The lips, perhaps more than any other facial feature, are an area where the medical practitioner’s artistry comes into play. For instance, it is important that the physician has a sense of balance between the upper and lower lips, or that the physician doesn’t roll the lips outward so much that they look like a duck’s bill, etc. Artistic lip contouring takes a lot of practice. It may take a physician many, many procedures before the physician becomes a virtuoso of sorts because of the subtle injection technique variations that are required, blended with each patient’s unique characteristics.
In this section, we will discuss how physicians are using progressive medical techniques and advanced liquid face lift products, including dermal fillers such as Juvederm® and Restylane®, as well as BOTOX®, to improve and contour lips and smiles - without surgery. Physicians can provide volume to the lips for a more voluptuous and sensuous look. For more subtle definition, medical practitioners will place dermal fillers, and perhaps BOTOX®, into the vermilion borders of the lips. Some physicians will position dermal fillers, and in some instances BOTOX®, in areas around the lips to decrease the appearance of frowning and scowling. The techniques discussed in this section may vary from physician to physician.
Prior to the procedure, most medical practitioners will numb the lips, usually with a topical solution such as lidocaine. With an anesthetic, a patient rarely feels much or any discomfort with the procedure.
Note: Before undergoing any procedure discussed on this web site, make sure that your physician has extensive experience with the specific procedure. Medical schools have only recently begun to teach some of these procedures. As with any medical procedure there are varying degrees of risk involved. Please consult your physician.
Over the years, the lips and nasal philtrum (ridge area between the nose and lips) tend to flatten out and lose youthful definition. Even individuals who do not want plump, voluptuous lips can make subtle, yet definitive changes in their appearance by adding definition to the ridges of the lips and nasal philtrum.
To regain definition, medical practitioners will generally place dermal fillers into the vermilion borders of the lips and perhaps into the ridges of the nasal philtrum. (The vermilion border is the upper ridge of the upper lip and the lower ridge of the lower lip.) Advanced dermal fillers used by most physicians in the lips include Juvederm® Ultra, Juvederm® Ultra Plus, Restylane® and Perlane®. The dermal filler chosen is often dependent upon the physician’s personal experience with each of these dermal fillers.
In addition to dermal fillers, BOTOX® may be used to help roll the lips outward. BOTOX® placement can help add definition and make thinner, flatter lips look more pleasing. BOTOX® is usually placed at or slightly above the upper vermilion border and at the lower vermilion border, with care not to place the BOTOX® around the corners of the mouth or near the cupid’s bow at the center of the upper lip.
Dermal fillers and BOTOX® also help with lines and lipstick bleeding around the lips and mouth (see Wrinkle Correction – Mouth Area)
To make lips more voluptuous, doctors will use a variety of techniques, depending upon the patient’s particular facial attributes and goals.
If the lips need more definition, then the physician will likely perform some or all of the procedures discussed in the Lip Definition segment above. In a few instances, these procedures may be all that is necessary to give the lips a more sensuous look.
Sometimes, however, medical practitioners will not place dermal fillers in the upper vermilion border because the dermal filler can weigh down the upper lip and pull it down (when the intent is to essentially roll the lip up and out a little). The choice whether to place dermal fillers in the upper vermilion border can also depend upon the patient’s facial structure and desired outcome.
To add volume to the lips, physicians will most often place dermal fillers such as Juvederm® Ultra Plus or Perlane® on the inside of the upper and lower lips, or mucosa. This augmentation procedure not only bulks the lips, but can moderately elongate the lips – a further benefit for those whose mouth area has become puckered. Depending upon the desired outcome and how plump the patient wants the lips, it can take more than a syringe of dermal filler for the entire procedure.
Some patients want their lips to look more fleshy or pouty. In these instances, medical practitioners will usually place a greater amount of the dermal filler to the lateral aspect of the lips, i.e. towards the corners of the mouth. BOTOX® may also be used to roll the lips out somewhat, which can accentuate the results. If a patient already has full, shapely lips but desires a poutier look, then some doctors may use BOTOX® without dermal fillers.
As a part of the aging process, many individuals begin to develop an exaggerated frown, as the corners of the mouth turn down and lines extending from the corners of the downturned lips (oral commissure lines) develop. Many individuals also have lines that fan out from the corners of the mouth, as well.
To diminish oral commissure lines and gently lift the corners of the mouth, some physicians will place advanced dermal fillers such as Juvederm® or Restylane® into the oral commissures, oral commissure lines and/or into the lips around the corners of the mouth. Some physicians will also place BOTOX® in an area that is a little below and to the outside of the oral commissures (in the depressor anguli oris muscle), or along the jaw line, to help lift the lateral aspects of the mouth.
These techniques will gently lift the corners of the mouth. They will also help fill in the oral commissures to return a more natural and friendly look, non surgically.
Advanced Dermatology PC of NY & NJ Ridgewood, Ridgewood, NJ
Mark M. Hamilton, MD F.A.C.S., Indianapolis, IN
Paul Vitenas, Jr., M.D., F.A.C.S., Houston, TX ~ Alexander Z. Rivkin, M.D., LA, Los Angeles, CA
Alexander Z. Rivkin M.D. Malibu, Malibu, CA ~ Drs. Gervais & Tholen FACS, Minneapolis, MN
Mark Berkowitz M.D. , Sterling Heights, MI ~ David K. Funt M.D. Woodmere, Woodmere, NY
Rebecca Fitzgerald, M.D., Los Angeles, CA ~ Catherine P. Winslow MD FACS, Carmel, IN
Brock Ridenour MD FACS, Saint Louis, MO ~ Theda C. Kontis MD FACS, Baltimore, MD
Michael D. Yates M.D., Huntsville, AL ~ Stephen Mandy M.D., Miami Beach, FL
George J. Bitar MD, Manassas, VA ~ Scott M. Sackman DO, Easton, PA