Lip injections have become popular with all age groups. Filling the lips has been painful for some patients despite me giving nerve blocks inside the mouth such as an infraorbital and mental block. When needles are used to fill the lips they are usually painful and patients can swell and bruise significantly. My favorite way to fill lips is with a cannula. I have several videos in my Instagram : aestheticlasercenter demonstrating lip filling with a cannula.
Younger patients who want their lips filled usually have good lip shape and want more volume. It is important to note that the bottom lip is usually 20-30% larger than the top physiologically. Women who have their upper lip filled too much will appear to have unnatural lips.
Below is a diagram of the landmarks of a youthful lip. Notice the larger size of the lower lip.
*Courtesy of Larrabee W, Malielski K, and Henderson J. Second Edition
Surgical Anatomy of the Face. Lippincott Williams and Wilkins 2004.
The Philtrum column helps create the cupid’s bow of the lip. This structure is sometimes missed and not filled in some patients.
My filler of choice is in the Restylane family of fillers. Since younger patients want volume and more bang for their buck, Perlane or Restylane Lift as it is called now has a very high G’ which means that it is resistant to molding and lifts pretty well. Since it is not very hydrophilic or filled with water molecules, the size does not decrease significantly in the first 2-3 months. In my experience it usually last 9-12 months in most patients.
Below is a cross section of the lips and one can see where the muscle and artery and submucosal fat is located. The Vermillion border is the top of the lip and the submucosa is located right below and above the muscle. The labial artery is located more superiorly near the Vermillion border which is why bruising is so common when it is injected with needles.
I like to inject the lips with a cannula and make the incision on the side on the lips. The cannula is then inserted through the small incision and then I will guide it into the lip. I usually inject in the submucosal plane and the muscle to add volume to the lips. I don’t inject as much in the vermillion border since this makes it look unnatural and gives a duck-like appearance. To make the lips evert more you can add a few units of neurotoxin superiorly in the upper lip. Weakening the obicularis muscle will cause it to turn up slightly.
Older patients will complain of smokers lines along with running of their lipstick and want those corrected. I also use a cannula to define the vermillion border and fill the lip above to correct the volume deficiency and will add small units of neurotoxin like Dysport, Xeomin or Botox to relax the muscle. This will erase the deeper lines and slightly evert the lip so there is more show superiorly.