One of the most popular treatment areas for dermal fillers is the lips. Why is this? Perhaps it is images from social media influencers, celebrities, and photo filters. Has this changed the societal images of what beauty really is? Or maybe it is because injectables are becoming more popular and mainstream. They are not something that everyone is keeping as a secret. It is normal for people to openly talk about their Botox or filler appointment. Beauty enhancement or youth preservation has become the norm in society.

REALITY VERSUS PHOTO

In addition to lip augmentation being an injectable trend, there are always different lip filler “styles” that many patients request,although it is not as simple as that. One cannot show a picture of what they want their lips to look like because that is unrealistic. The patient should ask themselves, “What are my lip goals?” For example, some people want larger and more voluminous lips, while others want more of a mild plump or hydrated look. Or perhaps one’s top lip has always been very thin, and the goal is to build the top lip. Whatever the goal, a plan can be devised with a professional aesthetic injector.

QUICK FIX

Lips are a popular injectable area because people of all ages are seeking lip augmentation, whether in their 20s and have always wanted plumper lips or in their 60s and wanted to restore their lips back to their previous life when they were younger.Lip filler is a quick go-to. Additionally, while some areas on the face may take multiple syringes, the lips can show a subtle but noticeable difference with just one syringe. Although, those with naturally thin lips will need more than one syringe to attain a full, yet natural pout.

EDUCATING CLIENTS ON STYLES

Recently, popular lip filler style that has been going around on social media platforms is the full Russian lip. This is a large lip that usually requires more than one syringe of lip filler. Depending on the provider, more filler may be broken up at subsequent appointments or one milliliter to two milliliters of filler at the same appointment.

As a provider, one must educate patients requesting the Russian lip filler style. There is a fine balance because not every individual’s face can accommodate large lips. Depending on facial structure and ethnicity, a larger lip may look natural. For example, typically Caucasians have thinner lips, as well as different lip ratios compared to African Americans or Asians.

RATIOS

While beauty is easily identified, it is has been attempted to quantify for thousands of years. In fact, various lip proportion measurements have been dated back from 300 B.C. The golden ratio, seen with da Vinci, has been used to describe classic proportions of the lips. In youthful Caucasians, the ideal ratio is 1:1.6, describing the vertical height of the upper lip compared to that of the lower lip. Again, this is very individualized as there are Caucasians that naturally have different lip ratios, such as more of a 1:1 ratio or various other ratios.

Other ethnicities tend to have more of a 1:1 ratio naturally. African Americans genetically have a greater lip volume, so a fuller lip may look more natural. While people with lighter skin obviously lose lip volume with age, people of darker skin tend to retain most their volume with aging. This is due to increased melanin that makes them less prone to solar elastosis.

In addition to taking into consideration different lip ratios, another measure to perhaps quantify beauty is the rule of horizontal thirds. Different ethnicities make up different proportions of these facial thirds, which divides the face into three equal parts horizontally. Furthermore, the lower third is also divided into thirds. This extends from the end of the nose to the chin. These represent the upper lip, lower lip, and chin. This rule can be helpful in harmonizing the facial aesthetics of an individual.

CREATING HARMONY

So, no matter what specific trend of lip filler a patient may request, if it is a larger lip they are hoping to achieve, it is important to assess the patient’s natural lip shape, as well as facial features. Some patients may want overly filled lips that can easily look disproportionate. Bigger is not always better. In fact, an overly large lip can make a patient look overdone and age their facial features.

DISPLACED FILLERS & TECHNIQUES TO UTILIZE

Overfilled lips can have a duck-like or Marge Simpson appearance due to filler migration. This is when the lip filler is outside the vermillion boarder. Sometimes this occurs due to the type of filler chosen, the injection technique, patients’ anatomy, or just the muscle of the mouth moving, which eventually can cause the filler to migrate. The orbicularis oris – the muscle around the lips is a sphincter muscle, so with repetitive movement, the filler will sometimes migrate. No matter what the cause, it is important as a provider to point this out to the patient during consultation. The great thing about hyaluronic acid filler is that it can be dissolved with hyaluronidase. Many patients may have built up to their current lip size, so when the discussion of dissolving them comes into play, they can be turned off. But adding filler to this type of lip can make the lip filler look even more displaced.

CONSULTATION & COMMUNICATION

For patients seeking a more natural lip augmentation look, hyaluronic acid fillers are great because they draw in moisture. Therefore, they help moisturize the lips. It is especially important to discuss the patients natural lip shape and volume. Many patients will say, “I just want my lips a little plumper.” If you do not ask more questions, the patient may end up with lips that they were not envisioning. When in turn, a few more questions asked by the injector would have given the patient exactly what they had in mind. Question lip ratios and what the patient seeks regarding this. Do they want a fuller top lip? Do they want the top lip to be the same size as the bottom lip? Asymmetries should be pointed out and targeted for correction.

A TRAINED EYE

The aging lip is inevitable. The vermilion body decreases in size, the cutaneous portion of the upper lip starts to elongate, the cupids bow becomes less defined, the development of upper and lower rhytids, and volume loss at the oral commissures cause the corners of the lips to turn down creating a frown appearance. From the age of 25,collagen production decreases by about 1% per year, including the lips. The aging lip can be targeted with hyaluronic fillers. Fuller lips are associated with youth, so when a natural volume is restored in the aging patient, it can add youthfulness. Many patients are pleased and think they immediately look a decade younger.

Is there an ideal lip? The answer is yes, there is an ideal lip shape for each patient based on their natural lip shape, facial features, ethnicity, and sexual identity. Lips are a focus of symmetry of the face. Lips create a state of harmony.They aide in balancing other facial features. Whilst different filler trends and societal ideals will come and go, a trained aesthetic eye will always take into consideration other facial features to balance one’s face and create unity and beauty.

Leigh Reese is a board-certified nurse practitioner and certified nurse injector. She earned her bachelor of science in nursing from Texas Women’s University in 2013 and her master of science in nursing from The University of Texas at Arlington in 2019. Her background in the medical field has been in emergency room medicine and aesthetic medicine. Her goal is to create a natural and youthful appearance for her patients and help devise a plan for their aesthetic journey. She has a passion for continuing education, and her position at SkinRXSpa allows her to attend monthly advanced trainings.