Lip Augmentation: The Assessment That Decides the Result
Lips are among the most requested filler treatments and the most publicly judged. Everyone who meets the patient sees the result, most have an opinion about it, and the difference between a result people compliment and one people notice is narrow.
Technically, lips are not the hardest region on the face. Aesthetically, they are the least forgiving, and that difference is where training should concentrate.
Assessment before anything else
The lips are one structure among several, and treating them in isolation is how faces stop looking like themselves. Before agreeing on anything, assess the lips within the whole face: volume, muscle activity and the underlying skeletal support [1].
Then look at the lips moving. A result that is beautiful at rest and stiff in speech is a failure the patient will notice every day. Ask the patient to talk while you watch.
Two findings should slow you down: a patient whose upper lip is already proportionally full and wants it fuller, and a patient whose real problem is perioral support or dental structure rather than lip volume. Adding product in either case makes things worse in a way that is obvious to everyone except the person who requested it.
The anatomy that keeps this safe
The superior and inferior labial arteries are the vessels that matter. In most people they lie deep to the vermilion, but their depth and course vary, including between the two sides of the same face, so no plane in the lip is reliably the safe one. Because vessel position cannot be assumed, the consensus precautions are slow injection with minimal pressure, small volumes at several points, and stopping immediately at any sign of intravascular injection [2].
Lips bleed and bruise readily and swell more than patients expect. Consensus advice is to consider antiviral prophylaxis for patients with a history of recurrent cold sores, so ask about that history every time and agree in advance what will be done about it [3].
Principles that produce natural results
- Treat structure before volume. Definition, support and shape usually deliver more of what the patient wanted than filling did.
- Build across sessions. A lip that is slightly underdone can be added to next month; one that is overdone is a dissolving appointment and a lost trust.
- Respect what the face can carry. Proportion is set by the rest of the features, not by the request.
- Keep movement intact. If the lips are noticeably stiff, the endpoint was passed.
- Treat asymmetry as normal. Every face has some; correcting it completely often looks less natural, not more.
Expectations, and the photograph
Patients arrive with images. Those images are usually of a different face, frequently edited, and often the result of several sessions and other procedures entirely. Treating the photograph rather than the patient is one of the most common routes to an unhappy outcome.
A useful response is neither refusal nor agreement: take the photograph seriously as information about what they like, then say which elements of it are achievable on their anatomy and which are not, and why. Patients respect that conversation. What they do not forgive is being told yes and then shown a result that was never possible.
Where a patient's dissatisfaction with their lips seems out of proportion to what is visible, or where the same request keeps returning after good results, the appropriate response is a pause rather than more product.
Aftercare and the two-week rule
Lips swell more, and more alarmingly, than most patients anticipate. Say so beforehand, and say specifically that the second day is often the worst and that the shape at forty-eight hours is not the result. Do not assess, correct or dissolve for shape before the swelling has settled — a substantial proportion of early requests for correction are requests to fix oedema. The exception is any sign of vascular compromise, such as blanching, mottling or disproportionate pain, which is treated immediately [2].
Read next
- Facial Arteries Vary: Why Landmarks Are Not Guarantees
- Screening for Body Dysmorphic Disorder Before You Treat
- Lip filler course: what a good first course covers