Lip Rejuvenation

As the lip ages, there are at least two separate processes that are going on. Both of these contribute to the decline in attractiveness of the lip, which is the most important cosmetic feature in the lower portion of the face. The first feature is the loss of volume of the lower lip. If you look at elderly people, it is almost as if their lips are about to disappear. The second event that occurs is the development of lines on the skin of the upper lip, as a result of folding of the skin by muscle movement. These lines are often called "smoker's lines", but these days they are generally due to movement of the lip as a result of speaking and the expression of emotion.

Replacement of lip volume has become a more rewarding task with the development of newer fillers. Collagen did quite a good job in this regard, but it only lasted about 3 months. The newer hyaluronic acid fillers last 6 or more months, and this time interval is more acceptable for most people. Furthermore we have become more skilled in the use of anesthesia, so the procedure is now associated with minimal discomfort. That being said, lip volume replacement is still very dependent upon the skill and artistic talent of the physician. There are many people walking around with bad-looking lips (think "sausage lips"). Lips should have shape but should not look unnaturally large; in filling the lips, less is frequently more.

Subdermal fillers
Before	After
Before	After

Recently we have mastered two new techniques that improve results. The first of these is the "Fern Pattern" technique, which was invented in the Netherlands and has primarily been used with Restylane. It allows the filler to be injected very superficially in the skin and this eliminates the problems with lumps. It also appears to improve the durability of the implant. We have now learned how to inject Juvéderm in a similar fashion through a very small needle, high up in the skin. Juvéderm is also a hyaluronic acid filler, but is a bit thicker and stiffer than Restylane. It is our initial impression that the Juvéderm gives even better results than the Restylane. Neither of these treatments is associated with any significant down time and we have never seen bruising occur with these very superficial injections.

The following photos show before and after photos of lip lines treated with Restylane using the Fern Pattern technique and Juvéderm using the fine needle technique. Although the upper patient has more lines, the improvement is perhaps 50%. In the lower photos, the improvement is about 80%. Either approach is a significant improvement over previously available techniques.

Restylane: Fern Pattern technique
Before	After
Juvéderm: fine needle technique
Before	After

Benefits

When done properly, lip rejuvenation can give you more attractive lips and an enhanced appearance, without making you look as if you have had a procedure performed. The desired effect is to have people tell you you look good, not to have them ask who enhanced your lips.

Alternatives

The primary fillers used are Restylane and Juvéderm. They both are hyaluronic acid fillers, but Juvéderm is a bit thicker and flows a bit more smoothly. Unfortunately Allergan, which manufactures Juvéderm, has priced it so that you only get 0.8 mL of Juvéderm for the same price as 1.0 mL of Restylane.

Repair of lip lines is a different challenge. These lines are the result of repeated folding of the skin, which is going on continuously. The definitive treatment is resurfacing of the area, but mild resurfacing is not enough. Only fairly aggressive resurfacing works, and that means the CO2 or Erbium YAG lasers, true dermabrasion, or the phenol-based peels. However, we are now able to fill the upper lip lines with Juvéderm, and significantly improve them with almost no downtime.

Lip resurfacing with Sciton Erbium YAG laser
Before	After

Safety and Side Effects

Since Restylane and Juvederm contain only minimally modified hyaluronic acid, a natural constituent of human tissues, they are biocompatible and very safe. There are no contraindications to the use of these products and those precautions are mainly those that should be observed for any intradermal injection.

Some injection-related reactions may occur, such as transient redness, swelling, pain, itching, discoloration or tenderness at the injection site. Typically resolution is spontaneous, within one to two days after injection into the skin and within a week after injection into the lips.

Recovery Time

Usually there is no recovery time with these fillers. The exception is the lips, where the swelling may be noticeable for up to one week. If there is bruising, that is usually gone within a week.

Questions and Answers

How does it work?

The fillers act by replacing lost volume and filling creases caused by repeated folding of the skin.

Who is a candidate?

Anyone with thin lips, anyone who wants fuller looking lips or is distressed by upper lip lines is a candidate.

Does it hurt?

Generally we use local anesthetic to nmb the lips before we inject filler.

Who performs the treatments?

Dr. Bock injects all fillers and Botox.

What can I expect?

You should see immediate results after the treatment. Treatment of the pink part of the lip is associated with about 5-7 days of swelling.

Before-treatment instructions:

You should tell Dr. Bock about all the medicines that you are taking. If possible avoid aspirin, blood thinners, Vitamin E and ibuprofen and related pain medications for about 10 days before the procedure.

After-treatment instructions:

If there is swelling, you can take Benadryl. If there is discomfort, you can use Advil or related products.

If you are interested in Lip Enhancement, what is the next step?

The next step is to call California Skin & Laser Center at 800-500-5842 and schedule a cosmetic consultation. At that time Dr. Bock will advise you whether you are a candidate for this procedure, and what other possibilities exist for improving your appearance.

Why should you choose to have your Lip Enhancement treatments at California Skin & Laser Center?

At California Skin & Laser Center, we want you to have an excellent outcome and to feel that your needs and concerns have been promptly addressed in a caring and sensitive fashion. We strive diligently to ensure your satisfaction, your comfort, your privacy, and your safety. All treatments are supervised or performed by a board-certified dermatologist with many years of successful experience in a large variety of cosmetic procedures. Many treatment modalities are available, and we can recommend the one or two that are most likely to meet your needs; we're here to meet your needs and help you realize your aspirations. At our clinic in Stockton, CA, we serve communities throughout San Joaquin County and the Central Valley, including Lodi, Sacramento, Tracy, Manteca, Modesto, Galt, and Valley Springs; many of our patients also come from the San Francisco Bay Area.