Lip fillers require finesse

"When one uses injectable fillers," says David A. F. Ellis, M.D., "where one puts them creates a different effect in the lip." Professor of otolaryngology at the University of Toronto, he focuses exclusively on facial plastic surgery.

Successful lip treatments require finesse and artistic appreciation, adds Dr. Ellis, who calls his approach in this area "designer lips."

"Many older patients want their lips defined a little more, so that when they put on their lipstick they don't have to use a mirror," Dr. Ellis says. If one augments the vermilion border, he says, "They will be able to feel that, so they can apply lipstick quite safely" without a mirror.

Conversely, Dr. Ellis says, "younger female patients usually have good definition of the lip border. In such cases, he says he typically augments lips through injections at the free margin. "For patients who want their lips to be a little more pouty," Dr. Ellis adds, "we put a little more filler into the center of the lip rather than the sides."

If a patient is undecided about lip augmentation, he says, "We will put in a temporary filler and record exactly where we put it."

That way, Dr. Ellis says that locations, amounts and photos are on file if the patient later chooses a permanent augmentation, which many do.

Aging lip

However, he points out that while permanent fillers last forever, the geography of patients' lips changes over time.

Depending on the patient's age, he says, "The lip continues to age. So it thins out, and patients may need some more augmentation in five to seven years."

Other problems with lip augmentation can include palpability.

"With Artecoll (Artes Medical)," Dr. Ellis says, "some patients complain that when they run their tongue over their upper lip, they can feel irregularities," though they're usually not visible.

He adds that if bumps are visible, which occurs in less than 1 percent of cases, he typically treats them first with a cortisone injection.

"That will help to soften some of the scar tissue around the clumps," Dr. Ellis explains.

As an alternative, he says one can freeze the lip before using a large-gauge needle to essentially suction out the clump in the manner of removing an apple core. Surgical removal represents another option, although he says this is very rarely required.

The typical cause of bumps is incorrect filler application, Dr. Ellis says.

Usually what happens is that the filler is injected through a needle that's too small, resulting in irregular squirts rather than a continuous line, he says.

However, he says that if one uses a large needle such as a 25 gauge, the material usually comes out very smoothly. Applying fillers that are too cold also can cause bumps, Dr. Ellis says. He adds that while one is performing injections, it's crucial to use one's nondominant hand to feel exactly where the product is as it's exiting the needle.