Lip Anatomy and Lip Filler Injections
When a facial cosmetic surgeon or other highly-trained injector looks at your lips, they don’t just notice if your lips are big or small, plump or thin: they observe the lips’ detailed underlying anatomy as well as your lips’ muscular movements, and how they interact with your surrounding tissues.
The best injectors translate this anatomical knowledge into where and how much to inject your lips to achieve your goals. This scientific view is critical to achieving a natural-looking outcome with dermal fillers—understanding the nuances of lip anatomy helps to avoid an over-filled or “duck lip” appearance and other obvious signs of filler treatment.
Below, we explain how board-certified facial plastic surgeons use the “architecture” of the lips to achieve customized, natural-looking lip augmentation with injectables.
What are lip fillers?
Dermal fillers are gel-like substances that are FDA-approved for injection beneath the skin, and a select group of these fillers, which have the appropriate level of flexibility for the dynamic mouth area, are used to augment the lips. Lip fillers are in the same class of dermal fillers that is used to restore lost skin volume and treat other signs of aging. Board certified facial cosmetic surgeons and other qualified medical injectors can use these dermal filler products to help you achieve a more plump, defined, or symmetrical lip appearance.
Hyaluronic acid (HA) fillers are commonly used to enhance lips; many patients are glad to learn that hyaluronic acid is a natural, supportive substance that is already present in the body. HA filler formulas bind to water, improving not just the volume of the lips but also their hydration. Lip filler results can last between 6 and 18 months; fillers tend to dissolve more quickly in the lips.
Hyaluronic acid-based dermal filler formulas used in the lips include (but are not limited to):
- Juvéderm®, Juvéderm Volbella, Juvéderm Ultra, Juvéderm Ultra Plus
- Restylane®, Restylane Kysse, Restylane Silk
- Revanesse® Versa, Revanesse® Lips
- Belotero Balance® (with or without lidocaine)
- RHA® 2, RHA 3, and RHA Redensity™
What are the elements of lip architecture?
Analyzing your lips’ architecture is a critical first step in lip augmentation with fillers. These anatomical aspects of your lips will influence where and how filler can be injected to achieve a result that is natural-looking and aesthetically pleasing. You can think of these as our guide to achieving “your lips, but better.”
- Upper lip (above the lips) — The area between the nose and lips
- Philtrum columns — Two parallel columns that connect the top lip to the nose area
- Cupid’s bow — The horizontal bow shape at the center of the upper lip, which may be more pronounced in some patients
- Vermilion lip — The visibly pigmented lip surface
- Vermilion border — The red margin of the lip
- Wet-dry border — The border between your lips and the inside of your mouth; this divides dry lips from moist inner lip tissues
- Oral commissure — The corners of the lips, which may sink and create a sad appearance
Who can benefit from lip augmentation with filler?
Individuals seek lip augmentation with filler for a number of reasons, including:
- They desire a more voluminous version of their natural lips as an enhancement
- They have lips that are genetically small, asymmetrical, or ill-defined
- They wish to address the effects of aging on the lips
How an experienced injector uses lip anatomy
Depending on your existing lip volume and goals, here are some of the areas where we may inject:
Increase the overall volume of the red/vermilion lip
In the classic lip augmentation technique, your injector places filler through the red/vermilion lip area to create an overall augmented appearance. Unless they are correcting asymmetries, expert injectors aim to maintain your natural lip shape—your cupid’s bow and your lips’ unique dips and curves—while creating a uniformly augmented appearance.
This requires precisely moving the needle or cannula to evenly deposit the filler product. (Poor injection results, like duck lips or lumps after injection, are common when an injector is inexperienced with how to choose, customize, and implement appropriate techniques.)
Expert injectors aim to maintain your natural lip shape while creating a uniformly augmented appearance.
For a typical lip augmentation with filler, your injector will aim for the vertical proportions of your upper lip to be about one-third less than the lower lip. If you prefer a different proportionality or aesthetic, work carefully with your injector to define your goals, using “wish pics” (including photos of previous patients with similar lips to yours) to aid in communication.
Enhance lips’ shape & address deflated vermilion borders
Modest injections placed along the lips’ red vermilion borders are used to restore or enhance the shape of the lips, helping them to be more pronounced.
Correct asymmetry in the lips
Many lip injections include slight variations to account for asymmetry, which is often easily improved, if not fully corrected, with lip filler.
Defining the shape of the cupid’s bow
The cupid’s bow at the center of the top lip can be enhanced by adding volume beneath this area or simply defining its shape by injecting into the border of the lip.
Augment the philtrum columns above the upper lip
The two philtrum columns, within the upper lip and extending from the nose to the top lip, are a popular area to enhance. A defined philtrum adds a more refined shape to the cupid’s bow and helps to provide a youthful look, since this area tends to become sunken or less pronounced with age.
Raising oral commissures for a more youthful, happy facial expression
The corners of the mouth, or oral commissures, may appear sunken with age. Filler can be used to provide structural support, raising downturned corners of the mouth and softening an expression of frowning or displeasure.
Side effects and safety
Be aware that, beyond aesthetic anatomy, your injector must have a solid, three-dimensional understanding of facial arteries in order to keep you safe during lip filler injections. Injecting dermal filler into an artery can lead to vascular occlusion, a dangerous side effect that requires the filler to be dissolved, and which may be difficult and costly to correct.
Typically, the arteries are located just under the wet-dry border of the lip, so this area is carefully avoided during injections. Additionally, injectors should take extra caution in the midline area of the lips (i.e. the cupid’s bow), keep injections to a shallow depth, and always puncture the skin from the vermilion border area.
Other techniques for optimal lip enhancement results
Beyond anatomical choices, there are other choices your injector will make that influence your results. Here are some of the most important:
- Cannula vs. needle: Using a cannula can help to reduce downtime after injections, among other benefits.
- Formula: Choosing an optimal filler formula, based on qualities like flexibility, thickness, and how long it will last.
- Follow-up appointments: Many experienced injectors offer follow-ups after 2 weeks or so to evaluate your final results and provide touch-ups. For those who desire a significant change in volume (i.e. to address genetically thin lips), staging injections throughout multiple appointment sessions can allow the skin to stretch and accommodate the larger volume of filler with a more natural-looking result.
- Complementary treatments: Treatments like the Botox lip flip or dermal filler in the nose or chin areas can enhance your lip filler results by balancing facial proportions
Choose a board-certified facial cosmetic surgeon for experience, aesthetic mastery, and a focus on your safety
When you choose a diplomate of The American Board of Facial Cosmetic Surgery (ABFCS), you are choosing a facial aesthetic specialist with a deep understanding of how to achieve refined results while keeping you safe during both surgery and non-surgical treatments like injectable filler. Our board-certified facial cosmetic surgeons have extensive hands-on training and experience in procedures ranging from laser skin resurfacing to dermal filler to facelift, so you can trust that they are genuine experts when it comes to facial cosmetic enhancements. Browse our surgeon database to find an ABFCS-certified surgeon near you.