Lip filling made less painfull. Filler used to increase volume and erase lip lines as one ages. Emphasis on a more natural appearance with less pain, swelling and bruising.

1. Painless Lip Filling
Lip injections have become popular with all age groups. Filling the lips has been painful
for some patients despite me giving nerve blocks inside the mouth such as an
infraorbital and mental block. When needles are used to fill the lips they are usually
painful and patients can swell and bruise significantly. My favorite way to fill lips is with
a cannula. I have several videos in my Instagram : aestheticlasercenter demonstrating
lip filling with a cannula.
Younger patients who want their lips filled usually have good lip shape and want more
volume. It is important to note that the bottom lip is usually 20-30% larger than the top
physiologically. Women who have their upper lip filled too much will appear to have
unnatural lips.
Below is a diagram of the landmarks of a youthful lip. Notice the larger size of the lower
lip.
The Philtrum column helps create the cupid’s bow of the lip. This structure is
sometimes missed and not filled in some patients.
My filler of choice is in the Restylane family of fillers. Since younger patients want
volume and more bang for their buck, Perlane or Restylane Lift as it is called now has a
very high G’ which means that it is resistant to molding and lifts pretty well. Since it is
not very hydrophilic or filled with water molecules, the size does not decrease
Courtesy of Larrabee W, Malielski K, and Henderson J. Second Edition
Surgical Anatomy of the Face. Lippincott Williams and Wilkins 2004.

2. significantly in the first 2-3 months. In my experience it usually last 9-12 months in most
patients.
Below is a cross section of the lips and one can see where the
muscle and artery and submucosal fat is located.
The Vermillion border is the top of the lip and the submucosa is
located right below and above the muscle. The labial artery is
located more superiorly near the Vermillion border which is why
bruising is so common when it is injected with needles.
I like to inject the lips with a cannula and make the incision on the side on the lips. The
cannula is then inserted through the small incision and then I will guide it into the lip. I
usually inject in the submucosal plane and the muscle to add volume to the lips. I don’t
inject as much in the vermillion border since this makes it look unnatural and gives a
duck-like appearance. To make the lips evert more you can add a few units of
neurotoxin superiorly in the upper lip. Weakening the obicularis muscle will cause it to
turn up slightly.
Older patients will complain of smokers lines along with running of their lipstick and
want those corrected. I also use a cannula to define the vermillion border and fill the lip
above to correct the volume deficiency and will add small units of neurotoxin like
Dysport, Xeomin or Botox to relax the muscle. This will erase the deeper lines and
slightly evert the lip so there is more show superiorly.
Courtesy Larrabee, W., et al. Second Edition, Surgical Anatomy of the Face.
Lippincott, Williams, and Wilkins 2004.

3. Young patient after filling of lips with 1 cc of Restylane Lift using a cannula.
Picture taken right after filling. No anesthesia used except on skin where cannula inserted
through. Minimal discomfort swelling and bruising seen.
68 y/o who wanted her lip lines softened. Icc of restylane was used to fill her vermillion border or lip border
on her upper and lower lip. The area above her upper lip border was also filled. Picture taken after filling.
Notice small holes in side of mouth where the cannula was inserted.
Quita Lopez Today, 11:34 AM