LIP LIFTING & LIP FILLERS
PLASTIC SURGERY DUBAI | 14 January 2024
You’ve likely already heard of lip injections, sometimes called lip fillers. These procedures give that bee-stung look to the lips. There’s another surgical procedure known as a lip lift that can give you a different kind of pout. Unlike lip fillers, it’s permanent.
A lip lift is an in-office surgical procedure that shortens the space between the nose and the top of the lip, known as the “philtrum.” The procedure increases the amount of pink tissue that’s visible which makes the lips look fuller and more pronounced. It also increases how much of your upper central teeth show when your lips are resting. It’s a good option for people who want to add height instead of volume to their lips.
Types of lip lifts
There are several types of lip lifts. It’s important to know the types and techniques so you can have an informed discussion with your surgeon about which is right for you.
Direct lip lift
A direct lip lift, sometimes called a gullwing lip lift, creates a more defined lip border. A thin strip of skin is removed just above the upper lip, and the skin is pulled upwards, creating the illusion of a more pronounced vermillion (the pink part of the lips). This procedure typically leaves behind a scar on the upper lip area.
The subnasal bullhorn is one of the more common lip lift procedures. Dr. Vigo will make an incision that’s typically hidden along the base of the nose where it’s less visible. The incision is often made in the shape of a bullhorn and the center, right, and left of the lip are all pulled up toward the nose.
Central lip lift
A central lip lift is similar to a subnasal bullhorn lift. It shortens the space between the nose and the lips by an incision at the lower nose.
Corner lip lift
A corner lip lift is sometimes called a “grin lift” because it gives the face a more smiley appearance. It’s done by making two small incisions at both corners of the mouth and removing a small amount of skin. Some people will get this in tandem with another lip lift to give fuller lips. It’s an option for people who feel they have downturned lips.
Italian lip lift
An Italian lip lift requires two incisions below each nostril, and other than that detail, it’s very similar to the bullhorn. It typically doesn’t involve a noticeable scar.
A lip lift can be a good option for older people who want to reduce the space between the lips and the nose. With age, this space typically increases and can make lips look thinner. Younger people who haven’t achieved the look they want from fillers, or if they find that fillers make their lips look unnaturally plump or duck-like, may prefer a lip lift. Lip lifts are also a permanent solution, so they can be helpful for people who are tired of the upkeep of filler.
The objective in treating the upper lip is to artistically create a form that harmonizes with the patient’s unique facial features and takes into account the age and ethnic background of the patient. The goal in treating the lower lip is to create bulk and greater prominence and artistic projection of the vermilion. The physician must establish appropriate guidelines and patient expectations for augmentation relative to normal lip proportions in order to avoid a cartoon-like appearance.
Any physician performing lip augmentation should recognize that temporary fillers can cause permanent stimulatory effects in tissues.After 2 or 3 sessions of lip augmentation, full correction may be obtained and persist indefinitely. Patients may return for additional filler merely because a certain amount of time has elapsed since their last injection, but the physician must evaluate the proportions of the lips to truly determine if additional filler is warranted. It is helpful to have a hand mirror for the patient to observe her lip proportions as the doctor seeks to determine whether more filler is needed. It is also beneficial to show the patient her lips from the lateral view; digital photography is extremely useful in this regard.
It’s important to see your box of injectables opened in front of you and to be sure only your dermatologist or plastic surgeon is doing the injections. Avoid blood thinners, like aspirin and fish oil, for at least a day beforehand, which can increase bruising. If you opt for numbing cream, expect it to be placed on the lips for approximately 10 minutes. The lips absorb quickly and do not require lengthy topical anaesthesia. Then, the skin surface should be cleansed properly and then injections are performed. Your doctor should go very slowly, often pausing to show you the progress that he or she is making. There is a real balance and art to it, I find that you really need to go little by little, so you normally inject the top lip first, balance it out on the other side, then inject the bottom lip. It takes about 15 to 20 minutes. What you see is what you get, you’re not waiting for it to work, like Botox.
Some doctors will gently mould the filler with their fingers after it is injected by squeezing and patting it into place, while others aim to inject it exactly where they want it and avoid moulding, since it can increase bruising and swelling. Based on my extensive experience, there is no single stance on moulding – it’s a technique that some like, while others do it sparingly. Your doctor should let you chime in along the way and help decide whether or not to add more or stop. I even recommend my patients go lighter than they think they may want, live with it for a week, and then decide whether or not to do more. “It’s best to start with baby steps.
After the injections, ice packs are applied. That evening, I suggest patients sleep on two pillows to decrease swelling. Use ice sparingly at home (getting the H.A. too cold or hot can prevent it from settling properly) and ask your doctor if additional anti-swelling measures are right for you, like oral antihistamines, pain relievers, or topical corticosteroids.
It’s no secret that some lip augmentations look incredibly natural and some look not so incredibly natural. This is partially because of the size that you and your doctor select, but it goes deeper than that. The fact of the matter is that some doctors have a better feel for nuance and aesthetics than others. It’s something you have to have an appreciation for, to get the proportions right for each person. There is a lot more artistry to injecting lips than just injecting a wrinkle or a line. That is another reason why the consultation is so important. I show actual before and afters of my patients, so that everyone has a realistic expectation for the type of filler I do.
Selecting where, and at what volume, to inject the lips is also an important decision to make in the consultation. The lips are supposed to be filled in a natural ratio, where the upper lip is approximately 2/3 the size of the lower lip.
That means that sometimes, only one lip needs to be filled, sometimes both, and often at different volumes, since not everyone’s pout is symmetrical. Where to inject is also a delicate matter. The lips can be injected into the skin surrounding the lips (to define the Cupid’s bow, for example), into the lips (for fullness), and into the lipline (for definition). It’s like sculpting.
Creating Philtrum Columns
Sculpted philtrum columns are in style today. As we age, these well-defined longitudinal pillars are lost, leading to a flattened, ill-defined, unattractive upper lip. If the patient still has discernible philtrum columns, the object is to further enhance them. If the philtrum columns have been completely effaced, it is imperative to re-create them. This is accomplished by superficial vertical injection of filler into each philtrum column. It is important to realize that the philtrum columns are not parallel to each other, but rather they form an inverted “V” that narrows as it approaches the nostril sills and columella of the nose.
Creating Cupid’s Bow
The pouty, Cupid’s bow appearance of the central portion of the upper lip is considered sexy, desirable, and very much in fashion today.
Creating Lower Lip “Pillows” or Tubercles on Each Side of the Midline
Here I ask the patient to evert the lower lip. I deposit approximately ~0.1 cc of filler as a depot injection into the orbicularis oris muscle at the vermilion-mucosal junction on each side of the midline. The depot injection is about one third of the distance from the midline to the oral commissure. This is gently massaged to prevent superficial lumpiness.
Supporting or Bolstering the Oral Commissures
Placing a small amount of filler in the most lateral aspect of the cutaneous lower lip so as to provide upward support to the commissures. Injectable neuromodulating agents (botulinum toxin A) placed into the depressor anguli oris muscles can be used as an adjunct to further elevate the commissures. This combines structural support with chemical neuromodulation to shape the oral commissures.
Filling the Nasolabial Creases
Placing a small amount of filler in the upper portion of the nasolabial crease helps to evert the upper lip. Augmentation lateral to the nasolabial crease only serves to deepen the appearance of the crease.
Cool compresses and ice packs can be used to minimize swelling and bruising. Patients should be advised to avoid ASA, NSAIDs, and other medications associated with an increased risk of bleeding. If anti-HSV I medication was prescribed, it should be continued according to physician recommendation. Because HAs are hydrophilic, they attract water from the surrounding tissues and further augment the soft tissue volume beyond that expected from mere implantation. The significant swelling of the vermilion in the immediate post-operative period may be camouflaged by applying flesh-toned foundation or concealer to the entire vermilion. Lipstick can then be applied to a smaller portion of the vermilion than usual so as to not exaggerate the swelling that may be present.
SELECTING THE RIGHT FILLER
There are a lot of difficult decisions you have to make when it comes to getting lip injections, but fortunately, picking the right filler isn’t one of them. Hyaluronic acid, in a few different forms, is both the industry standard for temporary lip injections and the only temporary lip filler approved by the FDA.
They’re marketed under different brand names – Restylane Kisse, Neauvia Lips, Juvederm Volbella – but they’re all made from the same molecule, which is hyaluronic acid, as you may already know, naturally occurs in skin and is a top ingredient in hydrating skin-care products, since it plumps skin by capturing and holding onto water. Picking which of the formulas is best for you is really up to your doctor. Hyaluronic acid is not only the best option, but the only option for those new to the world of injections, since it will dissolve on its own and is well-tolerated, since it’s already in your body. There are irreversible fillers and implants, but those are not for beginners.
Lips are one of the more uncomfortable places to inject filler. We have a lot of nerves in our lips, so I can do a combination of topical numbing cream and, sometimes, injectable numbing medications, so patients are comfortable. However, many of the H.A. injectables come with lidocaine (a numbing pain reliever) built right in, so some doctors opt out of additional measures.
One, or a combination of the above pain-reducing options, will normally temper the pain of the actual procedure, but you’re likely to experience pain later, since the skin is being stretched. The pain as mild to moderate and notes that it can last for a few days.
Any time there is a needle crossing the skin, there is a risk. Bruising, swelling, and pain – all of which can last up to days and in rare cases, even weeks – may occur. There is also the risk of infection. Naturally, this makes it very important to check in with your doctor post-treatment, especially if you’re feeling nervous about side effects.
While hyaluronic acid is a naturally occurring substance in your body, you can still have an allergic reaction to H.A. injectables, since there are often inactive ingredients (like carrying agents) and pain-reducing ingredients (like lidocaine) in the formula. Those prone to allergies or are just plain nervous can do a patch test on their forearm a few days before the procedure to be sure they won’t have an adverse reaction.
Injecting the lips can prompt cold sores for those who are prone to them, so he normally pretreats those patients with a round of anti-viral medication, like Valtrex.
There are also less common side effects that are important to consider. More rare side effects include nodules or palpable material within the lips – basically bumps of H.A. that don’t settle or feel natural. Extremely rarely, lip filler can be introduced into a blood vessel in the lip, which can have more significant consequences if not dealt with immediately and appropriately.
WHAT TO EXPECT
One of the great things about lip injections is that the results are instantaneous, so you’ll leave the office with fairly accurate (albeit swollen) results. For the first 24 to 48 hours, the filler is malleable and your skin is prone to swelling, which means be gentle! This is noted as the time that your injections need to “settle.” No facials, yoga, or exercise is recommended, which can alter the placement of the filler and increase swelling and bruising.
Lips often swell for one to three days after treatment, but this is highly variable and some patients will experience no swelling and some will have more dramatic swelling that will take longer to subside. Bruising can last approximately one week, but can be covered with makeup or lipstick, as needed. Some doctors will offer to treat more significant bruising with a laser treatment if necessary.
While the average length of time H.A. fillers will last is about six months, it varies for everyone, from around three months to a year. H.A. lasts different lengths, depending on where you put it and how active that body part is. I find that if the labelling says six to 12 months, patients normally come back every three to six months.