Lip augmentation is an excellent procedure for plumping the lips and creating a more youthful, sensual appearance. Lip augmentation can also restore volume to lips which have thinned with age and balance out asymmetries. A variety of fillers may be used. Hyaluronic acid fillers like Restylane, Perlane and Juvederm are ideal for lip augmentation as they replenish lost tissue to restore a fuller, plumper appearance. They are often a good choice for younger patients seeking lip augmentation and for older patients looking to reshape the lips due to volume loss. Two fillers may be used in combination. For example, Restylane may be used in the vermilion borders while Perlane may be used to treat the mucosa of the lips for increased volume and improved shape.
Collagen is often used when treating the vermilion or border of the lips and when correcting the radial grooves. There are bovine-based collagen products (Zyderm and Zyplast) and human-based collagen products (Cosmoderm and Cosmoplast). Collagen injections may be used with other fillers to achieve optimal results. There are a variety of other options which may be used for lip augmentation including fat injection, Isolagen, AlloDerm, Cymetra, Hylaform or Captique, and Gore-Tex.
Different injection techniques may be used depending on the individual patient and the particular filler used. Using the correct technique is essential to creating lips that not only look natural but feel natural as well. Some commonly used injection techniques include serial puncture, linear threading, and fanning.
With the serial puncture technique, a linear series of small punctures are made to inject the filler in small quantities along the lips. This technique affords the surgeon greater control of the injection and more precise placement of the filler, helping to avoid irregularities and empty spaces. However, because this technique involves an increased number of needle injections, patients may experience more pain as well as more needle stick marks and/or bruises. Serial puncture is most often used for collagen injections but may be helpful when touching up the lips.
The retrograde linear threading technique is often used for hyaluronic acid injections and is especially good for lip filling. With this technique, the injection is placed at a mid to deep level in the lips at a 30 to 60 degree angle and then advanced horizontally. The filler is gradually and continually released as the needle is withdrawn and this is repeated until the desired volume is achieved. With this technique, there are fewer needle sticks so patients often experience less discomfort. It may also result in a smoother appearance.
Fanning is another technique which may be used for deeper lip filling. This technique is similar to the linear threading technique except the needle is redirected in a triangular or circular pattern when withdrawn. This “fans” the filler out from the central point.
With most techniques, it is important to avoid overcorrection which may result in visible nodules or a sausage-like appearance to the lips. In addition, the lips should be gently massaged following injection to smooth out irregularities and ensure even distribution. Lip injections can be quite painful. To ensure patient comfort, it is best to perform a full perioral nerve block prior to treatment.