Beautiful Lips

Why would anybody want to enhance their lips?
Enhancing the lips and the lower face is one of the few things that can be done that has a major and significant impact on the overall look and youthful appearance of the human face. The approaches and filling agents that we have now are superior to anything that we have had in the past and, basically, a 30-minute procedure can take 10 to 20 years off the physical appearance of a face.

What causes the lips and lower face to look older?
There are multiple factors that contribute to what one would consider the aging look of the lower face. One of the natural supporting substances in the skin is hyaluronic acid. It is a sugar-based gel that naturally supports the cells in our skin, is a major component in the fluids that lubricate our joints, and is a component that gives our eyes their spherical structure. It’s a natural substance that’s already found throughout the body.
As we age, our body produces less and less hyaluronic acid, and this results in volume depletion of the human face, most notably the lower one-third of the lower face encompassing the cheeks, the area around the mouth, and lips. There are other factors that play into this including genetic factors and other exposures including sunlight and environmental toxins such as pollution and cigarette
smoke. By replacing the volume that has naturally been lost over time, a refreshed and youthful look can be created. In fact, psychologists have done studies where they show subjects pictures of the human face and the only difference is loss of volume, and it has been established that this is how humans judge the age of a person.
What is your approach to rejuvenating the lips and lower face?
The first thing I always do is make sure I am on exactly the same page as the patient. I give them a mirror and a Q-Tip, and I have them point out the areas they want improved. A common concern that patients present to my office with is that they hate the little lines around their mouth and lips. They say that their lipstick runs into the tiny creases surrounding the mouth. Oftentimes when I give them a mirror, they’ll point to these lines, but they’ll also point to the lines on the sides of their mouth, sometimes lines on their cheeks, and they also ask about increasing the volume of their lips.

I find it paramount to understand exactly what my patients’ concerns are and then discuss with them the appropriate approaches to solving their problem. So you see, restoring the natural beauty of the lips is a major component, but not necessarily the only component in giving patients the end result they desire. When you are dealing with the lower face, there are a lot of anatomic structures, nerves, blood vessels, and muscles that need to be taken into consideration when treating the area. I have spent many years in school learning the structure, function, physiology, and anatomy of the human face and I bring this knowledge and my experience to bear when I am treating my patients. In fact, when patients come to me for rejuvenating treatment involving Restylane or Botox, I am the only one in my office who performs these procedures. In this way, I can make sure the quality is consistent and that patients are receiving the highest quality treatment program.
I tend to use Restylane as a filling agent and a very minor treatment of Botox to relax the muscles around the mouth that tend to constrict over time, almost like a purse-string. Using a very small amount of Botox can relax these muscles and also improve the overall results. I will also do minor touchups for one or two months to make sure the results are maintained and are long lasting. I use special techniques that I’ve learned over time to enhance both the end result and the durability of the results that are achieved through the treatments I provide.
Additionally, some patients come in and they would like lip enhancement, but they always state, ‘I don’t want to look like one of those ladies in the movie The First Wives Club.’ I reassure them that one size does not fit all. As you will see in the case-study pictures (over page), lip rejuvenation and lower face enhancement cover a spectrum of responses. Some patients have had thin lips all their lives and they would like to have enhancement to bring their lips to normal size. I have other patients who have full lips but want them accentuated.
I have some patients who are concerned about scars and/or lip lines. These lip lines are often called ‘smoker’s lines’, but this is really misleading because many patients

w
ho have these lines have never smoked in their life.
Nevertheless, there can be a genetic predisposition to this
and their major concern is getting rid of the lines. I have
o
ther patients, who through time, have had a significant
amount of volume depletion in their lips and would like the
volume restored so their lips look like they did earlier in life.
T
hey don’t necessarily want them bigger, they just want
them to look like they did when they were younger.
One other consideration when rejuvenating the lower
f
ace and lips, is the preservation of what is known as the
‘cupid’
s bow’, or the two arches in the upper lip. There are
many dif
ferent techniques and tricks you can use to inject
b
oth the vermilion border (also knows as the wet-dry line)
and also filling within the lips. Once again, this must be
car
efully designed and executed based on the patient’s
anatomy. As you can see, everyone is unique and I tailor my
appr
oach to maximize the results for every individual patient.
Why do patients select you to rejuvenate their lips?
Patients come to me for many r
easons. First of all, I think
they can sense that my goal is to make sur
e they’re
completely satisfied with their treatment. I carefully listen to
their concer
ns, and I make the r
ecommendations that I
think would best give them the results they desire. I also
have a tremendous amount of experience. In fact, I was
the first one in Minnesota to use Restylane. W
e have also
received the Platinum Award from Restylane as the top
provider of Restylane of all physicians in Minnesota this
year
. Plus, we have also r
eceived the Gold Medal A
ward
fr
om Allergan for our extensive experience in the use of
Botox Cosmetic.
I am a Clinical Associate Pr
ofessor of Dermatology at
the University of Minnesota Medical School. I teach other
physicians and dermatology residents in training about
many cosmetic procedures including rejuvenation of the
lips and face. When other dermatologists in training and
other physicians are learning how to do these procedures,
oftentimes I am the one who is teaching them.
Finally
, many physicians themselves come to me for such
treatments. Several of the plastic surgeons in town, who do
more of the extensive major procedures, send their
spouses to me for minimally invasive pr
ocedures such as
rejuvenation of the face and lips with Restylane and Botox.
We also guarantee our treatments.
Finally, it is important I am the only one in my clinic who
does the procedures. This gives the patients the highest
quality treatment with consistent results. I have been
approached by many nurse injectors and even other physic-
ians who are not dermatology trained wanting to know if
they could work at our office performing such procedures. I
think this is a disservice to my patients. Once again, I have
years of experience in the structure, function, and physiol-
ogy of the skin, and I think performing these procedures on
someone’s face with lesser training is not giving patients the
quality results they both expect and deserve.
What agents do you use to make the lips fuller
and rejuvenate the lower face?
I use a combination of treatments including Botox and Restylane. Restylane, once again, is a sugar-based hyaluronic acid that is naturally found in our bodies. I prefer the synthetic brand called Restylane. Perlane is a heavier weight hyaluronic acid made by the manufacturers of Restylane but, unfortunately, it is not FDA approved for use in the US. Fortunately, Restylane still does a fantastic job.
How long does it take to administer treatment and how long do the results last?
I initially like to have a consultation with the patient so we can make sure their expectations are realistic and the results that we can provide for patients will meet their satisfaction. Generally speaking, most treatments take anywhere from 30 to 60 minutes. Touch-up treatments, which may occur anywhere from one to 12 months, usually only take about 20 minutes. The results of Restylane are dependent on location but, in general, the results can last anywhere from six to 12 months. I also find that whenever I do a touch-up treatment, I rarely have to use more than half of the volume that I used during the initial treatment. It seems like the product really forms a good solid foundation or base, and touch-ups involve just a slight amount to restore the area back to the way it looked after the initial treatment.
Are the treatments uncomfortable?
Any time you perform a needle injection there is a small amount of discomfort involved. The lips tend to be one of the most sensitive areas of the body so I almost always perform regional anesthesia similar to a dentist. This makes the procedure almost entirely painless. I have had patients who were not offered regional anesthesia at other offices and they were so grateful for our approach because it eliminates the discomfort associated with the
injection filling agent.
Are there any side effects of the procedures?
When you interrupt the integrity of the skin, you always run a small risk of infection. Usually with Botox and Restylane injections one may see some redness and swelling, and even bruising that is transient. This usually can last anywhere from a few hours to a couple of days.
There also might be some short-term swelling in the lips that usually resolves in 48 hours.
Sometimes because of the nature of the injection and the structure of the skin, you can actually feel tiny bumps of the material, but these can be easily smoothed out.
Once again, I tell my patients the goal is what it looks like, not necessarily what it feels like. No matter what the side effect results are, I tell patients to make the final evaluation at day 21. I have never had a patient who was not happy or thrilled with the results at day 21.
What do such procedures cost?
This answer really depends on the areas to be treated and how extensive the areas are that need treatment. On average, the cost is around $695, but there is a wide range and this is covered in a consultation.
Do you have any final comments concerning lip and facial rejuvenation?
There are many reasons and many approaches to rejuvenate the lower face, including the lips. If you take a look at the five case studies here, this is illustrated quite nicely. It is crucial for readers to know that the most important aspect of having any cosmetic procedure done is the skill of the person administering the procedure. Make sure you feel comfortable with the physician and ensure they are board certified in dermatology, plastic surgery, or ENT. Also make sure that you see before-and-after pictures of patients they have treated. This is very, very important as it also will demonstrate their level of experience in addition to the type of outcomes that they have.
There is also an exceptional list of questions you should ask your doctor before having any cosmetic procedure performed. This list can be viewed at www.SafeRestylane.com. Finally, I always tell patients that the price should only be one of many considerations. I often explain to patients firstly that quality matters, secondly that experience counts, and thirdly that the bitterness of poor quality lasts much longer than the sweetness of low price.