Lip enhancement with hyaluronic acid dermal fillers such as Juvederm and Restylane is truly just as powerful as the improvement of smile lines. It has gained popularity because of the very predictable results, long term safety, and natural look when performed by an experienced Plastic Surgeon. The goal is to achieve an aesthetically pleasing lip, establish facial harmony, and fulfill personal desires.
Abnormal “duck lips” result from a disregard or complete ignorance of lip anatomy. Even “overfilled” lips should take on a normal shape when attention is paid to the subunits. An attractive upper lip has a very distinct and prominent white roll, tubercle, Cupid’s bow, and a pair of columns. The white roll is separate from the skin of lip, peaks at Cupid’s bow, and tapers towards the corners of the mouth. Cupid’s bow is found at the center and is the double curve that resembles the bow of Cupid, the Roman god of erotic love. Above the upper lip and at the center are the two philtral columns.
They originate from where the white roll hits the peaks of the Cupid’s bow and connect the lip to the nose in a smooth concave fashion. The red portion of the lip is called the vermilion and has a distinct tubercle in the center under Cupid’s bow. The tubercle is the lowest portion of the upper lip. The lower lip has a rim similar to the upper lip white roll but is less distinct. The lower lip complements the upper lip but with opposite structures. There is a central depression with a tubercle on each side. These obliquely oriented tubercles help make the central pout. Lastly, the youthful lower lip has more red vermilion show than the upper lip.
The importance of knowing the anatomy and attention to detail is crucial to an excellent natural outcome. With this knowledge and the tools of experience, a lip augmentation can be performed at any adult age. With advancing age, the lips lose fullness, invert, deflate, and the upper and lower lips usually become similar in size. Previously full youthful lips are the best candidates while patients who never had attractive full lips present a bigger challenge. The amount of filler required to meet the goal range from one to four syringes. The average is closer to two syringes and it may require more than one session to reach the final aesthetic result.
The recent addition of local anesthetic to the hyaluronic acid fillers has resulted in a very tolerable lip augmentation experience. In my hands, there is no need for dental nerve blocks or even direct injection prior to placement of the filler. It is just as effective and easier on the patient to pretreat with ice packs and topical anesthetic. The procedure takes about thirty minutes and the results are instantaneous. Typically there is some mild to moderate initial swelling that usually resolves in 24-72 hours. Bruising is variable, but rarely significant. Once complete, the augmentation will last for approximately six to twelve months. At that point, it is common to return for an enhancement to reestablish that refreshed and youthful appearance.