About two months ago I had my plastic surgeon inject juvederm under my eyes (they were quite sunken) and into the lines around my mouth. I couldn't be more thrilled with the under-eye results. My eyes look wonderful. However, the lines around my mouth still seem pretty pronounced to me. My surgeon said that they would not go away completely, but rather soften. Is it possible for my surgeon to use more of the product for even better results? I think he was very conservative with the injection
Doctor Answers 22
Juvederm for marionette lines works well
Juvederm is a very thick injection. It is perfect for deep nasolabial lines. However, for thin lines around the mouth it is too viscous. You can inject a modest amount into the lips. More is not better in this area because they will be too large and thick and lumpy.
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How Much Juvederm is Enough?
My philosophy for treatment with tissue fillers such as Juvederm is to be conservative in the amount that I inject for the simple reason that it is easier to inject more filler than to treat an area that is over-filled.
So I suggest that you return to your plastic surgeon so that you can discuss your goals and expectations regarding your Juvederm treatments.
Hi GL. Yes, it is usually possible to improve the results by using more filler. As your doctor pointed out, the goal of volume correction is typically to soften and not to erase the lines that concern you. However, when additional correction is desired, the use of additional product is an option to consider. A conservative approach is desirable in most cases, since it is more predictable, less time consuming and less costly to slowly add volume than it is to overcorrect and attempt to remove volume. Discuss your concerns with your doctor and express your interest in additional correction.
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Combination of filler and botox best for lines around the mouth
Fillers such as Juvederm or Restylane are great for replenishing volumes and propping up valleys around the mouth. However, good portion of vertical lines on upper and lower lips is due to the way muscles (that are responsible for lip pursing) contract and judicious placement of small amount of Botox or Dysport can make a big difference. Fractional CO2 laser resurfacing can provide good long-term solution but one would still need volume replacment with fillers and muscle relaxation with Botox or Dysport periodically.
Fine lines of the mouth
The fine lines around the mouth are difficult to treat. Juvederm has a thicker viscosity and if overfilled can cause lumpiness along the treated lines. If you are a smoker or drink with a straw it is possible to treat these lines with a couple of units of Botox. The only problem with this option is it can distort the shape of your mouth when you pucker due to the weakening of the muscles. I would return to your PS and discuss all of the available options. I hope this helps you.
Neil J. Zemmel, MD
You may not be able to get rid of all of the lines around your lips with Juvederm.
While fillers like Juvederm and Restylane work very well to flil the lines around the lips, some lines are so deeply folded that laser resurfacing is necessary to completely get rid of the lines.
A Work in Progress
I agree that it is difficult to eradicate the fine lines around the mouth. You cannot put so much filler in them, as they will look lumpy. You may need to go back every few months for a little bit more, to layer the filler. The filler will also help to stimulate your own collagen formation. I agree that the goal is to soften.
Juvederm - How much is enough
One common misconception is that one syringe of Juvederm can be used to treat the whole face. In most cases, you need at least 1/2 syringe for each undereye and a whole syringe for each nasolabial fold. I generally suggested starting with 1/2 a syringe in each fold and then adding more if needed. On average, for a full face treatment, patient use anywhere between 2 to 6 syringes. If you post before and after pictures, we may be able to give you more specific advice. Additionally, you doctor is correct. The treatments will help soften the lines, but will not make them go away completely.
Making your lips look better could mean more. I have learned that simply filling volume loss in the lower face (with Radiesse for example) can bring out the lips and soften their look without even touching the lips. If there is "volume loss" around the lip area a small amount of Radiesse (placed very carefully) around the area can smooth out deep wrinkles greatly. Then more Juvaderm can be used to fill in some of the more superficial lines. Make sure you go to someone with lots of experience and you will get the results!
It's difficult to say without seeing you and your particular concerns if more Juvederm is the answer. Certainly, this may be all you need. It's always easier to add more to an area than it is to take away so as injectors we would much rather err on the side of not enough rather than too much. When you refer to the lines around the mouth, if you mean the vertical lip lines above the upper lip, it can be difficult to get the improvement you may want from filler alone. These lines become etched in to the skin's surface and may therefore need to be addressed with a laser (like Pearl Fractional or CO2) in addition to Juvederm for optimal results. It is always best to follow up with the your injector to see what the next step may be. We all want our patients to be happy with their results.
Dr. Grant Stevens