Lips can be daunting, even for the most seasoned injector. Many beginner injectors want to start with lip techniques; however, it’s not the most practical place to begin. For me, creating the perfect pouty lip is what puts a smile on my own lips! Lips are my absolute favorite place to inject on the face. However, in the first 6 months of my injecting career, if a patient asked me to inject their lips, I came up with any excuse as to why they shouldn’t! I turned away more lips than I care to admit, only because I didn’t have a good plan in place to address lip augmentation.
Lips come in all shapes, widths, and poutiness! Don’t you love the patient who comes in with paper-thin lips and brings a picture of Kylie Jenner’s lips as her ultimate lip wish? Dream on, sista!
Here is a simple 6 step approach for injecting a soft, pretty lip. I use this technique 80% of the time and teach it to beginners 100% of the time. If lip shaping is needed, I may stray from this 6 step approach; however, this is a great approach for the patient who has never had their lips injected with dermal filler.
1. Start with the oral commissures. Set those corners first; lifting them up at least to baseline position. This will begin to shape the lip, setting a nice support for the corners. Oral commissures can lend to an overall sad face so adding volume to this area will change the downward direction of the corners. My favorite approach is the “C” shape method of injecting filler around the oral commissure.
2. Next, inject the upper portion of the vermillion border, starting at the tip of the cupid’s bow. Using your 30 g needle (love this smaller gauge), measure 1/2 inch from the top of the vermillion border. Inject a linear thread of product into the VB, creating a soft projection of the border. A pretty lip has a “white roll” where light is reflected from the lip. With age, we lose that distinctive border volume. I inject right at the junction of the vermillion and the vermilion border, where the tissue transitions from the skin color to the lip color. Inject the left upper vermillion and right upper vermillion, 1/2 inch in length starting from the top of the cupid’s bow.
3. Lastly, inject 2 to 3 linear threads along the medial aspect of the lower vermillion border. These injections will add slight volume to the lower lip, everting the lip a bit creating a very pretty shape.
Typically, 0.5-0.7cc are used in total with these 6 injections.
My favorite products for lip injections are Juvederm Ultra Plus XC, Juvederm Ultra XC or Restylane Silk. If someone wants volume in their lips, go with Ultra Plus. If someone has a thinner lip and they are timid about lip augmentation, go with Ultra but let them know that a second syringe may be needed in 2-4 weeks after the edema resolves. Restylane Silk is my preferred choice if someone only wants reduction of radiating lip lines AKA pucker wrinkles. Silk won’t add much, if any, lip volume but it nicely softens the lines establishing a soft vermillion border that only the patient can notice.
Take note with Restylane Silk, it can create moderate edema so prepare your patient for this 48 hour event. I like to mix 0.2cc Lidocaine (without epi) with Silk, this seems to lessen the post injection edema tremendously! Inject slowly, more superficially and try not to massage Silk. It’s a bit more temperamental!
Another tip of the trade: I always leave 0.2cc in my syringe for touch ups. The lips are notorious for bruising and swelling quickly so this little bit of filler will be your insurance policy! I discard the used needle, place the sterile end-cap back on the filler and secure the syringe in an envelope we use to autoclave surgical instruments. This way, my filler is sealed. I don’t like to replace the syringe in the original packaging and tape the edges, like I used to do. I date the envelope, place it in the refrigerator and have the patient return for touch up in 2-4 weeks. If they don’t return for touch up, I discard the filler. I only use my kept syringes for touch ups, I don’t want to be in the business of saving syringes for future treatments.
What are your favorite lip injection tips? Share the lip love!