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Lip Augmentation, Juvederm & Botox and fillers

It seems like everybody’s getting something injected somewhere. Lips continue to gain in popularity as a favorite for enhancement. Pouty will never be out of style. Beautiful lips in women have a signature shape. There are particular subunits of the upper and lower lip that must be identified and respected. And there are areas of both the upper lip and lower lip that should never, ever be injected. Yet, so many women walk the streets of Beverly Hills with a trout pout.


View More Lip Augmentation Before & After Photos

The Principles of Lip Augmentation

Beautiful Lips Features

  • The bottom lip is 1.5x the size of the upper lip. That is, the lower lip is bigger.
  • The large majority of red lip show (mucosa) is in the center 2/3 of the lip. As the lips move to the corner of the mouth, the lips volume should taper off rapidly.
  • The upper lip has a dimple in the middle called the philtral dimple. Along the sides of this dimple are the philtral columns. These are prominent in beautiful lips.
  • The center of the lip in the bottom has a bump called a tubercle. This tends to fade with age. The lips are most pouty at age 14 to 15 in women paralleling estrogen in puberty.
  • The lower lip has a natural cleft creating two “cheeks”.

Understanding these elements are essential to creating beautiful lips. One specific subunits should be injected. And in the right proportions.

The idea of fillers is to replace volume that is lost with aging. As we age, our face deflates like a balloon. If you look at pictures when you were in high school, even if you were thinner, your face was fuller, particularly in the cheeks, temples, and lips. Our face can lose up to a cc per year in our 20s and the fat loss accelerates as we age. Sometimes facial fat grafting is a great way to replace volume. Other times, injectables work well.

There are new injectable products emerging all the time. Most of these products are exceptionally safe. There are temporary fillers, permanent fillers, and semi-permanent fillers. The safest ones are the temporary ones. Silicone is a permanent facial filler that can lead to terrible deformities down the road. I won’t inject silicone into the face.

Man semi-permanent fillers are new and very safe. Common semi-permanent fillers include Sculptra® and Radiesse® among. These products are not used for lip augmentation, but they do work well for filling out cheekbones and smile lines. They can even rejuvenate the hands. Unfortunately, many plastic surgeons ignore the hands when it comes to rejuvenation. The hands are a critical aging zone that should not be neglected. Fat, Radiesse®, and lasers are wonderful ways to rejuvenate the hand.

The most common products are the hyaluronic acid based products such as Restylane®, Juviderm®, Perlane®, and Prevelle®. These last up to 6 months and are great for the lips.

‘Filling Out the Face’ with a hyaluronic acid product, Juvederm Ultra

juviderm patient

Multiple areas were addressed to add subtle but significant changes to the face simulating a facelift including the cheeks, marionette lines, nasolabial folds, and the jaw line to ‘hide’ the presence of a jowl. This picture is taken 4 days after injection. There is very little down time. This patient went out to dinner the same night. A small, temporary bruise is apparent below the right lip. This was gone by the end of the week.

Sometimes a combination of fillers and fat grafting is necessary to restore youth. Below is a patient who received 2 syringes of Juvederm.

Botox® is most widely known as a vehicle to treat facial wrinkles particularly in the forehead, frown lines, or crow’s feet.

Botox® has gained tremendous popularity over the last 5 years. It works by temporarily weakening or paralyzing the muscles that cause wrinkles. And it works well. It usually takes a few days for it to begin working and its effects can last over 4 months.

Rhinoplasty / Fat Grafting

However, Botox® has some other very interesting uses in the cosmetic world. Botox is also FDA approved to treat excessive sweating in the armpits and palms. This is actually pretty common among celebrities before big events and among people who do a lot of hand shaking for work. Just one in the office treatment can last as long as 6 months. The results are amazing.

Believe it or not, Botox® is also used to treat migraines and severe headaches. Just a pinch in the frown line area has been shown to significantly reduce the incidence and intensity of migraines. Although the mechanism isn’t completely understood, it works. And it works very well.

Also, Botox® can also be used to feminize the face by shrinking the jaw muscles in women. This is done with just a few tiny injections in the jaw.

Big, beautiful lips are “in”.  Thankfully, there is a very easy way for plastic surgeons to create beautiful lips in just under 30 minutes using products like Juvederm and Restylane.

Frequently Asked Questions About Lip Augmentation

Is there anything permanent?

How long does it last?

Does it hurt?

How many syringes do I need?

Can you just inject my upper lip?