What lip filler techniques to increase lip height/turn lips out without an exaggerated lip ridge or migration? (Photo)

Question

What lip filler techniques work well to increase lip height or turn the lips out without risking an exaggerated lip ridge or migration? I would like to avoid too much change in plumpness, projection, or smoothing. I've seen some people say that injecting just anterior to the wet-dry border can expose more red lip at rest, but I've also seen warnings not to inject close to that border because of lumpiness and the vein nearby.

Ryan Rebowe, MD · Answer

It is difficult to increase the vertical height of the lip with filler itself, although it is possible depending on your anatomy. I would consider things such as the “lip flip” with neuromodulators (Botox/Dysport) or even a lip lift, which can be performed as a short in office procedure.

Gary M. Horndeski, MD · Answer

An alternative to consider is a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Anna Chacon, MD, FAAD · Answer

Increasing lip height and turning the lips out without creating an exaggerated lip ridge or experiencing filler migration is a delicate balance. Here are some techniques and considerations that can help achieve a natural-looking result:

1. **Micro-Droplet Technique:**
   - **Description:** This involves injecting small amounts of filler in multiple micro-droplets along the vermilion border.
   - **Advantages:** Helps to gently elevate the lips and can avoid creating a pronounced ridge.
   - **Considerations:** Precision is key to avoid lumpiness and ensure even distribution.

2. **Tenting Technique:**
   - **Description:** Small amounts of filler are injected vertically into the lip, creating a tenting effect that turns the lip outward and increases height without adding significant volume.
   - **Advantages:** Provides a subtle enhancement and helps avoid over-plumping.
   - **Considerations:** Requires skill to ensure it is done symmetrically and without creating ridges.

3. **Lip Tenting with Cannula:**
   - **Description:** Using a cannula to place filler in small amounts along the vermilion border and just anterior to the wet-dry border.
   - **Advantages:** Minimizes trauma and reduces the risk of lumpiness and vein damage.
   - **Considerations:** Cannula technique can be more challenging but offers a smoother, more natural finish.

4. **Linear Threading Technique:**
   - **Description:** Filler is injected in a linear threading manner along the vermilion border and slightly anterior to the wet-dry border.
   - **Advantages:** Helps to gently elevate the lip and can avoid creating a pronounced ridge.
   - **Considerations:** Care must be taken to avoid injecting too close to the wet-dry border to prevent lumpiness and vein issues.

5. **Pillar Technique:**
   - **Description:** Filler is injected in a series of vertical columns into the body of the lip to support and subtly evert the lip.
   - **Advantages:** Increases the height and outward turn without significantly increasing volume.
   - **Considerations:** Proper placement is crucial to avoid unnatural ridges or over-projection.

6. **Avoiding the Wet-Dry Border:**
   - **Description:** While some practitioners inject just anterior to the wet-dry border to expose more red lip, it’s crucial to stay slightly above this area to avoid complications.
   - **Advantages:** Reduces the risk of lumpiness and avoiding veins.
   - **Considerations:** Precision is key to achieving the desired effect without complications.

**General Tips:**

- **Gradual Enhancement:** Start with a conservative amount of filler and reassess. Additional touch-ups can be made if needed.
- **Consultation:** Discuss your specific goals and concerns with an experienced injector. Photographs and clear communication about desired outcomes can help.
- **Product Choice:** Use a softer, more pliable filler that integrates well with the tissue to avoid ridges and lumps. Hyaluronic acid-based fillers are often recommended for their natural feel and ease of adjustment.

**Post-Procedure Care:**
- **Massage:** Gentle massage by the practitioner immediately after injection can help smooth out any irregularities.
- **Avoid Excessive Pressure:** In the days following the procedure, avoid activities that put pressure on the lips to prevent migration.

By employing these techniques and considerations, you can achieve an increase in lip height and a gentle outward turn with a natural, subtle appearance. Always consult with a skilled and experienced injector to ensure the best results and minimize risks.

Leonard Grossman, MD · Answer

I believe I’ve already said many times that there is no such a thing as a filler migration. Filler winds up being in the incorrect position because it was injected there incorrectly. The best way to create more height to the lip is by an approach which is called the Russian lip lift. Find yourself a doctor such as a plastic surgeon or a dermatologist who is well-versed with lip augmentation techniques. I hope this helps and good luck from Leonard Grossman, MD, organic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

I’m not sure if there are names for the techniques you are referring to, 
I don’t think there’s any particular way of injecting that’s going to increase the length of the lip.
Injecting superficially at the vermilion line causes a rolled appearance of the upper lip and should generally be avoided in my opinion, though this is done all the time.
All injectors should be familiar with the labial artery. The vessels can have variations though. 
I suggest focusing on provider selection more than anything else. 
The number of providers who are exceptional with this kind of work is in reality quite small. 
There are so many individual components or variables that differentiates quality work the discussion is a bit beyond the scope of this forum. 
Results are only one variable. Patient comfort, avoidance of bruising, minimizing complications should also be considered when selecting a provide. 
There is so much bad work being done. All you have to do is look at people in any metropolitan area. There are so many people who don’t look normal with upper lips that are bigger than the lower lips. You should ideally not be able to tell if someone has had work done. If it’s obvious to strangers than the work isn’t being done well. 
Finding the right providers is not at all easy or straight forward. Many plastic surgeons who at least have the anatomy training and can comprehend safety issues can’t be bothered doing fillers and instead hire nurses to do this work for them. 
It seems the idea of consulting to simply vet a provider is not a thing. I think most providers would take offense at the idea of scheduling an appointment for the purpose of the patient getting educated and as part of finding the right provider without having a treatment. 
I’ve been particularly impressed by the work done by David Mabrie MD in San Francisco. You can look up his website if you want to see the results he is getting. His work is the best I’ve seen. He is better than me when it comes to working with fillers. 
It’s who I refer to when money is not an issue. 
Best,
Mats Hagström MD

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