we're not over doing the lip with the product in addition to the water that later adheres to it and there's an order of adhesion of water or hyperphilicity of these products, that starts with Juvederm being the highest and then goes down lower when you get in to the Perlane variety, which I don’t often use for lips.
Many people have taken the new Juvederm Voluma which holds less water and used it in an off-label fashion in the lips, this is a newer product that's much more expensive. It’s a great product but there's no data that it has the longer duration of effect that is shown in the midface studies that where done that shows 2 years of duration and up to 60% of patients again using it again in the mid-face. Spending the extra money you have to decide whether or not that's worth it until we get to the point where we have actual data on it.
So there's two parts to the question I often answer about lips: which product do you chose and if you want a little more fullness in the slightly more" bee stung look" and I do say slightly in my practice because I don’t like the "banana lip-look" here in San Francisco, it doesn't go well, I'd choose Juvederm.
So that's slightly more volume because of the water hydrophilicity, the water attraction to the molecule. If we want to do lip boarder enhancement, we use Restylane or Restylane Silk products which provide a little better definition right along the lip border.
A couple little caveats. This is an art. Lip augmentation, and everybody sees that when it’s bad, and everybody thinks that's what its suppose to look like when it’s done. Very well done lips, you'd never tell that they were done at all.
So there are augmented suddenly, they are augmented in a way that provides nice fullness but they're not augmented in a way that makes somebody look like they've have filler done in their lips, very, very important. One of the very common area is that you'll see a lot of fullness above the vermilion and that really has to do with placement accuracy in the position when doing lip augmentation.
For more information on lip augmentation, I encourage you to go to my website at MaasClinic.com or even the video blog here where you can more information about the choices of products and how we do them DrMaas.com.
As always, I welcome questions, photographs or even videos of yourself that can describe your questions about how you might best be treated. This is Dr. Corey Maas on "Looking Your Best.""