Lip enhancement vs. lip rejuvenation

Lip enhancement with dermal filler is one of the most frequently requested non-surgical cosmetic procedures in the world. According to research conducted by Allergan Aesthetics, over 40% of surveyed Australian women would consider treatment for thin lips. Patients from multiple age groups have an interest in lip filler treatments, although their individual aesthetic goals can differ greatly. Using injectable fillers, different techniques can be implemented to address either the youthful or more mature lip.

Every lip is unique (and beautiful)

Our lips are unique. So unique in fact, that our lip prints can be relied upon for identification in forensic science. Did you know that the pattern of wrinkles on the lips has individual characteristics like fingerprints, which can be used to identify humans based on lip traces? Google ‘cheiloscopy’ to learn more.

The uniqueness of our lips also extends to our lip shape and size. Full lips, thin lips, wide lips, narrow lips, heavy upper lips, heavy lower lips, heart shaped lips, downward-turned lips… Despite what your Dolly and Cosmo magazines told you growing up, your lip shape has nothing to do with your personality, or what type of kisser you are. However, the lips are an essential component of the symmetry and aesthetics of the face. Our lips also play an important role in facial expression, speech, sensation, chewing, physical attraction and intimacy.

There have been multiple attempts to define the ‘perfect’ lip shape and size. One of the hallmarks of beauty and a youthful appearance is a voluminous, elegantly shaped lip. The ideal lip ratio has been described by using the golden ratio of 1:1.618 for the upper and lower lip.

However, the ‘ideal lip’ is not this simple. Cultural and ethnic backgrounds can also impact individual lip shape preferences. A study evaluating perception of lip attractiveness across different cultures showed that people in Latin America liked large lips, North Americans and Europeans preferred large lips less, and those living in Asia preferred smaller lips.

It is your cosmetic injector’s role to guide you towards an aesthetic outcome that complements your natural lip shape and surrounding features. Unfortunately, everyone has a different idea of what is beautiful and natural looking- including the health care practitioners who provide these treatments. I am relieved to see a trend back towards more conservative lip filler treatments. However, there is still a long way to go before we stop seeing patient’s lips walk into rooms before they do.

Lip assessment: considerations for treatment

In addition to the recommended lip ratios and what is perceived culturally as ‘beautiful’, your individual aesthetic goals are equally as important. Other considerations I have when selecting an appropriate dermal filler and technique for your lips include:

• Your age/gender/ethnicity

• Your individual lip shape and size

• Your facial shape and size

• The projection of your chin and nose

• How your lips change when you smile, talk, kiss etc.

• Whether a lip filler treatment will positively influence your facial harmony, in comparison to your facial features

Although lip filler is a popular treatment to enhance your natural beauty and address the visible signs of ageing, it should be thought of as the ‘cherry on top’ in your treatment plan. Sometimes, if I don’t believe a lip filler treatment will improve your facial appearance, I may refuse to treat you, or recommend that you have an alternate treatment to balance your surrounding facial features before proceeding with lip filler (such as a chin filler treatment). If I refuse to treat you, please know that this is in your best interest. I am always happy to discuss other cosmetic or skin treatments with you if I believe this is appropriate. However, sometimes no treatment is the best treatment.

What can be achieved with lip filler?

My patients often find it difficult to put their lip aesthetic goals into words. This is because they are not familiar with the correct anatomical terms for each area of the lip, or what is considered ‘normal’ in each anatomical area. An example of this is when I am asked to make “my top lip the same size as my bottom lip”. For a Caucasian patient, this could result in a less than ideal aesthetic outcome. Generally speaking, your top lip should be more projected than your lower lip, but your lower lip should be fuller than your top lip. A more appropriate request might be “I would like to define my cupid’s bow” or “I would like to increase my lip volume and balance my lip proportions”.

I hope that by educating you on the correct anatomical terms for each area of the lip, you feel more empowered to articulate your aesthetic goals to your injector and engage with your treatment plan on a deeper level. This also makes it easier for me as an injector to establish whether or not your goals are realistic. As much as I’ll always do my best to help you achieve your aesthetic goals, there may be limitations in what can be achieved, depending on your natural lip shape and volume. The result also needs to be age-appropriate.

01. Increase lip volume

The lip vermilion is the visible red part of the lip. It consists of both an outer dry and inner wet portion, separated by a noticeable border. As the lips lose volume, the lip vermilion becomes less defined and assumes a deflated appearance, with lines appearing in the red portion of the lip.

Dermal filler can improve the volume and definition of the lip vermilion and reduce the appearance of lines in this area. Increasing lip fullness can improve lip show when smiling and balance volume between the upper and lower lips, and symmetry between left and right.

02. Define cupid’s bow

A key feature of the upper lip is the cupid’s bow, which is formed by two peaks of the vermilion and a central V-shaped depression. The cupid’s bow is also known as the ‘GK point’.

Prominence of the cupid's bow can vary greatly between patients depending on their natural lip shape. With age, the cupid’s bow widens and loses definition.

Dermal filler can improve the shape and definition of the cupid's bow.

03. Restore vermilion border

The vermilion border outlines the lip and defines the shape of the lip. It’s junction with the above cutaneous lip is known as the ’white roll’.

Throughout the ageing process, the border of the vermilion becomes less visible. Mature patients may find it more difficult to apply lipstick, as the lack of definition in this area causes the lipstick to 'bleed' into the surrounding areas.

Small amounts of dermal filler can restore the vermilion border and indirectly improve perioral lines.

04. Enhance lip tubercles

The lip tubercles are the natural ‘pillows’ of the lips. These are projected areas found in both the upper and lower lip.

It is considered aesthetically pleasing to have a central tubercle in the upper lip, and two evenly spaced tubercles in the lower lip.

Subtle dermal filler can enhance the lip tubercles by providing projection and fullness to these areas. This can help to achieve a more feminine lip shape.

05. Upturn oral commissures

Oral commissures are the areas at the corners of the mouth where the upper and lower lips meet. The oral commissures turn downward throughout the ageing process, creating prominent marionette lines.

It is important to note that there are many contributing factors to downward-turned mouth corners, including increased strength of muscles in the lower face and volume loss in the midface and lower face. For an optimal treatment outcome, a combination of dermal filler and anti-wrinkle injections may be required to lift and correct downward-turned oral commissures.

06. Reshape philtral columns

The philtral columns are found in the cutaneous lip, where there are two angled columns with a central area of depression. The philtral columns tend to flatten with ageing.

Reshaping of the philtral columns can be achieved with small amounts of dermal filler. This also helps to further define the cupid’s bow.

Some patients may not be suitable for treatment of the philtral columns, including those who have an elongated cutaneous lip area.

07. Soften perioral lines and smooth surroundings

The perioral area between the nose and upper lip is also known as the ‘cutaneous lip’.

Women of mature age generally have thinner soft tissue in the cutaneous lip area compared to men. Throughout the ageing process, volume loss, sun exposure and repeated use of the orbicularis oris muscle over time contribute to vertical perioral lines (or ‘smoker’s lines’, although you don’t have to be a smoker to experience them).

Dermal filler can be placed in the skin and soft tissue layers to soften perioral lines and smooth lip surrounds. Anti-wrinkle medication can also be useful to relax the orbicularis oris muscle.

Lip enhancement vs. lip rejuvenation with dermal filler

Lips are a central part of facial aesthetics due to their colour, surface texture and shape. During social interactions, our focus is often drawn to the lips and the eyes. It is my job to make sure the focus is drawn to the lips for the right reasons. Despite being one of the first dermal filler treatment areas an injector learns, the lips are actually a technically challenging area to treat and get right. A small ‘top up’ to the lips can be all it takes to disrupt the harmony and balance of your face.

A successful lip filler treatment will leave people thinking wow, she has beautiful lips, I wonder if she has had any treatment; rather than making it difficult for them to focus on anything other than the lips, because they look so obviously ‘done’. Working with your natural lip shape and selecting an appropriate dermal filler and technique is important for a natural outcome. Knowing when to stop injecting is perhaps the greatest skill of all.

Enhancement of the youthful lip

Image credit: Rohrich & Pessa 2009

In most cases, younger patients desire more lip fullness and tend to focus on lip shape and size, with less focus on the surrounding perioral area. According to research conducted by Allergan Aesthetics, increasing lip volume is highly important to 47% of Australian women surveyed. Lip filler treatment plans should always be individualised. However, typically a lip enhancement for a younger patient will involve increasing lip volume, defining the cupid’s bow and enhancing the lip tubercles. Some patients may also require treatment to the oral commissures and philtral columns for an optimal outcome.

It is often assumed that patients with naturally thin lips require more dermal filler than patients with naturally full lips. However, in my experience the opposite can actually be true. Patients with extremely thin lips have very little subcutaneous tissue and less ‘give’ or potential space to accommodate filler. This makes expanding their lip size challenging, as their lips can only ‘handle’ small amounts of dermal filler at a time. For these patients, a very subtle lip enhancement may be more realistic and natural-looking. This can be achieved by adding small amounts of dermal filler over multiple sessions, spaced at least four weeks apart.

Patients with naturally full lips may also seek a lip enhancement to balance volume and symmetry and enhance their natural lip shape. In contrast, small amounts of dermal filler may not go as far as it would in a thinner lip, as there is a larger surface area to cover. Therefore, a patient with fuller lips might need more dermal filler in a single treatment to expand their lip size, but they are less likely to require subsequent treatments to achieve their desired outcome, as their lips can ‘handle’ the desired amount at an earlier stage.

Rejuvenation of the mature lip

Image credit: Rohrich & Pessa 2009

According to research conducted by Allergan Aesthetics, lip thinning is a top concern for Australian women. As the lips mature, they lose volume and appear deflated, with less definition and shape. Loss of support from age-related changes to the underlying structures of the perioral area contributes to flattening and lengthening of the upper lip and the development of perioral lines. Other noticeable signs of ageing include drooping of the oral commissures (mouth corners) and the formation of marionette lines. Lastly, a decrease in the production of collagen and elastin in the skin leads to fine lines, hyperpigmentation and skin laxity in the perioral area.

Loss of volume is one of the most significant age-related changes, and fortunately, one of the easiest to address with injectable fillers. Patients with mature lips tend to be much more averse to an unnatural outcome and can be apprehensive about adding dermal filler to the lips. They often prefer a subtle treatment outcome, with more attention to the wrinkles and volume loss in the surrounding perioral area.

The focus of treating a mature lip shifts from one of enhancement, to one of rejuvenation. I will often need to address more areas of the lip compared to when I treat a younger lip, as there is a degree of ‘rebuilding’ that needs to occur. The goal isn’t to give you back the lips you had 20 years ago, and neither is this possible. However, treating the age-related changes that occur in both the lip and surrounding perioral area will ensure a balanced and natural outcome.

When treating a mature lip, I tend to focus on addressing lip volume and structure (including treatment of the lip vermilion, cupid’s bow, vermilion border and lip tubercles) and softening lines and wrinkles in the perioral area. I am likely to use more dermal filler for a mature lip rejuvenation compared to a younger lip enhancement. However, I may use less filler in the lips themselves and more filler in the surrounding areas (such as the chin, nasolabial folds and perioral area) to ensure a subtle and balanced outcome. In addition to using a volumising dermal filler, some patients may also need skin-boosting dermal fillers or bio-remodelling injections to address skin dehydration and fine lines in the perioral area. Additionally, some patients may require small amounts of anti-wrinkle medication to reduce the strength of lower face muscles such as the orbicularis oris (contributes to perioral lines) and depressor anguli oris (contributes to downward-turned mouth corners).

*Even after a perfectly executed lip enhancement/rejuvenation treatment with dermal filler, it is common for the lips to appear swollen, bruised and slightly uneven immediately following treatment. They may appear larger than the desired size for the next few days. Although most swelling subsides within one week, it can take up to 2-4 weeks for the filler to fully integrate with the surrounding tissue. Therefore, I recommend planning your lip filler treatment at least four weeks ahead of any important events (and for weddings, at least six weeks in advance).

Lip filler case study

Age: 26

Concerns: desiring improvement in lip fullness and shape

Treatment goals: enhance my natural beauty

Treatment details: lip filler injections to increase lip volume, define cupid’s bow, enhance lip tubercles and upturn oral commissures

Treatment by Cosmetic Nurse Elysia.

What is the difference between lip filler and a lip eversion (lip flip) treatment?

I’m going to answer this question in advance, as it is frequently asked during Butter consultations. The truth is, both treatments may play a role in helping you achieve your lip goals. In my opinion, lip filler is more likely to provide you with treatment satisfaction. Here’s why:

Lip eversion treatment with anti-wrinkle medication (lip flip)

The orbicularis oris is a complex muscle which encircles both the red vermilion lip and the cutaneous upper lip area. This muscle controls the shape and movement of the lips. A lip eversion treatment (commonly known as a ‘lip flip’) involves injection of anti-wrinkle medication into the upper part of the orbicularis oris muscle, just above the vermilion border. This treatment does not add volume to the lips. However, relaxing this muscle slightly rolls or ‘flips’ the upper lip outward. This results in the appearance of a fuller upper lip and a more prominent cupid’s bow.

Pros: This is a subtle, affordable treatment with very minimal downtime. It is a great option for patients who are looking for a minimal change or those who lose a lot of upper lip show when they smile. It can also help to improve the appearance of a gummy smile.

Cons: Some patients are not appropriate for this treatment, due to the way their muscle contracts. It takes up to two weeks to see the full treatment result. The result is unlikely to last beyond 6-12 weeks, due to the low dosage of anti-wrinkle medication used in this area. It is not possible to use a higher dose to ensure it lasts as long as your upper face anti-wrinkle injections. This is because the orbicularis oris muscle plays an essential role in speech, facial expression, swallowing, chewing and sucking. A dose that is too high will prevent normal function of the lip, resulting in an unnatural appearance and a reduction in your ability to suck on a straw, pout your lips or eat normally. Even when the function of the upper lip remains normal following this treatment, some patients still report the area feeling a bit ‘strange’. Therefore, it is not for everyone. However, a small dose can be trialled to assess whether the aesthetic outcome outweighs any potential side effects, knowing that if you don’t like it, the result is temporary and does not last very long.

Lip filler

Lip filler is an effective treatment to temporarily add volume to the lips. Volumisation may be sought to enhance your existing lip shape or replace volume lost throughout the ageing process.

Pros: You can achieve more with lip filler compared to a lip eversion (lip flip) treatment. This includes increasing lip volume, improving lip shape, balancing lip proportions and smoothing the surrounding perioral area. Although there is more downtime for a lip filler treatment, the result will last much longer than a lip eversion (lip flip) treatment. This means you will not need to come back for retreatment as often. Lip filler treatments last from 6-18 months, depending on the dermal filler used. Lip filler treatments also provide hydration to the lips.

Cons: Initially, you may experience more swelling, redness, pain and bruising, as there are more injections involved in this treatment. This means you need to allow for more downtime following a lip filler treatment, compared to a lip eversion (lip flip) treatment. Most swelling tends to settle within one week, with the treatment taking 2-4 weeks to fully settle. There are some additional risks to be aware of for this treatment such as the possibility of nodules (small firm lumps) and vascular occlusion. Although extremely rare, these risks need to be carefully discussed and considered during your consultation. I am fully trained in responding to these adverse events and I have policies and procedures in place if they occur.

*It is possible to use prescription strength numbing cream for both lip filler and lip eversion (lip flip) treatments. Every patient is unique and requires an individual treatment plan.

Why I don’t offer 0.5ml lip filler pricing at Butter

Another question I am asked quite frequently: “How much for 0.5ml lip filler?”. The lip filler pricing at Butter Cosmetic + Skin Clinic Hobart is based on the aesthetic outcome I provide and the type of dermal filler I use. Most dermal fillers only come in 1ml syringes, so clinics who offer 0.5ml pricing actually use one syringe across two patients. While they may decant the filler into different syringes, this is considered an ‘off label’ use of dermal filler and something that doesn’t sit right with me. You can be confident at Butter that each syringe used for a dermal filler lip treatment is opened for you and you only, at the time of treatment. Do I always use the full syringe in a lip filler treatment? No. I will use the amount that is appropriate for your individual aesthetic goals and what your lip is capable of ‘handling’ in a single treatment. Any remaining leftover product from the treatment will be discarded. Occasionally, if the type of dermal filler I am using is appropriate, I may use some of the remaining product in surrounding areas such as the chin to support the lower lips.

So, rather than thinking about the value of your lip filler treatment like this:

Lip filler price = x ml

Think about it like this:

Lip filler price

= The right amount of product to meet my aesthetic goals

= My injector’s experience and training, which helps me to achieve a safe and natural outcome

= The time my injector spends on my lip filler treatment

= Covers the costs my injector incurs to complete my lip filler treatment

= Covers the risk my injector takes on to complete my lip filler treatment

These variables do not change, regardless of whether 0.5ml or more of lip filler is being used.

Lip filler prices at Butter Cosmetic + Skin Clinic Hobart range from $500-$650. Patients requiring significant perioral support may need additional treatment which can exceed this cost. For an accurate lip filler price, please book a Butter Consultation.

Lip filler dissolving

No amount of dermal filler or the right technique will fix lumps, significant asymmetries or migrated product caused by previous lip filler treatments. It is best to dissolve your current lip filler and start from scratch if this is the case. This will save you from spending more money and needing to dissolve it anyway down the track. It is my preference that you return to your original cosmetic injector to dissolve previous dermal filler. When this is not possible, I am happy to assess your suitability for a dissolving treatment on a case-by-case basis. Please book a Butter Consultation to discuss dissolving your lip filler.

At Butter, I only use reversible dermal fillers. This means I can dissolve the treatment with a naturally occurring enzyme that breaks down the filler if required. This would be indicated in the unlikely event of a complication, or for cosmetic reasons.

How to prepare for your lip filler appointment

To reduce your risk of complications, please:

• Do not seek any cosmetic injectable treatments in the same treatment area in the four weeks prior to your appointment

• Do not book any vaccinations or dental appointments in the two weeks prior to/following your appointment

• Ensure you have no overseas travel booked in the two weeks following your procedure

• Avoid drinking alcohol or taking medications that increase your risk of bruising for at least 24-48 hours prior to your appointment (such as aspirin, ibuprofen, fish oil, vitamin E) unless prescribed for a medical reason

• Complete your medical questionnaire form prior to arriving to the clinic (this will be sent to you via SMS)

• Contact me ASAP if you become unwell before your appointment, or develop an active infection or cold sore

• Come to your appointment with your hair tied back, wearing no makeup. All makeup will be removed before your treatment

• Come to your appointment prepared to discuss your medical history, a list of your current medications (including dosage/frequency taken), your allergies, any skin conditions and information about previous cosmetic treatments/planned cosmetic treatments

• Practice hand hygiene upon arrival to the clinic and avoid touching your face

Lip filler appointments at Butter Cosmetic and Skin Clinic Hobart

Stage 01. The Butter Consult Room

• Clinical photographs taken

• Discussion about your lip goals

• Assessment of your lips and surrounding features

• An individualised treatment plan is formed

• Medical consultation with myself and my prescribing doctor. Treatment plan is approved, consent forms completed and treatment quote provided

Stage 02. The Butter Treatment Room

• Thorough cleansing of the treatment area

• Prescription strength numbing cream applied. There is also prescription numbing inside the dermal filler I use. Some of my patients hug our Hommey cushion for extra comfort!

• Dermal filler treatment performed by myself

• Plenty of checking in with a mirror throughout your treatment to ensure I’m meeting your lip goals

• Antiseptic cream applied and gentle massage performed to ensure a smooth result

• Treatment details, aftercare advice and emergency contact details provided. Four week follow up appointment booked

• After clinical photographs taken

I allow plenty of time for you to take breaks throughout the treatment if you need them. However, most patients only experience mild discomfort throughout a lip filler procedure.

I recommend asking these questions when discussing lip filler with your injector:

• Am I an appropriate candidate for lip filler?

• What other treatments would you recommend to help me achieve my lip goals?

• Why are you choosing this dermal filler product?

• Which technique will you be using on my lips?

• Have you been trained to use this technique safely?

• Can you show me some examples of patients you have treated with a similar lip shape?

• How many treatments will I require to meet my lip goals?

• How much should I budget for my lip filler treatment?

• Would you recommend any other cosmetic treatments to ensure my facial appearance remains balanced?

• What are the risks I need to be aware of regarding a lip filler treatment?

• How can I prepare for my lip filler appointment?

• Can you explain the aftercare advice I will need to follow post treatment?

• How can I contact you if I experience a complication?

Ready to book your lip filler treatment at Butter?

Still have a question about about lip filler?

Key topics

Lip Filler | Lip Fillers | Lip Injections | Lip Flip | Lip Filler Before and After | Lip Enhancement | Lip Rejuvenation | Lip Filler Hobart | Lip Filler Cost | Dermal Filler Hobart | Cosmetic Injectables Hobart

References

Allergan market research, 2,000 Australian women surveyed in 2018, aged 18-65 years

Allergan market research, 2,008 Australian women surveyed in 2016, aged 20-49 years

Dineshshankar J, Ganapathi N, Yoithapprabhunath TR, Maheswaran T, Kumar MS, Aravindhan R. Lip prints: Role in forensic odontology. J Pharm Bioallied Sci. 2013 Jun;5(Suppl 1):S95-7. doi: 10.4103/0975-7406.113305. PMID: 23946586; PMCID: PMC3722715.

Greene RM. Comparing the Use of Injectable Fillers for the Youthful Lip and the More Mature Lip. Facial Plast Surg. 2019 Apr;35(2):134-139. doi: 10.1055/s-0039-1681083. Epub 2019 Apr 3. PMID: 30943557.

Harris S, Alfertshofer M, Allen R, Castellari F, Othoro D, Bran G, Cotofana S. Introduction of the Lip Classification of Tubercles: A Novel Approach to Minimally Invasive Aesthetic Lip Treatments. Aesthet Surg J Open Forum. 2023 Mar 15;5:ojad007. doi: 10.1093/asjof/ojad007. PMID: 36937993; PMCID: PMC10016322.

Heidekrueger PI, Szpalski C, Weichman K, Juran S, Ng R, Claussen C, Ninkovic M, Broer PN. Lip Attractiveness: A Cross-Cultural Analysis. Aesthet Surg J. 2017 Jul 1;37(7):828-836. doi: 10.1093/asj/sjw168. PMID: 27677824.

Iblher N, Stark GB, Penna V. The aging perioral region -- Do we really know what is happening? J Nutr Health Aging. 2012;16(6):581-5. doi: 10.1007/s12603-012-0063-7. PMID: 22660001.

Kar M, Muluk NB, Bafaqeeh SA, Cingi C. Is it possible to define the ideal lips? Acta Otorhinolaryngol Ital. 2018 Feb;38(1):67-72. doi: 10.14639/0392-100X-1511. PMID: 29756617; PMCID: PMC5952987.

Ramaut L, Tonnard P, Verpaele A, Verstraete K, Blondeel P. Aging of the Upper Lip: Part I: A Retrospective Analysis of Metric Changes in Soft Tissue on Magnetic Resonance Imaging. Plast Reconstr Surg. 2019 Feb;143(2):440-446. doi: 10.1097/PRS.0000000000005190. PMID: 30688885.

Rohrich RJ, Pessa JE. The anatomy and clinical implications of perioral submuscular fat. Plast Reconstr Surg. 2009 Jul;124(1):266-271. doi: 10.1097/PRS.0b013e3181811e2e. PMID: 19568090.

Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The Facial Aging Process From the "Inside Out". Aesthet Surg J. 2021 Sep 14;41(10):1107-1119. doi: 10.1093/asj/sjaa339. PMID: 33325497; PMCID: PMC8438644.

Wollina U. Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures. Clin Interv Aging. 2013;8:1149-55. doi: 10.2147/CIA.S48102. Epub 2013 Sep 2. PMID: 24039412; PMCID: PMC3770626.

Elysia Hodge
Cosmetic Nurse + Founder
Butter Cosmetic + Skin Clinic