Lips are an integral part of the well balanced, attractive, feminine face. The past decade has witnessed the emergence of a preference for more robust, fuller lips. Today women are enjoying the benefits of lip augmentation in record numbers. It is important to understand the anatomy and proportionality that constitutes aesthetically desirable lips.
The aesthetically pleasing female lips shown above have a well defined “cupid’s bow” shape in the upper segment. Volume is distributed in roughly a ratio of one third in the upper lip and two thirds in the lower. Properly performed, lip augmentation should preserve these important relationships.
The before and after images below were selected from a website gallery depicting the results from another practitioner. Although the volume of the patient’s lips has been increased her natural upper/lower lip ratio has been altered.
The set of before and after photographs above demonstrates the effect of increasing her upper lip volume disproportionately relative to the lower lip. Unfortunately, this result is all too common and demonstrates what can happen when the injector is not aware of the consequences of altering these lip features. In the set of photographs above the upper lip is too large and out of balance with the lower. For all practical purposes, her lips were more attractive before she had the procedure.
During a consultation for lip augmentation at Wetherington Plastic Surgery (www.WetheringtonPlasticSurgery.com) I always strive to determine how well my patient comprehends these concepts. This procedure needs to be performed in a thoughtful fashion to avoid this blatantly obvious disregard for the true aesthetic qualities of the beautiful female lips. There is no room for a “bigger is better” mentality.
My preferred method for lip augmentation is a serial injection technique performed using a nerve block and thus complete numbness of both upper and lower lips. I stress treating this as a surgical procedure and thus use a powerful antimicrobial prep to reduce the risk of infection. I like to begin by injecting the red/white border of both the upper and lower lips. This is the line that most women target when they apply their lip liner. Next, volume is added to the actual vermillion, where needed, to achieve a pleasing central tubercle and correct any asymmetries she brings to the procedure. Lastly, I vigorously massage the Juvederm into the tissue to smooth the distribution and avoid any lumps. Ice packs are applied and the patient is instructed to massage again in another hour before the block wears off. She should be able to be presentable the next day without drawing attention to her lips. Bruising, if present, is usually minimal.
Detailed records are vital to the process. I record the location and amount of injected filler and use pre and post operative photography to document her native anatomy and my results. Future treatments may be fine tuned to achieve optimal and consistent results.
Although there is an immediate increase in the volume of the lips, it takes two to three weeks for the injected material to reach is fullest potential. Juvederm and related products attract tissue fluid into the deposited gel material and thus achieve their pinnacle effect in due time. Most of my patients enjoy the benefits of the procedure for nine to fourteen months. Experience suggests that the injection may actually induce the patient to increase her own collagen in the area.
The longevity of the result is in part related to the depth of injection. If the Juvederm is placed to close to the muscle then premature absorbtion is more likely. Injecting too superficially may result in lumps and even ulcerative lesions. Inadequate attention to sterile technique may result in infection.
I insist on seeing my patient back at four weeks post injection to judge the outcome and document any special issues. Photographs are taken and only then can a true analysis of my results take place. If results are optimal then the technique documented in her medical record will act as a guide to future treatments.
I believe that anything short of what I have described here is unacceptable. These simple “best practice” techniques help drive the quality of lip augmentation to its fullest potential and thus reduce the occurance of suboptimal results. By applying these principles I believe that most women can enjoy safe, reliable and reproducible lip augmentation.