Best Fillers for Lip Augmentation
Many patients who are unhappy with the shape and size of their lips choose to undergo non-surgical lip augmentation procedures that offer near instantaneous results with minimal side effects and minimal recovery times. The success rate of these aesthetic procedures is influenced by the expertise of the physician, injection technique, type and volume of filler injected, and the patient’s unique anatomy. The article below will explain in detail the suitable injection techniques and the best types of soft tissue implants that can be used to augment the perioral region effectively.
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Lip filler suitability
Since the perioral region and the lips are quite sensitive, injectors should choose hyaluronic acid-based soft tissue implants with lidocaine that are specifically formulated to augment these areas of concern. This helps to reduce the risk of undesirable side effects such as palpable lumps and swelling. Some of the best lip volumizing fillers are detailed below:
- Belotero Intense: This filler contains 25.5mg/ml of thick and cross-linked hyaluronic acid gel that is malleable enough to be injected easily through fine-gauge needles. The highly elastic gel helps to volumize thin lips for fuller-looking pouts. The manufacturer, Merz Pharmaceuticals, claims that the lip plumping effects of this filler can last for about six to nine months.
- Emervel Lips: This lip-volumizing implant that currently goes by the name of Emervel Kysse is made of 20mg/ml of cross-linked hyaluronic acid gel. The degree of cross-linking and the size of the hyaluronic acid particles are altered using, resulting in an implant that can effectively augment and enhance the lip body and border. It is ideal for patients who want to subtly enhance their lips without overcorrecting. Once injected into the lips, the aesthetic outcomes can last for about six to nine months.
- Juvederm Volbella: This soft tissue injectable gel is composed of 15mg/ml of cross-linked hyaluronic acid that is processed using patented Vycross Technology. This propriety technology reticulates short and long chains of hyaluronic acid together without increasing the stiffness of the gel. Hence, the filler is an optimal option for patients that want subtle and natural-looking lip enhancements. Due to the strong cross-links between the hyaluronic acid chains, the filler gel is able to deliver 12 months of lip-plumping effects.
- Teosyal RHA: This brand of aesthetic implant is made of resilient hyaluronic acid (RHA), so the injectable gel is durable and highly stretchable. Out of the four types of fillers available in the Teosyal range, Teosyal RHA 2 and 3 are most suitable for augmenting the lips. Since Teosyal RHA 2 is softer and less viscous than Teosyal RHA 3, it is ideal for patients who desire a natural-looking appearance. Patients who prefer fuller lips should be treated using Teosyal RHA 3 instead. Nevertheless, both these implants can augment the lips for about a year, according to the manufacturer.
Though all of the fillers listed above are ideal for augmenting the lips, physicians are encouraged to thoroughly assess the following factors to identify the best implant for individual patients:
- Previous patient experience with filler: The satisfaction of a patient plays a vital role in the success rate of a treatment session. If a patient has had beneficial and satisfactory clinical results with a particular brand of filler and are otherwise happy with the product, then physicians are encouraged to use the same filler.
- Longevity of the filler: The longevity refers to the time taken for the filler to disintegrate after being injected. It is important that patients know the approximate residence time of a filler before they even undergo the procedure so that they will not be dissatisfied once the implants break down. Patients looking for a permanent solution to their aesthetic issues must be made to understand that hyaluronic acid-based fillers are only temporary.
- Reversibility: This simply ensures that the filler can be easily dissolved and removed should it be accidentally injected into the blood vessels or if patients experience other filler-associated complications. Hyaluronic acid-based fillers can be prematurely dissolved using hyaluronidase enzyme. Physicians who offer dermal filler treatments should have an emergency kit with hyaluronidase on site.
- Cross-linking technology: This determines the longevity of a filler and its tendency to cause post-injection swelling. Since the fillers can be cross-linked using different types of reticulating agents (e.g. divinyl sulfone, 1,4-butanediol diglycidyl ether, etc.), patients’ medical histories must be thoroughly reviewed to ensure that they are not allergic to any of the filler components.
- Cost: Another important factor to consider is the ability to of patients to commit to the treatment costs. Some of the fillers may require regular touch-up sessions to maintain results for a prolonged period of time; therefore, patients must be aware of their financial commitment.
Injection method suitability
The decision to use a cannula or a needle depends on the area of lips that is being treated. Physicians should use a cannula when they are treating patients with thin lips and the filler needs to be injected behind the muscle. Using a cannula greatly reduces the risk of accidentally injecting the implant into the labial arteries, which are usually located behind the muscle. By implanting the filler behind the muscle, the lips will be projected forward and appear plumped. On the other hand, since needles are thinner, they should be used to plump the lip in the sub-vermilion region, erase perioral wrinkles, lift oral commissure, sculpt the vermilion border, restructure the philtral columns, and create lateral protrusions in the lower lip.
Lip augmentation technique
Most aesthetic practitioners have their own approach when it comes to non-surgically augmenting the lips. However, the following factors explain the suitable techniques to augment and enhance different parts of the lips:
- Visual assessment of the lip in 3D: During the pre-procedural assessment session, physicians should take photographic documentation of the lips in both lateral and frontal views. This helps to gauge the amount of projection required. For an ideal lip, the upper lip should project about 2mm further than the lower lip.
- Smile assessment: Besides a 3D assessment, the smile must also be assessed. Patients with a gummy smile, whereby the lip disappears upon smiling and the gums are very noticeable, should be treated with botulinum toxin injections. The muscle-relaxing medication helps to soften the contraction of lip elevator muscles. For the best results, the botulinum toxin solution should be injected deeply at about 1cm lateral to the lateral alar of the nose. Patients with a downturned mouth caused by a highly active depressor anguli oris muscle may also be treated with botulinum toxin injections. Following the procedure, the downward pull of the muscle on the corners of the mouth should be prevented.
- Determine the adequate volume: Physicians must discuss the volume of filler that will be injected with their patients. It is important to not underfill or overfill the lips, as the results will be aesthetically unappealing. Avoid injecting more than 1ml of soft tissue into the lips, as it could create a “duck lip” appearance or even cause vascular compression.
- Enhancement or restoration: The type of lip augmentation, whether it is lip enhancement or restoration, depends on the patients’ ages and their preferences. Both physician and patient alike must agree on the common treatment goals before the procedure can be commenced.
- Age appropriateness: The end result of any lip augmenting procedure should be appropriate for the patients’ age. It is highly unadvisable not to recreate the lips of a 25-year-old on a 60-year-old patient.
- Signs of aging: If patients are displaying signs of aging, physicians should treat the perioral complex in addition to the lips. They can inject the filler to correct various aging signs, such as oral rhytids, loss of volume in the cutaneous lip and chin area, and the downward pull of the corner of the mouth at the oral commissure. Besides that, botulinum toxin can also be injected into the mentalis and depressor angular oris muscle to reduce hyperkinetic muscle activity.
- Consider the vermillion border: The vermillion lip border can be seamlessly sculpted using fillers with low viscosity. This type of implant will create maximum light reflection without damaging the delicate lip structure by creating a well-defined demarcation between the lips and the rest of the face.
- Consider single lip treatment session: If there is a prominent volume discrepancy between the upper and lower lips, then only the upper lip should be treated for best results.
- Cupid’s bow: The Cupid’s bow should not be corrected using filler injections, as this delicate feature may be inadvertently flattened. It is best that the center of the Cupid’s bow, also known as the Glogau-Klein point, is treated instead.
- Cannula use: In thin and older lips, using a cannula to implant filler material behind the muscle can provide dentoalveolar support to the inverted lip. Physicians who use a cannula may obtain better results if they volumize the lips first before shaping them. This procedure requires about 3 to 4ml of filler, which should be injected gradually over multiple treatment sessions. A 25G cannula seems to the best size to augment lips: anything smaller may potentially damage larger blood vessels. Patients must be made to understand that the treatment session to restore thin and aged lips may take as long as 12 to 18 months.
- Everting upper lip: Physicians who want to evert the upper lip are advised to inject about 0.4ml of filler into the vermilion border and the sub-vermillion region, which is located 2mm below the lip border. The filler volume varies depending on the patient’s lips.
- Correcting lipstick lines: This aesthetic issue is also known as vertical lip lines or smoker’s lines; it can be treated by strengthening the vermilion border using a firm filler. Administration of a firm filler also helps to sculpt the Cupid’s bow and evert the lip.
- Increasing pout: In order to increase lip pout, estheticians should mark the boundary of the pout by drawing a line from the external nares. Drawing centerlines will help to ensure symmetry. They can then administer the chosen filler inside the marked lines to intensify the pout.
- Vermilion border treatment: Physicians must remember that the superior labial artery travels along the vermillion border of the upper lip to the facial sagittal midline at a depth of 3mm. Hence, the needle must be placed superficially when the vermillion border is treated from its lateral view so as to prevent intraarticular filler placement.
- Philtral column treatment: When augmenting the philtral column, the filler must also be injected superficially due to the position of the columellar blood vessels.
Physicians must equip themselves with the necessary anatomical knowledge, the appropriate type of cosmetic filler injection, and the appropriate technique so that they can perform non-surgical lip augmenting procedures successfully. They must thoroughly assess their patients and educate them on the treatment limitations, so that only suitable patients are treated, and optimal results are achieved.