Juvederm for lips - good for lip augmentation?

Juvederm is a great filler to "plump" the lips.   I use it all the time. This is one of several filler products that can be used on the lips. 

Juvederm is one of my favorite fillers used for shaping and enhancing lips! Juvederm is one of several fillers made out of hyaluronic acid. There are two types of Juvederm available in the United States.  There is Juvederm Ultra and Juvederm Ultra Plus.

Both products come in a 0.8 cc syringe.  The Juvederm Ultra Plus is a little thicker than the Juvederm Ultra. Both products can be injected off label into the lips for the purpose of shaping and enhancing the lips.

In other countries, Juvederm is available in three forms, Juvederm 18, Juvederm 24 and Juvederm 30. The Juvederm 24 and Juvederm 30 are the same as the Juvederm Ultra and the Juvederm Ultra Plus in the United States.

One of the things that I like best about Juvederm is that it seems to inject very smoothly.  This makes it easier to avoid lumps.  Furthermore, if Juvederm does cause a lump it is easy to massage the lump during the injection process and eliminate it. 

If Juvederm forms a lump several weeks after the injection it can be dissolved with a chemical called hyaluronidase. With proper injection technique Juvederm can make a wonderful enhancement to the size or shape of the lips.

The Background

Juvederm® is an excellent material for lip augmentation.  It is made out of hyaluronic acid, a substance that is found naturally in the intra- and extracellular matrices of our bodies.  Juvederm® is derived through a synthetic process by Allergan, the maker of Botox®.  Juvederm® provides and even volumetric enhancement (plumping) of the lips because it is hydrophilic (attracts water), which helps prevent lumpiness. 

The Procedure

Juvederm® is administered as an office procedure, usually with the assistance of nerve blocks (dental blocks) to numb the lips and facilitate treatment. When the patient is completely comfortable, the procedure is generally smoother and the patient has less anxiety about repeating the procedure in the future.

I have also used topical anesthetics which are specially formulated, but have found them to be less effective than nerve blcoks.  The nerve block generally lasts for 1-2 hours.  I do not use epinephrine in nerve blocks to avoid increases in heart rate.

The Result

Juvederm® is very highly cross-linked form of hyaluronic acid, making it less likely to be broken down quickly than other hyaluronic fillers.  Juvederm® typically lasts for 4-6 months for volume enhancement in the lips. However, I have seen it last for up to 1 year when injected in the vermillion border, which represents the transition area, or "white roll" between the red and white lip. 

Studies have shown that hyaluronic acid fillers can stimulate collagen production through a flattening effect on fibroblasts (collagen producing cells in the skin).  The amount of enhancement to be obtained is up to the patient, but I advise patients trying it for the first time to choose a more subtle look and 1 syringe will generally facilitate this.

At Skin Speaks Spa M.D., Juvederm Ultra is now our #1 choice for providing fuller, softer, and beautiful lip enhancements.

Juvederm is often used alone and is capable of shaping and correcting the borders, the columns, and the cupids bow, and is ideal for adding the volume! Our patients have been much more satisfied with the Juvederm experience, both in the enhancement and the life of the treatment.

On rare occasions, we may combine the use of collagen, and in some cases, Juvederm Ultra Plus is advised.

Juvederm is one of the fillers used for lip augmentation. This is an off-label use of Juvederm, which is FDA approved for use in the deep lines around the mouth. Restylane is also used for lip augmentation.

While lip augmentation is an off-label use of these products, they are very safe products and give beautiful, natural-looking results.

During the procedure, the doctor will use local anesthesia to make you comfortable. I inject my patients while they are sitting up, so that I can see how gravity affects them. I also examine how the skin of the mid- and lower face, and any other lines and wrinkles on the face, affect the appearance of the lips. It may be a good idea to inject some filler around the mouth and/or the chin area to give more support to the mouth and lips.

The lip augmentation procedure usually takes 10-15 minutes. You may be swollen and slightly bruised for up to one week. The results typically last 3 months.

Augmentation of the lips should be subtle. A small increase goes a long way and gives a natural, sexy fullness to the lips. Your lips should not arrive in a room before you.

You should discuss what you'd like your lips to look like. Do you want more body in your lips, more definition of the edges of the lips, or both? Your upper lip should be smaller than your lower lip (70% the size of the lower lip). The lower lip should not be filled all the way to the corner (oral commissure) to avoid a "sausage" appearance.

For lip augmentation, I offer my patients dental nerve blocks to numb the lips, which makes the treatment much more pleasant for both of us. In patients who decline a nerve block, numbing gel is applied, and then prior to each injection an ice pack is held on the lip.

Lips should not be overcorrected with Juvederm, as the product attracts more water from under the skin after it is injected. Initially your lips should look more swollen than you would like, just from the trauma of the injections. Patients do comment that their lips feel smoother after Juvederm than with other fillers. Within 12-24 hours they should look how you'd like them to look.

If after one week there is asymmetry, then return to your doctor. If they are too big, then Widase can be injected to help dissolve some of the product. If they are uneven, a little more may be added.

Lastly, I just read Dr. Arnold Klein's (Dr. Klein is THE expert in injectables) comments here on RealSelf.com, which are very informative.

Good luck.
Dr. P

Juverderm, like Restylane, is a hyaluronic acid. This is a naturally occuring sugar in our bodies, so it is easily accepted by the body and not likely to create a reaction like you can get with man-made synthetic agents like silicone and Artefill.

Juvederm and Restylane work very well for lip enhancement, and while not FDA-approved for this use, I feel they are very safe and effective and I use them daily in my practice.

• Your lips are sensitive and, when injected, can be painful. Many doctors give dental blocks for this, but I use a strong formulation of topical ointment, which is specially formulated for me and works extremely well.
• I don't like dental blocks because they can distort the natural motion of the lips and cause additional swelling, which can make it difficult to see what is from the block and what is from the filler.

Lip augmentation/enhancement involves more than just injecting the lips. You must also add volume and restore the corners of the mouth, below the lip area and often the jaw and chin as well. It is only through this process of restoring the lost support of the lower third of the face that you can restore natural looking lips without causing a distorted over-filled look, which we all have seen walking the streets.

• I also use the application of ice before, during and after lip enhancement, which helps with the discomfort and with post-procedure swelling.
• Also, unless the is a medical reason not to, I ask my patients to discontinue aspirin, ibuprofen and other anti-inflammatory medications at least 5 days prior to the procedure. This helps reduce the chances of bruising.

My biggest tip is to spend time selecting your doctor. Not all doctors are created equal. You need someone who is well trained and a specialist in this area, not your family doctor. Make sure you see examples of his or her work and ask people who have been to them.

Remember, price should not be your main consideration when choosing a good cosmetic surgeon; experience, training and education are all important factors when making this important decision.

You can expect to get some great lips from your Juvederm!

Your doctor may inject local freezing to numb your lips prior to injecting the Juvederm or may use ice packs to decrease the sensation of the needle in your lips.

Likely you will be asked to lie down on an exam table and usually the top lip injections are done first. There are several different methods for actually injecting the Juvederm but each involves multiple small needle pokes - so be patient and try not to flinch with the needles.

You may experience some bruising at the sites of the needle pokes but these will disappear in a few days. You may also experience some swelling which will also settle over a few days. You can decrease any chance of swelling or bruising by apply icepacks to your lips immediately after the treatment. Also, avoid taking any aspirin or ibuprofen products for 3 days prior to and 3 days after your injections to also decrease the chance of bruising. Make sure to tell your doctor if you are on any blood thinning medications.

If your doctor puts local freezing in your lips you will stay numb for several hours. During that time make sure to avoid any hot drinks or soup since you can burn your lip and not feel it. You may also find it difficult to talk with numb lips and may also have the sensation that you are drooling. So if your doctor is going to freeze your lips plan your appointment for the end of your work day!

It took several days for the swelling to settle down from my Juvederm lip augmentation, but it was well worth it. I love my Juvederm lips and love giving fantastic, plump, kissable Juvederm lips to my patients!

Watch as Dr. Renato Saltz, spokesperson for the Physicians Coalition for Injectable Safety, demonstrates Juvederm treatment for non-surgical lip augmenation on a patient experiencing a lip augmenation for the first time.

Narration by Marie Czenko Kuechel, consumer advocate and active participant on RealSelf.com.