Thank you for your question.
You provided two photos and you stated in your question that you have very thin lips
and you are concerned if injectible filler will make your lips look unnatural.
And it’s very good the way you submitted the photos - you submitted the photos of your
lips at rest and then your lips puckering showing the vertical lines and you express
the concern in your question.
Well certainly I can share with you how I discuss this concern with my patients in my
practice.
A little bit of background, I’m Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been practice in Manhattan and Long Island for over 20 years.
Lip enhancement of the area we refer to as perioral area of the lower third of the face
is a significant part of my daily practice.
And facial aging is an area that I have been significant focus for me in the over 20 years
I have been in practice.
And the evolution of the solution and the integration of the solution is something that
I have a lot of experience with.
And certainly your concern about looking unnatural is probably the first thing that people always
express when they talk to me about doing something for their lips
Unfortunately there are a lot of people walking around with what is often referred to as trout
pout or duck lips and other not so kind descriptions of people who appear to have been quite overdone.
And so people who never have done anything they are very much afraid of having an outcome
such as that from what they’ve seen whether it’s on television, movies or magazines.
So let’s just take this opportunity to just learn a little bit the anatomy of the lips
and how it is generally approached in my practice and how I do it a kind of a stepwise way.
So I think that’s the right approach.
So to begin with what’s happening and why are this vertical lines are forming people
always look at wrinkles when they think about aging but when we think about aging more holistically
or globally you have to understand that there’s a lot of bone loss, there loss of fat in the
soft tissue around the lips.
And in the lips and there’s loss of collagen in the skin.
So when you show your lips at rest you notice there is some vertical lines that they at
rest those line refer to as static lines.
And then when you pucker you’re actually using a muscle called the obicularis oris
muscle and this is the muscle that contracts that cause this vertical line to get deeper
and those are called dynamic lines.
Now when you look at somebody’s lips and people always look at the lines and they notice
the volume has diminished well there is few ways to actually address this.
And I think if we looked at the anatomy in this area you can come across a lot of different
solutions that do involve fillers as well as other injectables that are relevant.
So generally speaking when someone like yourself is wearing lipstick, very often they are literally
drawing more lip than they actually have.
So I usually tell my patients that let’s differentiate the pink part from the skin
where the lines are.
And then from the pink part of the lip, I understand that there’s a transition point
and then the transition point it is called the vermillion border.
So when it comes to just filler alone and restoring volume we actually have a good number
of options in terms of choices.
Basically as far as fillers are concerned, I’m really very happy about the number of
options we have these days we have everything from thinner fillers such as Juvederm Volbella,
Restylane Silk which are very good for finer lines of the skin to slightly thicker such
as Restylane, Juvederm that can be used for the pink part of the lips as well as vermillion
border, the border in the line.
Now this comes back to not so much to product and I always caution people to remember to
differentiate product from the practitioner.
The products are tools.
And although their companies make these products, promote aggressively the incredible benefits
of these products it’s the practitioner who applies these products and very often
patients have come to me and say XYZ product I tried it once it doesn’t work for me.
Well let’s understand what happened and then I tried to distinguish and differentiate
product from procedure, procedure and practitioner got a little alliteration there.
So understanding that being conservative is a very good way to approach this.
So starting with limited quantities to help restore the pink part of the lips, maybe a
little bit along the vermillion border and along the vertical lines with the different
filler choices which continuously evolves so it’s not as about a specific brand or
variety it’s really about the technique and so finding a doctor that you can have
a good dialogue with, and understand your desires and what the doctor sees as a good
aesthetic outcome is the ideal process for you.
Meet with the doctor who you maybe by the referral, maybe by seeing someone else who
may a friend who may share with you that kind of referral, or just do research online like
everyone does and just start the journey of learning and start conservative.
You know the volumes that are used in injectable fillers are relatively low.
Each syringe which sounds like a lot is typically one milliliter which is not a lot of volume.
Now certainly placement in the wrong area not so optimal areas can certainly make someone
not look so good but it’s the art of using the volume and placing it.
But you certainly cannot really overdo it when you start very conservative so again
meet with doctors.
There many doctors who do injectable fillers around the lips.
There is a role for various neurotoxins Botox®, Dysport etc.I think that’s more of a refinement
for the activity of the muscles.
That’s a kind of a different story in terms for me and in terms of volume.
People want to see the result immediately and want to know that they’ve got actually
gotten something significant with their office visit and that’s where the fillers can be
done so nicely and artfully and look natural and fit your face.
I think that’s also to take a take home message as long as the appearance fits your
face and it’s within your natural anatomy and history.
I look at it more as correction versus augmentation.
You know when we’re talking making something larger than it is naturally let’s say breast
augmentation we’re augmenting we’re increasing.
But when it comes to facial aging I look at it more as correction where we’re filling
and restoring rather than augmenting.
So hopefully that with that I give you some guidance from somebody like myself that will
be helpful on how I approach patient like you.
So I hope that was helpful I wish you the best of luck and thank you for your question.