When assessing and treating a patients lips there are several subtle changes that can rejuvenate the mouth area without making the lips look “done”. Although some patients want much fuller lips, a lot of us prefer subtle changes.
As we age our upper lip changes in several ways. We tend to lose the definition along the vermillion border, the philtral ridge/columns (the vertical columns that start at the tip of the cupids bow and end below the nose) flatten and the space between the upper lip and nose elongates. Subtle changes can be created with easy injection techniques, including defining the vermillion border, restoring the philtral columns and accentuating the cupids bow. Restoring the philtral columns frequently make the lip lift slightly. Filling these columns can return the contours that were likely once there. Vertical lip lines can be softened as well. Small amounts of filler can be placed within the lip itself to restore lost volume. There are many fillers to choose from these days, giving the patient and provider options, depending on the treatment plan. Fillers vary in their hyaluronic acid %, viscosity, elasticity and cohesiveness.
When assessing and treating the lower lip there are several changes that can have a nice impact, other than just looking fuller. Again, the vermillion border can be defined and fine lines can be corrected. The oral commissures, which tend to turn down as we age, can be turned back up with filler placement techniques. Volume restoration can be completed to obtain the desired effect.
The ideal balance of upper lip to lower lip is 1/2 to 2/3’s. This does vary individually and you and your provider can decide the best proportions for you.
In addition to fillers, small doses of Botox® or Dysport® can be utilized to relax muscles in this region of the face. If a person tends to purse their lips Botox® or Dysport® can be used in the muscle surrounding the mouth (the orbicularis oris) to minimize the pursing. This injection technique also tends to roll the upper lip up and out slightly, making it appear slightly fuller. Additionally, for a gummy smile, an injection a little higher (closer to the nose) in the upper lip can relax the muscle that lifts the lip up. This injection prevents as much gum tissue from being exposed with animation.
Another placement of Botox® or Dysport® that can help in the lower face and lip area is treating the depressor anguli oris ,(DAO) which, in some individuals, pulls down the sides of the mouth. Very small doses are utilized in these muscles to help minimize the appearance of frowning.
As with all facial injections, make sure your provider has a thorough understanding of facial anatomy. Ask if there is an “emergency kit” for injectables in the clinic. (a kit containing an enzyme to dissolve filler, should it be required)
Do not worry that having injectables in the mouth area will leave you with unnaturally big lips. (which we have all seen) If you and your provider are on the same page, you can obtain a natural restoration of the volume and definition you once had.