How Do You Make Thin Lips Fuller Without a Duck-Lip Look?

Hi, welcome to another injection series. What we're going to demonstrate today is Juvederm, and I'm going to show you a slightly different technique. You've seen me inject with a long-needle threading technique, you've seen me do the short-needle technique, and we've done micro droplets. When we start with thinner lips, a lot of patients look at their thin lips and say, okay, how can I get them volumized? I went somewhere and ended up looking ducky, and so on. You can't make thin lips go full in one shot. That's just not going to happen. If you look at Kylie, for example, at her lips when she started thin and where she ended up, she had to go in multiple stages. You have to expand the lip, and this has to happen at three to four week intervals. If you do it on day one and then wait six months, it's all gone, essentially. But if you do it all in one shot and try to put three syringes in the lip, it's going to look very ducky, very stiff. Even one cc can sometimes look very artificial. So you do it in steps. You do it on day one, then three to four weeks later you do a second injection, three or four weeks later a third injection, and so on, giving the lip shape and slowly stretching it.

Restylane and Juvederm are my two favorite products for lip injections. Restylane is a little stiffer, more structurally sound, so when you have to create borders and definition, I prefer it. Juvederm lasts a little bit longer. It's a little bit more concentrated. Our patient prefers Juvederm, so we're going to stick with that, but I'm going to show you a variety of techniques.

The lips have been numbed just with topical numbing. There's no dental block here. It's just topical numbing. It really takes the pain down to a very tolerable level. You still feel it, but it's not that bad at all.

Rest your head back. I'm going to start on one side, and you can see there's not much lip show laterally at all. The white lip is kind of overhanging the red lip. There is absolutely no way of rolling this out all in one shot. This has to be done in stages. If you do a lip lift and pull it up, it can be done, but with injections it can't. And if you over-inject, it gets very stiff and ducky.

So we're going to start with little tiny droplets. What I'm doing is going in tangentially. I'm actually starting at the vermilion border and going in at almost 45 degrees, popping out the lip. The next one is right next to it, at 45 degrees. The area that fills up is just a little bit ahead of me, so it's kind of numbing as we go. Smooth it out, and that's it. If you've injected the right amount, you don't need to massage it terribly much.

Now, you can see she's kind of got fullness in the central lip. If I start putting too much here, this will look very ducky, so we're not going to do that. The lower lip is doing okay. So we're going to come back to the other side. I go back and forth when I do the micro droplet technique, because you want to allow the lip to numb up a little bit, and as you go back over the same area the second time, the third time, it gets more comfortable. Go ahead and swallow a little bit. There we go. The lips and the throat tend to numb up with the numbing cream, so sometimes the patient's tongue and throat go numb.

Now we're going to go in the other direction, vertically, with little tiny shots, and all of this is meant to spread out the red lip and get better lip show. Put your lips together. You're starting to see some definition out here, and you keep going. It's in multiple planes, trying to stretch the lip so you see the red lip over the white lip. Going in the other direction again, vertically. Now we go to the wet-dry border. I still really haven't put anything in the central lip yet, because I want to see how much lip show I can get. Make sure she's nice and smooth. This is going to be the first of a series of injections.

Now I'm going to come back and do a little bit of the vermilion border. The border is more sensitive. It always hurts a little bit more. I tend to wait until some of the numbing has kicked in elsewhere on the lip, but it still is a little bit more sensitive. The border injection is more superficial. You barely see the needle, but you can follow it, and you can start seeing some shape.

In a patient who doesn't have a lot of lip show, if you start injecting the upper lip, it's going to over-project past the lower lip. So you've got to balance out the lower lip. Her lower lip is more of a standard injection, just to make sure we have enough lower lip show so the upper lip doesn't project over it. Very gentle. There's no jabbing, there's no stabbing. Very gentle moves. You can start seeing some more.

Now here's another technique that I'm going to use. To create a little bit more here, I'm actually going into the red lip and giving some volume to the red lip and its continuity with the white lip in this area. I've still done nothing to the very central top lip yet. If you get a little bleeder, just hold a little pressure so it doesn't bruise. You can start seeing the lip shape a little bit more. Still no bruises.

We tell patients to relax, not to clench. Sometimes patients want to give themselves a little distraction. They may clench their hands, grip a ball, grip an armchair or even dig their fingers into another finger, and all of that basically raises your blood pressure and creates more bleeding. So it's going well.

Now I'm going to do a little bit just lateral to the center, not the center itself, because again, she's got good projection in the center. Smile for me. Good. I have her smile to check for symmetry. Now try to blow a whistle. Good. I check for symmetry that way as well. Relax the lip.

Now, this is going to be full. I want that fullness, because we're trying to stretch this and get more lip show. We talked about this being a project, meaning it's going to take several sessions. But you can see the red lip now, whereas before you couldn't see it. Very symmetric at this point. When you do the injections, the lip is definitely more numb, because we've been putting these in there. I feel it to make sure there are no lumps or bumps. Looks really good. Smile one more time. Good. Relax it a little bit. I feel like we need a little bit right there, in this space. The other side was a little bit different, so this side now needs it. And that's it for the lip injection.

So we're going to clean it up. There are no bruises that I see. That's about all the bleeding that she had. No bruises. Looks good. You feel it with your fingers to make sure there are no lumps or bumps. You don't want to send the patient home with lumps or bumps. And this is the first session. In about three or four weeks, we do a little bit more and build it up from there. How bad was that? Not bad at all? Okay. That's it. Thank you.