MIAMI BEACH Remember the three P's of perfect lip enhancementproportion, profile, and plumpingand you are more likely to get a satisfied patient who will use their new lips to refer other patients to your office.
Always keep proportion in mindthe ideal lip size ratio is about 40% for the top lip to 60% bottom lip, Dr. Glynis R. Ablon said at the South Beach Symposium.
The main goal of augmentation is to give patients natural-looking lips versus an overdone or "trout" lip appearance. "Don't completely change their look," she said, because no one should be able to tell the lips were enhanced.
For guidance, look at very young women or men, depending on what you're doing, "and see what looks natural to you," she said.
Look at each patient in profile and keep in mind you are sculpting the appearance of their lips from all sides, Dr. Ablon said.
Err on the side of injecting less filler material versus too much. "Less is more," Dr. Ablon said.
Start with a small amount and have the patient return for additional enhancement if desired. "Make sure you don't create lips that enter the door before the patient does. Not everyone will look normal with large lips, especially in Hollywood, where I work," commented Dr. Ablon, who is in private practice in Manhattan Beach, Calif., and on the dermatology faculty at the University of California in Los Angeles.
The actress Demi Moore, for example, has thin lips and "might look strange with enhanced lips."
When injecting filler, pay particular attention to the philtrum and cupid's bow on the upper lip, she said. You can also enhance or recreate the Glogau-Klein point, the dimple in the lower lip.
A general rule for the lower lips is to only inject in the central two-thirds. "Don't go too lateral. It will look like sausage otherwise," Dr. Ablon said. One exception, she said, is a patient with significant facial wrinkles who might get improvement to the side of the mouth (below the nasolabial fold).
Always have patients seated upright to allow for normal gravity. Another tip is to start with a nonpermanent filler, something you can dissolve, Dr. Ablon said.
Juvederm (hyaluronic acid, Allergan) is her lip filler product of choice, which she also injects above the vermillion border in some patients to provide additional enhancement. "It is a softer filler, and very moldable and malleable. Patients cannot notice there is anything inside their lips." Collagen and calcium hydroxylapatite are other lip filler choices.
Surgical options include lifts and advanced flaps. "The only surgical approach I typically use is the butterfly lip lift," Dr. Ablon said at the meeting.
The technique is best suited for patients with an elongated philtrum.
The lips are very sensitive and Dr. Ablon recommends use of topical and injected analgesics, such as lidocaine, before augmentation. She also uses the ArTek cooling device (ThermoTek Inc.) to increase patient comfort during the procedure. "If the patient is miserable, they will not return."
Tips to minimize bruising include avoidance of aspirin, nonsteroidal anti-inflammatory drugs, and vitamin E, and addition of bromelain supplements (a compound from pineapple). Also, consider antiviral treatment if the patient has a history of herpes outbreaks.
Dr. Ablon disclosed that she is a member of the Medicis advisory board (makers of Restylane and Perlane fillers).
'Don't create lips that enter the door before the patient does. Not everyone will look normal with large lips.' DR. ABLON