Why Does Overfilled Lip Filler Look Like It Migrated?

All right, guys, we're going to do a lip injection. You guys have seen me do lip injections for 20 years. I've been a little lazy, not making lots of videos, but I figured, you know what, let's use the opportunity to show you some of the innovations and technique. You guys have seen a lot of trends and fads and hype on Instagram, but I want to show you what really works, what's safe. One of my favorite products for lips is Restylane Kysse. There's other products as well, but I love Restylane Kysse.

You've heard about migration. Migration is complete nonsense. Fillers do not migrate. If you overfill the lips, the filler goes from here and spills over, so you lose the border, and basically it looks fuller above it. So there is no migration. The filler from here is not ending up over here. That doesn't happen. So I need injectors to stop saying that. It's basically a spillover effect, and we don't want that to happen. So where you put the filler, when you inject the filler, is important. Where you're directing the needle is important. But also understand there's limitations. If you take somebody whose lip capacity is overfilled, then that filler has got nowhere else to go. It's just going to spill over to the surrounding structures. And when it comes to lips, the vermilion border needs to be sharp, needs to be crisp. If somebody wants giant lips and they don't have enough capacity to stretch out their red lip, which is this area, what ends up happening is that the lip starts to look full above it, and it looks like it has migrated. But it has not migrated, because there is no such thing.

So we're doing the border, and we're going to do the red lip itself as well, to keep it nice and sharp. Open your lips, please. Leave it open. If you go ahead and overfill it, remember, this lip is not a flat structure. This is not a two-dimensional structure. When you put on lipstick, it's two-dimensional, it's flat. But when you put in filler, it's going to come out this way and it's going to go up this way. So this entire place that I'm holding in my fingers fills up, and guess what happens then? When you get this fullness in the white lip, it looks like it's migrated. So I need all of the nurse injectors, dermatologists and people out there using the word migration to stop doing that, please, and educate people properly about spillover. The spillover effect. We don't want spillover.

So again, the needle's going at the proper angle. You can see where the needle tip is ending up. It's away from the white lip. I'm going to go back to the border. The border is something that some people have very crisply and some people don't have. You can create more definition at the border. Somebody who's got lots of lines in their lips, those lips are more stretchable. If somebody has more wrinkles and lines in their lips, you can make their lips dramatically bigger, because it has room. It'll stretch. But some people come in, especially young Caucasian patients, with very smooth, thin lips. There is no room for that lip to stretch. So if you try to make it 50%, 60%, even 30% bigger, you can't do it all in one shot. It has to be done in a series, to do what's essentially a tissue expander. You're slowly, slowly, slowly expanding the lips, and those people are at much, much higher risk of this migration effect, or spillover.

The bottom lip has two tubercles, right and left, so the injection to the bottom lip is very different. You're trying to basically enhance those tubercles. I've seen some patients on social media get dental floss or strings placed between their lips. It's very gimmicky, because guess what happens afterwards when you take that string out? The filler can blend and move between those. Now, in that situation it is migration, but it's not migrating to somewhere else. It's basically sliding over. So if you use a straw, if you sit there massaging your lips, you'll see some of the filler will move over. It's here, and it can slide over across this, but it's not going to go into a whole different area. There is a plane where, as I put the needle here, the filler will fill and go across as well, and I'm actually counting on that, so I can poke her less. It's fewer injections. You can see the top lip requires more injections; the bottom lip requires fewer injections.

Now, you've seen these ultrasonic devices, people trying to map out where blood vessels are. Blood vessels are tortuous. You may see one at the surface, but they still snake and are tortuous as they go across, so those devices are not that helpful. You've seen people aspirate, pulling back every time they poke. It's not necessary if you're actually using proper technique. So never high-pressure injections. Never stay in one place and inject at high pressure. Very low pressure, and you're slightly moving it, so you're never in the same blood vessel for more than a nanosecond. As I'm putting it in, I am pushing it in, so the filler is actually pushing blood vessels out of the way, and I'm injecting going forward, going backward, so it's never staying in the same place for more than a few nanoseconds. That way you're not going to get a vascular occlusion.

Lips open. Now, here's a technique you've seen plenty of on social media, in this direction. This can definitely help tent the upper lip, creating more upper lip show. Now, this patient eats a ton of nuts and seeds and omega-3s and seaweed, so she is going to bleed more. She is going to bruise more. We have a whole list of foods and supplements that you should be avoiding about two weeks before any injections. All of the healthy Mediterranean fats, omega-3s, should be avoided, because they'll create more bruising and more bleeding.

Relax your mouth. Cool. Same thing in this direction. These are minor. You can see me injecting a million times and the plunger barely moves. So these are true micro injections. These are true nano injections. Barely anything is being put in. All the injection that I did, it's not even half a syringe yet, because what I don't want to do is put too much in one spot and then have to rub and massage and massage and massage it away. I want to make sure that micro droplets are placed in the right place.

All right. Smile for me, really big. Blow a whistle. Good. I'm checking for symmetry. I'm going to sit her up, and you can actually see the symmetry of the lips. You can see how now she has the proper outline. She has proper definition of the vermilion border. The central tubercle is fuller on the top, the lateral tubercles are fuller on the bottom, and there's perfect symmetry right there. So that is proper lip injection. Smile a little bit. She's numb, obviously, so it's a little bit weird, but that's going to wear off. There's no lumps, there's no bumps. Cool. Chin up a little bit. Perfect.