Alice Henshaw owner of Harley Street Injectables (one of London’s top dermatology cosmetic clinics) and skin care brand ‘Skincycles,’ shares her top filler tips for creating a flawless, natural lip and best practice when it comes to managing patient expectations.
Make the lips suit the patient’s face and their life.
Ensure you have adequate consultation time, discover the patient’s history of treatments and study the patient’s current condition. The patient and the injector must have exactly the same goals. Some people’s “natural” is another person’s “extreme”. Looking at photos together is useful to work out the look that the patient is after.
Be careful with the dose.
We tend to limit patients to 1ml or less per treatment to the lips. More than this and side effects go up, for example more swelling. Also as recovery time may increase so does the chance of complications during recovery. Symmetry is an important risk. When injecting too large an amount, asymmetrical issues are more common in the lips. Precision can be better achieved by a lower volume but a multiple treatment series of injections.
Keep the proportion of upper lip to lower lip within the realms of nature.
Phi is what is classically thought of as the ideal upper to lower lip proportion. ie 1:1.618 upper to lower lip. When I picture the look that I personally like, I think about it as 40% upper and 60% lower. This can be discussed with the patient to see what they like.
Always watch the profile.
Not many people like the look of an overly projected upper lip, so keep it in the correct relationship with the lower lip and nose and chin in terms of projection.
Lumpiness of lips is a fact of life with lip fillers and happens often in the first couple of weeks after treatment. It should resolve. If it doesn’t, make sure this is addressed. I prefer the manual method of massage or removal rather than the riskier hyalase injections where possible.
Don’t overfill the borders.
Saying this, I personally love injecting the border, because nothing else can achieve as good a lift. But be careful of too much of a good thing!
Don’t forget the surrounding areas.
The chin and marionettes and nasolabial folds can look more obvious when the lips become more projected, so address these when it is needed. The cutaneous lip and the oral commissures may also need to be addressed.
Consider the anti-ageing aspects of treatment.
Assess what needs to be done from an anti-ageing point of view as well as from a straight “beauty” perspective. We are making lips beautiful, but in this we need to also consider making them appear less sad and down-going at the corners, and we need to address the smokers lines in the lip border and the cutaneous lips. The oral commissures may need to be lifted and the marionettes may need to be supported.
Symmetry with lips is interesting and on occasions can be quite difficult. Often patients want to correct a muscle issue causing the asymmetry with filler, which is not ideal. Review the symmetry issue and diagnose the correct cause and discuss this with the patient, and set expectations correctly.
Make sure the treatment downtime fits into the patient’s life.
This is an important one. I have some patients who inject their lips with 0.2mls per treatment, regularly. No one in their life knows they have it done, they never have noticeable swelling because we use such small amounts. Patients like this are great as long as they are patient and their expectations are set correctly. The reverse are the patients who want to achieve their end result as quickly as possible. With these patients you just need to go to the other end of the treatment spectrum and give them a plan on how to do this – for example, 1ml every month until they are satisfied with the size.
Last and most important of all: safety.
You must know your anatomy and risk minimisation techniques. The risks of occlusion and infection are real. The patient must be aware of these risks and accept them, and the injector must have continuing medical education and safety protocols so that they can reduce the risks. The amount of times I have heard of clinics “not having hyalase available” is upsetting. No injections should be performed without plans for what to do when complications occur.