LIP AUGMENTATION & FILLERS By Joshua Zuckerman, MD, FACS in New York City

Before and after image of a non-surgical lip augmentation by Dr. Zuckerman. Patient pictured before treatment and immediately after. Patient desired mild augmentation of the upper lip. Injected 0.8cc of Juvederm Ultra Plus XC.

Dr. Zuckerman is well-known in the New York region for his lip augmentations. Patients regularly travel to seek his treatment, and it is among the non-surgical treatments he performs most. He uses the latest lip injection techniques and has developed a few of his own over time. Lip augmentation with dermal fillers is a very common non-surgical aesthetic treatment nationwide, but it is a medical procedure requiring artistry and precision due to the lips’ cosmetically sensitive nature and intricate anatomy. Dr. Zuckerman has mastered this treatment for many shapes and sizes of lip anatomy and has years of experience and thousands of hours injecting. Dr. Zuckerman’s lip augmentation is a very customized treatment depending on patient goals and existing lip anatomy.

Aesthetic Issues Addressable via Lip Augmentation with Fillers: Lip Asymmetry, Thin Lips, Upper to Lower Lip Balance, and More

Dr. Zuckerman can address several types of aesthetic issues of the lips via augmentation with lip fillers including overly thin lips, lip asymmetry, upper to lower lip balance and more. Model, not an actual patient.

Dr. Zuckerman can address several aesthetic issues of the lips with his lip augmentation and fillers treatment:

• Enhancement and plumping of the overall size of both lips
• Correction of the balance of lower to upper lip to bring the ratio closer to the “ideal” of 1:1.6 (lower lip larger)
• Correction of left to right lateral lip asymmetry
• Enhancement of the points of the Cupid’s bow of the medial upper lip, which can descend due to lost volume through aging or which may not be prominent in those with thin lips
• Enhancement of the upper lip by accentuating the philtral columns, the vertical structures located between the nose and mouth (This is a particular specialty of Dr. Zuckerman’s technique.)

Which Lip Filler to Use for Augmentation?

This is a comparison of the three available lip fillers. Each is quite similar to the others, and the choice is largely a matter of patient preference. Since its FDA-approval, Dr. Zuckerman has employed Volbella frequently for subtle lip augmentations.

Dr. Zuckerman performs lip augmentation using one of three FDA-Approved injectable Hyaluronic Acid fillers, which are compared in the diagram:

• Juvederm Ultra Plus XC: This Allergan-made Hyaluronic Acid filler is the most popular dermal filler and has been FDA-Approved the longest.
• Volbella: This is Allergan’s newest FDA-Approved lip filler and confusingly is also in the Juvederm product family. This product is less viscous and therefore lowers the risk of looking “overdone” or having “duck lips”, which is already a low risk with Dr. Zuckerman as your injector. Dr. Zuckerman prefers this product for subtle lip augmentations and plumping.
• Restylane Silk: This is a similar Hyaluronic Acid filler to Juvederm, but it is manufactured by Galderma. It is more hydrophilic than the other two, meaning patients may experience more swelling initially post-treatment. Restylane Silk is slightly better for larger lip augmentations.

All three of these products are very similar, and the treatment choice is to some degree a matter of patient preference. However, most of Dr. Zuckerman’s patients prefer a subtle result, so in recent months, Dr. Zuckerman has employed the newest product Volbella more frequently.

Dr. Zuckerman’s Philtral Columns Technique for Lip Augmentation

A before and after of lip augmentation by Dr. Zuckerman with the philtral column injection technique, which produces a subtle upturn in the upper lip to enhance the patient’s “pout”.

The philtral columns are the two vertical anatomical structures above the lips. Dr. Zuckerman is able to inject a small amount of filler, as shown in the video below, into this area to subtly enhance these structures. This lends a slight upturn to the upper lip, enhancing the “pout”. In the before and after image at left, the patient has had this technique performed by Dr. Zuckerman as part of her lip augmentation. The philtral columns technique is an advanced injection style that should only be performed by an experienced injector with knowledge of the sensitive facial anatomy in the area, such as a board-certified plastic surgeon like Dr. Zuckerman.

Key Aspects of Treatment

Lip augmentation by Dr. Zuckerman before and after image. Patient pictured before treatment and immediately after. Patient desired a subtle augmentation, and Dr. Zuckerman injected 0.5cc of Volbella.

Lip Augmentation & Fillers Recommended Regimen

Most patients require one to two lip injection treatments per year to maintain a continual effect.

Lip Augmentation & Fillers Longevity

Treatment takes three days to one week to set in and lasts six to nine months.

Lip Augmentation & Fillers Procedure Time

10 – 20 minutes per treatment

Lip Augmentation & Fillers Pretreatment Guidelines

Dr. Zuckerman recommends patients take the following precautions before undergoing forehead lip injections to minimize bruising: no ibuprofen or aspirin within a couple days before and after treatment, refrain from excessive alcohol consumption a day before and a day after, refrain from lying flat or working out within 2 hours after injection.

Lip Augmentation & Fillers Recovery (Downtime)

Some patients experience slight redness around the lips immediately post-treatment and minimal bruising, which generally resolves within 24-48 hours. Most often, Dr. Zuckerman is able to minimize or eliminate such side effects, and his patients often go straight back to work after a daytime treatment. Makeup can be applied immediately after treatment if necessary to camouflage any post-treatment redness or bruising. The lips may be somewhat numb for a few hours after treatment, but despite this, most patients are still able to form natural-looking facial expressions.

Lip Augmentation & Fillers Associated Risks

Lip injections with Hyaluronic Acid filler are very safe, but well-done lip augmentation requires experience and artistry. The most common complaint that Dr. Zuckerman receives from patients who previously visited another practitioner is an unhappiness with their prior aesthetic result, which Dr. Zuckerman then endeavours to correct. Consequently, he recommends you visit an experienced board-certified plastic surgeon such as himself for your treatment. In rare cases, patients may be allergic to the dermal filler, and a board-certified physician will be able to safely and quickly reverse the treatment to eliminate the Hyaluronic Acid. In the case of an unsatisfactory result, Dr. Zuckerman could reverse the treatment result, although this has never been needed in his practice.

Dr. Zuckerman performs lip augmentation for one of his patients using Juvederm Ultra Plus XC and demonstrates one of his techniques for enhancing the “pout”.

Frequently Asked Questions About Lip Augmentation & Fillers

Is lip augmentation with lip fillers safe?

Yes, this treatment is overwhelmingly safe, especially when performed in a medical setting with the proper sterility and medication to address a rare allergic reaction.

How do I avoid having my lips appear overdone after lip fillers?

Dr. Zuckerman’s treatments never result in an artificial “done” look. Avoiding suboptimal results means being careful with the amount of lip filler injected, especially in the upper lip. As a board-certified plastic surgeon and expert injector, Dr. Zuckerman is well aware of all anatomical concerns in this cosmetically sensitive area. In addition, because the effect is immediately visible post-treatment, Dr. Zuckerman can help you take additional precautions to avoid having others notice a significant change in your appearance. For example, if you desire a significant augmentation, Dr. Zuckerman recommends that for a first treatment you strive for about 50-60% of your desired ultimate result. Then, in about 3 months time (half the life of the filler), you can undergo a second treatment with Dr. Zuckerman to bring your lips to the full desired effect. Maintenance treatments are then required every six months to maintain the full effect. Note that our office needs advanced warning for this particular treatment regimen, becausewe typically performed these fillers by full syringes and may need to purchase half-size syringes of your desired filler. Finally, Allergan’s new filler Volbella is great for subtle augmentations: it is less viscous and therefore would be quite difficult to inject so much as to create artificial-looking, overly full lips.

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