Lip augmentation is one of the few aesthetic concerns that bridges all age groups. Young patients often come to practices seeking larger, more lustrous lips; while aging patients are dismayed at loss of definition and the appearance of perioral lines and wrinkles. In order to create the aesthetic outcomes these patients seek, one must gain an understanding of their desired outcomes and step back to examine the entire lower face. “If you are only treating the lip proper, you will not deliver the best result because the lips form part of the environment of the perioral area,” says Vince Bertucci MD, FRCPC, medical director of Bertucci MedSpa in Woodbridge, Ontario, Canada.
The first step in approaching lip enhancement involves understanding the patient’s goals and pre-existing facial anatomy. “When a patient comes in for a consultation, we always do a full-face assessment,” says Dr. Bertucci. “While they may ask for treatment of the perioral region alone, it’s important that we take into consideration how the different parts of the face fit together. I systematically go from top to bottom to assess the components of the face and the role that they play in perioral rejuvenation and enhancement.”
Because patients seeking perioral treatments vary widely in age, they may require anything from a subtle enhancement to architectural change, says Dr. Bertucci. “If you are treating a woman in her 20s who has never had large lips, then structure and support are important. I would use a product such as Restylane, Emervel Lips, Juvéderm Volift or Juvéderm Ultra,” he says. “At the other extreme of the spectrum we might consider a 50-year-old woman who has always had fuller lips. In that case, I use a refining and defining product such as Juvéderm Volbella or Restylane Silk so as to rehydrate the lip and provide subtle volume.”
Different age groups also have different goals. Younger patients tend to want fuller lips, while older patients are concerned about lip lines. For patients seeking volume, Michelle Yagoda, MD, a facial plastic surgeon in New York City, typically injects Restylane along the vermilion border to add volume, but avoids injecting directly into the pink part of the lip. “The lip is a muscle,” she says. “It is active when kissing, whistling, drinking and talking, and the filler can bunch up.”
Injecting botulinum toxin along the vermilion border can help to create a fuller-looking upper lip without the use of fillers. “This will evert the lip and create a more voluptuous, youthful appearance, because when the orbicularis oris muscle is active it pulls the lip down,” says Tracey Hotta, RN, a plastic surgery nurse and owner of TH Medical Aesthetics in Thornhill, Ontario, Canada, who notes that some patients opt for only toxin injections to enhance the appearance of their lips.
For older patients, Dr. Yagoda uses Restylane Silk to fill perioral lines and may also recommend Restylane Lyft to replace lost volume in the face, which can help improve the appearance of the entire perioral area.
Photo copyright Getty Images.