What about bad lip augmentation - what do I need to look out for?

One of the tell tale signs of a "bad" result (my opinion) is when after augmentation, there is unnatural disproportion between the upper and lower lips (often an over-augmented upper lip). The "norm" is for the upper lip to be less full than the lower lip - according to the "golden proportion" the lower lip should be about 60% fuller than the upper lip (1.6:1, the Fibonacci Sequence).

When augmenting the lips it is important to pay attention to the baseline balance and proportionally enhance both the lower and upper lip.

A lot of people do not need lip augmentation. One has to be honest with them.

I recently had a lady come in wanting lip augmentation performed. She had beautiful round lips that were naturally full. She had never had work done on them before. She said she wanted to have more bigger lips. I performed a simulation using a computer and she chose not to have that treatment.

Look at the physician's pictures of patients he or she has treated. The lips look good. If you are having lip augmentation done for the first time, insist on a hylauronic acid based filler because if you do not like it, it can be immediately removed using an injection of hylauronidase, which any reasonable physicians will keep in their office.

A good physician will insist that you augment your lips slowly as you do not get any overfill.

I hope that helps.

One tell-tale sign of obivious work done is a bad upper lip augmentation. Traditionally, a bad lip augmentation has this "ducky" look to the upper lip.

What causes this look? I feel is it a not paying attention to facial aesthetic and creating facial harmony.

The "ducky" lips appear so for several reasons. The major reason is because the upper lip projects too far from the face and lower lip. Facial aesthetics guidelines suggest the ideal upper lip position should be slightly more projected from the lower lip, which is slightly more projected than the chin.

Another reason lips may look "done," is inappropriately adding volume to the lips in wrong places. Frequently, lips are injected with synthetic gels (Restylane is a popular example). This gel should be evenly distributed throughout the upper lip. Injecting too much material at the junction of the true lip and skin can create a "ducky" appearance to the lip.

In general, I would agree with the other surgeons on the recommendation in using temporary injectables first before using a more permanent material. Consult your local facial plastic surgeon to learn more.

If you go to a good doc. they'll start out using less filler because everyone's body reacts differently as far as how much and how fast it reabsorbs various fillers...and even then it changes a bit between injections.

It shouldn't cost you more to stay on the safe side (lower side) of fillers because they should save your syringe and add more in a few weeks if you want more.

Although Restylane can always be dissolved, it's embarrassing to have duck lips for even a few days, so stay conservative with injections. Also NEVER have Radiesse injected here. Although many doctors do this with promises that it will last longer, it isn't designed for the lip region, and so many people have had to have surgery to get it removed. Stick to shorter-lasting but easy-to-remove fillers like Restylane and Juvederm.

I would echo Dr. Persky's sentiment - with a few additional points.

In patients who are interested in lip augmentation, there are temporary solutions and permanent ones. Currently there are several permanent solutions for lip augmentation including fat transfer (transferring fat from the belly or thigh to the lips) and silicone or ePTFE implants. I favor fat transfer to implants because fat is the patient's own body material and not a foreign substance which is introduced. This decreases the risk of infection and extrusion.

In my patients who are considering a fat transfer to the lip I strongly recommend a temporary filler first. The good and the bad part about temporary fillers such as Juvederm or Restylane is that they are temporary. If you do not like the results, they will go away in a matter of a few months, but if you like the results you will have to come back for another treatment or a more permanent solution. By going with the temporary filler first, patients are able to see what the expected results would be with fat transfer and decide if they like them. If so, we can proceed with fat transfer once the filler has gone.

When you walk into a room, your lips should not enter the room before the rest of your body. I don't know how many of you watched the recent red carpet style show hosted by Lisa Rinna, but her upper lips look like they have growths, especially the upper right corner.

Aside from avoiding whomever injected her lips and whatever was put into her poor lips, here are the essentials of sexy, beautiful lips.

• Sculping lips is an art. The person injecting should have a sense of aesthetics, balance, and symmetry.
• "Less is often more" when it comes to lips. More product can always be addedif needed.
• All lips are not the same, so a standard "recipe" does not apply.
• The lip should be enlarged only enough to return natural fullness and shape.
• The upper lip should always be about 70% the size of the lower lip. If you see an upper lip that is larger than the lower, bingo, you know that some things been put in those lips (i.e. Julia Roberts in Ocean's 11).
• Only the middle 2/3 of the lower lip should be injected to avoid a lower lip "sausage" appearance.
• When the lips apear natural and very "kissable." I know that I have reached the end point of the augmentation.
• Patients state that they feel Juviderm is the smoothest product in their lips. Restylane is also good. Radiesse causes lumps and bumps for a long time, so avoid it.
• If you decide to have fat transfer, be careful of the amount and placement of the fat.
• I'd avoid the "permanant fillers" like Silicone, and Soft Form.