According to the American Society of Plastic Surgeons 2016 Plastic Surgery Statistics Report, more than 2.6 million soft tissue filler injections were performed in 2016 alone. This number is up by nearly 50,000 since 2015 and by almost 300% since 2000, a testament to just how popular fillers have become in the past two decades. While hyaluronic acid fillers account for the vast majority of all soft tissue fillers administered each year, there are several different subtypes of HA fillers to choose from.
When it comes to getting the lips just right, choosing the right filler for your patients is half the battle. To help you and your practice streamline this process and ensure that your patients will love their final outcome, below is a four-step guide on how to select the most appropriate filler for each individual patient who walks through your door.
1. What Are Your Patient’s Goals?
The first step is to make sure you understand what your patient wants. Is it more of a vermillion border? Is it more of a “V” in the cupid’s bow area? Maybe it’s increased volume or improved symmetry. Whatever his or her cosmetic goals are, use these as a starting point to choose the best filler for each unique situation.
You’ll also need to take into account the patient’s age and natural anatomy. For aging patients, for example, thinning lips, wrinkles, and volume loss are often the primary concerns and can affect the final results. In some cases, lip fillers can be combined with other lip treatments to help diminish the appearance of lines and wrinkles such as the vertical “barcode” lines above the upper lip for a more comprehensive end result. Younger patients, on the other hand, might be after that plumped Kylie Jenner look that has become so popular.
Once you have a clear understanding of both your patient’s starting point and where they would like to be, it becomes much easier to choose a lip filler and create a treatment plan that’s right for them.
2. Choose a Filler Based on Its G’ Value
When choosing a lip filler, it is important to consider the G’ (pronounced “G-prime”) of the product. G’ refers to the stiffness of the filler, with low G’ fillers being softer and less firm than high G’ fillers. In regards to the lip area in particular, lower G’ fillers such as Belotero® and Juvéderm® Vollure are typically the best options for plumping the body of the lip, whereas high G’ fillers like Restylane® Silk are better suited for addressing changes in the lip shape and lip border (called the vermillion border).
3. Think about Down Time
When patients get lip fillers, they should expect down time. Filler choice can affect what down time can be expected. Restylane Silk tends to swell more than other HA fillers because it is made of tiny pieces of HA that has a lot of surface area to bind water. The swelling tends to begin at 6 hours post injection and remain for about 12- 18 hours. The benefit of this is that the swelling tends to prevent bruising by pushing a bit on the vessels preventing leakage of blood. If a patient doesn’t want their spouse to know they had their lips injected, this filler might not be the right choice. Alternatively, Volbella, Vollure and Juvederm Ultra tend to swell less or not at all but bruising is more likely if the patients do not take certain steps to avoid bruising. Regardless of the filler used, patients should be told to avoid heat, alcohol and exercise for 48 hours to minimize swelling and bruising.
Lips just after injections with an HA filler with mild swelling most notable in lower lip.
Patient went to the beach and drank alcohol after lip injections. The lips started swelling in the heat.
Patient developed bruising and lumps the next morning. This could have been avoided if the patient had avoided heat, sun and alcohol.
4. Pay Attention to Lip Proportion
Finally, in order to achieve the soft, natural look that so many of your patients want, it’s crucial that you take into account proper lip proportions. Otherwise, the end result could look fake and out of balance with the rest of the patient’s facial features. Improper lip proportion is the main culprit behind the dreaded “duck lips” or “fish mouth” look.
The ideal proportions between the top lip and the bottom lip are 1:1.618. This is based off of the “golden ratio,” also referred to as the “divine proportion.” This ratio occurs naturally in patterns such as seashells, snail shells, flower petals, and in human anatomy. Therefore, the most aesthetically pleasing patterns and even faces closely follow this 1:1.618 ratio.
When placing lip fillers, it is important to follow this roughly 1:2 ratio, where the top lip is half or slightly less than half the size of the bottom lip. Keep in mind, too, that the ethnicity of the patient can also play a role in the desired final lip appearance. Studies have found that the most desired lip shape, size, and ratio between the top and bottom can all vary based on ethnicity. Korean women for example, were found to have the highest ratio between top and bottom lips, while Caucasian women were found to have the thinnest upper lips.
When designing a lip filler plan for your patients, several different factors need to be considered. First, sit down with each patient one-on-one to go over his or her specific needs and goals. Then, choose the right filler based on what you and your patient discussed during the consultation. Finally, consider the patient’s natural facial features, ethnicity, and lip proportions when placing the injections to reveal a smooth, natural-looking result that is in balance with his or her surrounding features.
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