Lip Rejuvenation: How to Use Fillers to the most Natural, Youthful Appearance

Dr Day demonstrates symmetrical beauty
Nefertiti is a perfect example of “phi,” the golden ratio of balance and proportion

Lips send a message even when they’re not moving. To create beautiful natural lips I often combine devices such as lasers and radiofrequency or ultrasound, products that contain antioxidants, neuromodulators such as Botox, Dysport or Xeomin and hyaluronic acid fillers. And, of course always, always, always use sun protection to defend against collagen breakdown and damage to this very delicate area of the face. Before I address the lips I evaluate the face as a whole and the teeth and area around the mouth, including the chin in particular.

Considerations: For beautiful lips take into account: Your Genetics, Your Age Group , Your Personality & Life Style, Your Race – Culture – Gender. It’s About Attention to details – It’s the little difference that makes the big difference.

Nefertiti is a perfect example of “phi” the golden ratio balance and proportion.

The green line that goes from one inner eyelid to the other is called the intercanthal distance, it is unique to you and it stays the same from 9 months to 90 years. It determines the perfect balance and proportions for the rest of your face, including your lips.

Start with the area around the lips:

I always start with looking at the teeth. Very often when lips are flat or uneven, it’s due to the lack of support of underlying teeth. I often see a strong overbite, crooked teeth or teeth that are angled inward and therefore not supporting the overlying lip. We can try to correct the lips, but the results won’t be as good or as long lasting if we don’t address the underlying cause distracts from the area.

Gummy Smile: I always study the lips at rest and the lips in animation. Some people have beautiful full lips at rest but they become small and flat or roll under when they smile, exposing their gums. This can be corrected with a neuromodulator like Botox and the results are fantastic. It is an area of advanced injection technique because there are different types of gummy smile causing the changes you see and also because the treatment can affect the way you speak and pronounce certain sounds like the letter ‘p” or “o”. The results are fabulous when done well and unfortunately last too long when not done correctly. The basic rules for the lips is that the left and right sides should be identical. In white skin people the balance of the upper to lower lip is 1:1.618. The center “bow” to the outer lip should also be 1.1.618. The majority of the product should fit in the areaas wide as the sides of the nose (see image below).

Dr Day explains how lips benefit from fillers
The center “bow” to the outer lip should be the correct ratio.

Consider the image below as being like the frame  of a painting. The upper white roll is more pronounced, the lower white roll is more subtle.
Vermillion: This is the red and main part of the lips. There are different products we use for different purposes and sometimes we layer product for best effect. The most common product used for lip filler is hyaluronic acid, but there are many different types and brands and it can make a very big difference in how the end result looks and how long the results last. Some fillers are thicker and give more of a fill or augmentation while others are softer and more flexible and help enhance.

Dr Day lip illustration after fillers
The most common product used for lip filler is hyaluronic acid, but there are many different types and brands and it can make a very big difference in how the end result looks and how long the results last.

 

Steps

Step 1. The doctor may apply a topical anesthetic to help minimize discomfort.

Step 2. They may use a needle or a cannula (blunt needle) to inject the proper product into the lips to augment
(make bigger) or enhance (make more beautiful and balanced).

If you have relatively smaller lips be prepared to be patient and allow for several sessions with small amounts of a more robust filler to reach the final result and avoid having too much projection and that dreaded “duck lip” look.

After desired volume is reached the doctor may use a softer filler to enhance and balance the lips and surrounding area. It takes time for the product to settle and there may be swelling for a few hours to a few days after the treatment. There can also be bruising, which can be treated with a laser to speed healing if needed.

Dr Day explains lip anatomy

The majority of the lip product should sit between the nasal ala one side of the nose to the other as in the photo above.

Dr Day demonstrates intercanthal distance

Lower lip: The lower lip should be slightly larger than the upper lip, except for African American and Asians where the natural proportion is for them to be the same size. Also, the bulk of the filler should be within the lines that would drop straight down from one inner eyelid to the other (called the intercanthal distance as seen in the photo above).

Oral Commissure (aka corners of the mouth): as we age the corners of the mouth can drop and droop and give the appearance of a frown even though you’re not sad or angry!

A firm filler can give an excellent lift to this area and instantly reframe the lips. A little Botox into the muscles along the jawline that pull the corners down can also have an excellent impact in helping to lift the corners.

Dr Day before and after dermal fillers photo
As women age, our chin recedes and gets smaller. By adding a filler right into the center of the chin, we can help bring this area back into balance and change the look of the lips before even injecting any product there at all.

Chin: As women age, our chin recedes and gets smaller. This can make the lower lip slip back and look smaller and it can make it more difficult to keep the lips together, which forces us to use the muscles that surround the mouth more to push our lips together. This ends up creating those dreaded upper lip lines. Filling the lower lip without addressing this area makes the lips look unnaturally larger and out of proportion to the face.

By adding a filler right into the center of the chin, we can help bring this area back into balance and change the look of the lips before even injecting any product there at all. This has to be done carefully in order to create the proper look. Injected too low it can make the face longer, injected too high and it will look like a bump. There is a sweet spot to inject that looks beautiful and natural and gives lasting results.

Upper lip line creases: These are usually caused from sun exposure over years, from repetitive motion of the area and from volume loss. It is best addressed with a softer more flexible hyaluronic acid filler to give support to the delicate skin around the lips and to stimulate collagen production. Sometimes a laser treatment, radiofrequency or other in-office treatment along with topicals containing retinol and growth factors are also needed to help restore and enhance the skin around the lips.

The best way to proceed is to see a board certified aesthetic physician like a dermatologist or plastic surgeon so you get a proper consultation and the right products are chosen for you. It often takes 2-3 sessions for optimal results and to avoid getting that over projected “duck lip” look.

Tools: There are different ways to deliver the filler. The doctor may use a needle directly into the area or they may use a blunt needle called a cannula. Both are excellent options. The cannula lowers the risk of bruising and is becoming a more popular technique for injections.

Bottom Line: The goal is to have balance and harmony of the lips and the face. A proper aesthetic evaluation along with using the right filler for the right area is very important to restore, reflate and rejuvenate this very sensitive and important part of the face. There is a science to the art of lip injections and for beautiful lasting results see a doctor trained in aesthetics, such as a dermatologist or plastic surgeon.

3 Top Tips To Save Your Skin This Winter

Winter is approaching and for most of us that means it is time to tackle our changing skin needs. As the air outside gets colder and the humidity decreases, indoor heat gets hotter and drier, which can lead to skin that is parched from moisture as the air around us, indoor and out, selfishly steals our reserves. Rosacea, which is commonly triggered by extremes in temperature, can flare more easily.  Eczema and psoriasis can flare too, and those with acne-prone skin may even start to see an increase in breakout.

Another tricky aspect we are presented with these days is that while winter weather may be imminently approaching, temperatures can range widely from day to day or week to week. One day it can be cold and blustery and the very next temperatures can soar into the 60’s, making it difficult to know what coat to wear let alone which moisturizer to use.  Wool and coarse fabrics can irritate your skin and add to the problem. Here is the solution to your winter skin woes:

1. Listen to your skin: It will always tell you what it needs, and what it doesn’t like. If your rosacea is flaring or you’re breaking out like you haven’t in a while, there is still hope. Try to pinpoint any triggers, avoid them when possible and be sure to stick to your skin care routine especially when you’re under stress. Perhaps you are overdue for a maintenance treatment or a visit to your dermatologist for a peel or skin care assessment? Did you run out of a skincare product that you love? Your skin will need different ingredients and products as weeks, months and years go by, but a common thread of consistency in your daily routine- cleansing, hydrating and sun protection- is important to prevent flares and keep your skin looking it’s most beautiful radiant best.

2. Check the weather: Just like you think ahead for seasonal weather changes, you should also prepare for the effects the changes in season will have on your skin. Learning to layer the right products and adding or subtracting ingredients throughout the year will lead to happier, healthier, more beautiful skin. Warmer days tend to be a bit more humid, so layers of antioxidant serums, hyaluronic acid serums and lightweight sunscreens may do the trick for you. Colder days, especially when it is dry and windy, may require a moisturizer designed to help seal in precious moisture. The body is drier than the face, and all skin loses water as you sleep and your body repairs damage from the day, so be sure to add a richer layer of hydration at night and find an easy to maintain humidifier to use in your bedroom as you sleep, allowing your skin to protect, replenish and restore its moisture bank.

3. Have the right skin care products ready in your arsenal: Key pieces are critical. Once you know which products you love and what works best for you,  make sure you have them supplied and available to use on the fly as needed. Once you learn to listen to your skin and remember to routinely think of your daily skincare as you would your outfit selection for the day, you will start feeling and seeing more consistency in your skin health. See below to learn how to select the best products for your skin needs.

If all your efforts still only get you so far, trust the experts- after all it is what we are here for!

Skincare products that help you cope:

Facial Serums with Hyaluronic Acid

Depending on how prone to dryness your skin is,  the cold air will quickly steal moisture from your skin. Layering serums, thinnest to thickest, under lotions and creams, helps to infuse your skin with deeper hydration. Topping off with the right lotion or cream will seal in all the good stuff so you’ll be best prepared for blustery, cold days.

I like to think of using Hyaluronic acid, which is a humectant, helping to pull in and hold water in the skin, as an ingredient that helps to fill the well. HA attracts water from the air around you and holds onto it, up to 1,000 times its weight, and is part of how your skin hydrates itself naturally. After a week or so of consistent HA use your skin’s moisture well will be replenished so you have better defense against dryness. As we age, we lose our reserves of naturally occurring HA so it’s important to supplement with it topically. Not only will it help you feel less dry but your skin will also plump up and the appearance of fine lines and wrinkles will soften.

A few favorites: SkinCeuticals H.A. Intensifier, Skin Medica HA5 and PCA Hydrating Serum

Facial Antioxidant Serums

Using antioxidant serums year round is a must. In the summer, we tote antioxidants for their protective qualities when layered with sunscreens and the same is true in the winter months. Some of us can upgrade to more emollient formulas in the winter for an extra boost of hydration. If you don’t already have a facial antioxidant you love, Alastin Skin Nectar, SkinBetter Alto, SkinCeuticals CE Ferulic and Skin Medica TNS Essential Serum are all highly recommended!

Super Gentle Exfoliants

You might notice that treatment ingredients and acne medications  suddenly begin to irritate your skin as the weather gets colder. This is because as your skin loses moisture and naturally occurring protective oils, active ingredients penetrate more deeply. To counter this, use actives less often and sandwich them between serums and moisturizers. If they still irritate you, switch it up and try these clever products from RestorSea, which exfoliate without any irritation and help to enhance skin function and barrier repair. RestorSea Intensive Treatment 10x is a safe and non-irritating alternative to retinols. Apply RestorSea Rebalancing Lotion on top for additional hydration.

Facial Moisturizers

Your moisturizers will never work better than they do when layered over your favorite Hyaluronic Acid and Antioxidant Serums. And for some of us, these layers of serums might be enough, especially when topped in the day with a protective sunscreen. For those who need a bit more, we recommend finding a formulation designed for your specific skin needs. Drier skin types can use moisturizers morning and night. For combination-to-normal-to-dry skins, we say sleep in one that you love, remembering to slather your neck and chest too.

Dry Skin: Skin Medica Dermal Repair, MD Rejuvena Ultra-Rich Hydration, Neutrogena Hydro Boost Gel-Cream (for extra-dry skin)

Normal-to-Dry Skin: Epionce Medical Barrier Repair, SkinCeuticals Triple Lipid Restore, Sente Dermal Repair Cream, Skin Medica Total Defense and Repair SPF

Oily or Combination Skin: SkinCeuticals Physical Fusion SPF 50, NeoCutis MicroDay

Hydrating Masks

1-2 nights a week you can apply a hydrating mask. For very dry skin, apply a cream or gel based mask like SkinCeuticals Phyto Corrective Masque  for 10-20 minutes, tissue the mask off and then apply your regular nightly routine. For normal to dry skin, apply your evening skincare and then a sheet mask over the products, wearing the sheet mask, like SkinCeuticals Biocellulose Restorative Masque for up to an hour or even overnight. Make sure you’ve got a good humidifier going while you sleep, too. Certain essential oil diffusers also infuse the air with moisture with the adding bonus of sleep-enhancing essential oils like Lavender or Chamomile. In a pinch, take a tip from our grandmothers and great grandmothers and place a bowl of water by your bed- it doesn’t work nearly as well as the other options but it’s certainly better than nothing.

Lips, Hands, Feet, Body

Dry, chapped skin can start to appear on the hands, legs and body as soon as the weather starts to change. Keep a bottle of liquid coconut oil (Nutiva Organic Cold-Pressed Liquid Coconut Oil) in the bathtub and apply it to your whole body while the water is still running. A little coconut oil goes a long way and the warm shower water helps you spread it evenly over your whole body (do not apply to feet while standing in the shower and be especially careful not to slip getting in or out!). Before drying off, try applying 1-2 pumps of an exfoliating, hydrating body lotion. Some of my favorites are: PCA Body Therapy, AmLactin Hydrating Body Lotion, SkinFix Extra Strength Soothing Body Cream and Theraplex Emollient for Severely Dry Skin.

Replace hand soaps with richer moisturizing formulas and keep hand lotions next to your sink in the bathroom and kitchen and apply after every hand wash and in your purse for when you’re on the go. Pro tip: If you don’t like your hands to feel greasy, just apply the formula to the back of your hands from time to time. Keep your hands covered with gloves or mittens on especially cold days to protect them from cold, dry air.

To better manage dry cracked feet, begin by exfoliating regularly. Most of us get pedicures less frequently in the winter but when you do, skip the exfoliating callus remover and more aggressive exfoliation methods offered at spas as they can go wrong, making you more prone to cracked heels. Instead, when you step out of the shower, apply an exfoliating serum designed specifically for the feet, then apply something rich like Aquaphor and put on your socks. For less dry feet use a milder exfoliating and hydrating formula when you get out of the shower and before you go to bed.

Lips need love too! Physically exfoliate them gently with your toothbrush then apply a hydrating lip serum. Top off with something more occlusive and reapply it throughout the day. Keep it easy by having a travel version in your bag at all times.

Hands- Dr. Day’s Handle With Care, Neutrogena Norwegian Formula Hand Cream, Aquaphor

Feet– Clarisonic Pedi-System, Clarisonic Pedi Boost Renewing Peel, Isdin Podos

Lips-RestorSea Lip Magic, EpiCeram Lipcare, Aquaphor

For questions about how to best treat your skin, please call us. We can help answer your questions over the phone or in person during a consultation with Dr. Day or myself (Holly Montgomery).

Many of these products are available on our online store! If you’re not yet signed up for access please call us at (212) 772-0740 and we will happily register you! Access allows you to store our recommendations and other favorites so you can order them as needed or have them shipped automatically, making life that much easier.

 

The following in-office treatments are some our favorite skin savers in maintaining glowing skin during the winter months:

 

Hydrating Facial Peels

Dermaplaning

Clear and Brilliant

Fraxel

Hyaluronic Acid-based Filler

Botox