How Do You Balance a Thin Top Lip with Filler?

Hi, good morning. I'm going to demonstrate something about lip imbalance, with an attractive young woman here. She's here to get lip injections. When I evaluate her, she has a beautiful bottom lip, so it's about balance. Some people like the bottom lip fuller, and some people like the top lip to be fuller. I personally like them to be almost the same size, but other things, age, sex, a lot of things come into play. A little bit of an imbalance is okay, but in her situation, the top lip definitely could use more volume, and that's what we're going to do.

We're using Restylane for her top lip. We could use Juvederm or Volbella, but Restylane gives you the biggest bang for the buck. It's 0.5 cc, and I think it gives the best shape. Volbella is a little bit too soft in this situation, and Juvederm Ultra comes in 0.4 cc, so I wouldn't have as much material as I need. So I'm going to demonstrate the technique here with Restylane.

She has had topical numbing placed. There's no dental block. It's very tolerable. It's not pain-free, but it's very tolerable. If you go in really slowly, it hurts less. When you jab and stab, that's when it hurts more. Just watch how slowly the needle goes through. Taking my time. There's no pressure. Pressure sets off certain nerve endings. The nerve endings that pick up sharp are different from the nerve endings that pick up pressure, and you don't want to set both off. Now, Restylane does have 0.3% lidocaine in it, so as we go through, it gets more and more comfortable. But again, you see the technique. If you're gentle, you get less bleeding, less swelling, less bruising.

I'm watching it take shape right in front of my eyes, watching the filler go. The central part of her top lip is fuller, so I'm not going to do much there. You don't want to inject everything uniformly, because then it's going to look like a uniform sausage. We don't want that.

Ten, fifteen years ago, you'd see dental blocks numbing people's entire midface. In the last five to seven years, I can't remember how many dental blocks I've done. Maybe just a handful. It's not necessary with good topical numbing and good technique. It's very tolerable. People come in and say they had injections and it was brutal, so much pain. Well, either no topical numbing was used, or it was a jab-and-stab technique. This patient has driven from quite far away to come here.

Put your lips together. More balanced. We're going to do a little bit more in this zone, going in a different direction. She does have a good vermilion border, so I don't need to do much there.

My massage for lips is this. That's it. When I do this, it smooths everything out. I've heard from patients who've gone somewhere for injections, and then the doctor spent quite a bit of time just wrestling the lips, massaging and massaging and massaging. That's not necessary if you do the micro droplets. You put tiny, tiny, tiny little droplets in different places. The beauty of that is you don't feel lumps and bumps, and the other beauty is it lasts longer, because the Restylane goes into different levels.

Put your lips together. More balanced. Smile really big. Now whistle. Very symmetric. You can see it was 0.5 cc, and I don't know if anybody's keeping count of how many times I poked, but that's a true micro droplet. Very little bleeding, no bruises. I tell my patients, don't go to lunch, because your lip is numb and you're going to drool all over yourself. But you can go out tomorrow morning. It's a little bit more swollen.

There's a tiny little bleeder, like that. No big deal. Just a little pressure, and that stops. Those are tiny little capillaries. Now, when you hold pressure, I've seen people dab and dab and dab. You've got to hold pressure. Hold pressure for 15 to 20 seconds, and it'll stop the bleeding. Things that make you bleed and bruise more: nuts, walnuts and almonds; seeds, flax seeds and chia seeds, sesame seeds; fish, fish oil, avocados, even vitamin D that's fish-based, which has a lot of omega-3s. With those patients, you'll see you have to hold pressure for 45 seconds. Normally, bleeding time is about 25 seconds. Somebody should stop bleeding in 25 seconds. But people who eat a very healthy diet, you'll see, they bleed more. Just hold more pressure, and that's essentially it. Every bleeder stops. Now we're done. So that's basically the micro droplet technique for the top lip. Thank you.