Draw the Line on Injecting Fillers to Create the Perfect Lip

WILLIAMSBURG, VA. — Creating the perfect lip may mean telling a patient to step away from the fillers, Dr. Stephen H. Mandy said at a meeting sponsored by Skin Disease Education Foundation.

Following a procedure to increase lip fullness, most patients will want more filler injected. Dr. Mandy tells his patients that if they think they need more, they can come back to him but if he thinks they've had enough, he won't do any additional lip injections. "I just don't want duck lips walking around with my signature on them," he said.

He offered several other tips to create the perfect lip. First, it's important to recognize that there are significant differences in lip shape and size between the races. Even within a racial group, there can be substantial variation. "Look at the patient's lip before you start," said Dr. Mandy, professor of dermatology at the University of Miami.

Be sure to show patients their natural lip asymmetries, if they have any. "If they don't get shown it before hand, they're going to blame it on you," he said.

Sharp definition of the lip margin is critical, so avoid injecting hyaluronic acid there since it blunts or rounds the lip margin. Instead, use collagen injection such as Zyplast or CosmoPlast.

Dr. Mandy uses hyaluronic acid to add fullness to the body of the lip. "If you look at the lip, there is fullness in the lateral portions of the upper lip on each side," he said. These two sites, along with the central tubercle of the top lip and the two medial lower lip protuberances, make up the five sites for hyaluronic acid injection.

Dr. Mandy uses a 0.4-cc syringe. For the lateral portions of the upper lip he injects 0.05 cc on each side. At the central tubercle and at both medial lower lip protuberances, he injects 0.1 cc. Inject along the wet/dry line of the lips in the submucosa to get "a much more natural-looking lip," he said.

In the aging lip, dermatologists may also have to contend with rhytids, volume reduction, elastosis, excess facial hair, and dyspigmentation. For rhytids, he uses botulinum toxin type A in 4–6 injections (1 U total) across the upper lip and about 2 U on the bottom lip. He also uses CosmoDerm to fill rhytids around the lips. He often uses resurfacing as well.

Dr. Mandy disclosed that he has received funding and is a consultant for Surgical Specialties Corp. and Sanofi-Aventis. SDEF and this news organization are wholly owned subsidiaries of Elsevier.

WILLIAMSBURG, VA. — Creating the perfect lip may mean telling a patient to step away from the fillers, Dr. Stephen H. Mandy said at a meeting sponsored by Skin Disease Education Foundation.

Following a procedure to increase lip fullness, most patients will want more filler injected. Dr. Mandy tells his patients that if they think they need more, they can come back to him but if he thinks they've had enough, he won't do any additional lip injections. "I just don't want duck lips walking around with my signature on them," he said.

He offered several other tips to create the perfect lip. First, it's important to recognize that there are significant differences in lip shape and size between the races. Even within a racial group, there can be substantial variation. "Look at the patient's lip before you start," said Dr. Mandy, professor of dermatology at the University of Miami.

Be sure to show patients their natural lip asymmetries, if they have any. "If they don't get shown it before hand, they're going to blame it on you," he said.

Sharp definition of the lip margin is critical, so avoid injecting hyaluronic acid there since it blunts or rounds the lip margin. Instead, use collagen injection such as Zyplast or CosmoPlast.

Dr. Mandy uses hyaluronic acid to add fullness to the body of the lip. "If you look at the lip, there is fullness in the lateral portions of the upper lip on each side," he said. These two sites, along with the central tubercle of the top lip and the two medial lower lip protuberances, make up the five sites for hyaluronic acid injection.

Dr. Mandy uses a 0.4-cc syringe. For the lateral portions of the upper lip he injects 0.05 cc on each side. At the central tubercle and at both medial lower lip protuberances, he injects 0.1 cc. Inject along the wet/dry line of the lips in the submucosa to get "a much more natural-looking lip," he said.

In the aging lip, dermatologists may also have to contend with rhytids, volume reduction, elastosis, excess facial hair, and dyspigmentation. For rhytids, he uses botulinum toxin type A in 4–6 injections (1 U total) across the upper lip and about 2 U on the bottom lip. He also uses CosmoDerm to fill rhytids around the lips. He often uses resurfacing as well.

Dr. Mandy disclosed that he has received funding and is a consultant for Surgical Specialties Corp. and Sanofi-Aventis. SDEF and this news organization are wholly owned subsidiaries of Elsevier.

WILLIAMSBURG, VA. — Creating the perfect lip may mean telling a patient to step away from the fillers, Dr. Stephen H. Mandy said at a meeting sponsored by Skin Disease Education Foundation.

Following a procedure to increase lip fullness, most patients will want more filler injected. Dr. Mandy tells his patients that if they think they need more, they can come back to him but if he thinks they've had enough, he won't do any additional lip injections. "I just don't want duck lips walking around with my signature on them," he said.

He offered several other tips to create the perfect lip. First, it's important to recognize that there are significant differences in lip shape and size between the races. Even within a racial group, there can be substantial variation. "Look at the patient's lip before you start," said Dr. Mandy, professor of dermatology at the University of Miami.

Be sure to show patients their natural lip asymmetries, if they have any. "If they don't get shown it before hand, they're going to blame it on you," he said.

Sharp definition of the lip margin is critical, so avoid injecting hyaluronic acid there since it blunts or rounds the lip margin. Instead, use collagen injection such as Zyplast or CosmoPlast.

Dr. Mandy uses hyaluronic acid to add fullness to the body of the lip. "If you look at the lip, there is fullness in the lateral portions of the upper lip on each side," he said. These two sites, along with the central tubercle of the top lip and the two medial lower lip protuberances, make up the five sites for hyaluronic acid injection.

Dr. Mandy uses a 0.4-cc syringe. For the lateral portions of the upper lip he injects 0.05 cc on each side. At the central tubercle and at both medial lower lip protuberances, he injects 0.1 cc. Inject along the wet/dry line of the lips in the submucosa to get "a much more natural-looking lip," he said.

In the aging lip, dermatologists may also have to contend with rhytids, volume reduction, elastosis, excess facial hair, and dyspigmentation. For rhytids, he uses botulinum toxin type A in 4–6 injections (1 U total) across the upper lip and about 2 U on the bottom lip. He also uses CosmoDerm to fill rhytids around the lips. He often uses resurfacing as well.

Dr. Mandy disclosed that he has received funding and is a consultant for Surgical Specialties Corp. and Sanofi-Aventis. SDEF and this news organization are wholly owned subsidiaries of Elsevier.