I don't think these look so great. Thoughts? (Photo)

Question

I was recommended a place for lip fillers. When I went to their website I saw these before and after pics. I don't think these look so great. Thoughts?

Camille Cash, MD · Answer

Beauty is in the eye of the beholder.  Each patient comes in with different goals for their treatment.  It's the responsibility of your injector to listen to what you would like, discuss results, and select the correct filler that best matches your needs.  The patient photo shows a subtle enhancement which may be what they requested.  You can ask to see other photos if you are unsure if this is the right injector for you.

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated. Using Word recognition. My apologies for any grammatical errors.
In my opinion, what differentiates it truly great lip, filler treatment from the rest of the following.
First is keeping the procedure comfortable and minimizing bleeding bruising and complications.
From first an experience I found that the most comfortable way to do this treatment is the first apply high concentrated topical anesthetics for at least 5 to 10 minutes.
After that I inject 2% lidocaine with an epinephrine ratio of one to 30,000. (to get this ratio requires mixing your own local, anesthetic) I make a single local anesthetic injection at each corner of the mouth using only a tiny amount of local at Aesthetic. The corner of the mouth is the only location or needles enter.
I use needles long enough to reach the midline and typically do lip injections as for separate injections into the four quadrants all coming from each of the two corners of the mouth. The local anesthetic (about 0.5ml)is injected with a 1 inch 30 gauge needle injecting very very slowly. I typically let the local anesthetic sit in for 10 to 15 minutes, which is sufficient to get intense vasoconstriction, making the lips blanch and almost turn white. This is temporary and harmless, but serves as a safety measure to minimize bleeding, bruising, and intravascular injection of filler.
With the vasoconstriction from the added epinephrine concentration the chance of the patient having any bleeding or bruising, goes down to almost zero. With the patients lips being completely numb, I can focus on my attention on perfecting the lip filler, which is done with single injections from the corner of the mouth into each of the lip quadrants.
It’s much easier to pay attention to the Aesthetic work when there is no bleeding and the patient feels zero discomfort
Most fillers come with inadequate, short needles that don’t reach the midline, causing providers to do multiple injections leaving lips lumpy.
There is a significant difference in the quality of needles, depending which brand is purchased.
The highest quality injection needles are generally made in Japan the companies like TSK.
Before starting, I make careful notes regarding each individual persons, upper to lower lip volume ratio.
I generally do not strive away from this ratio and maintain a natural relationship regarding upper and lower lip size.
In the pictures you’ve included, the upper lip is larger than the lower lip and this is rarely if I ever seen in real life. To me , the person has obvious signs of having treatment and does not look natural.
The lower lip is larger than the upper lip in almost 100% of people.
Some people have lips that are close to equal, but the upper lip is never larger than the lower lip.
Providers should be careful injecting volume in the upper lip Vermilion border. Individuals who have naturally thin upper lips should be treated in a very conservative manner to avoid having a treated appearance. Volume injected needs to be reduced naturally, as we approach the corner of the mouth. No filler should be injected in the midline of the lower lip. The upper lip has a central region of fullness, followed by two lateral. Subsequent areas of fullness.
The upper lip should be seen as three segments while the lower lip should be treated as having two segments.
Using injectable, local anesthetic will create slight distortion, and this needs to be taken into consideration when adding the filler.
When done well, I found this to be by far the most comfortable way of doing lip augmentation with minimal chance of leaving people bruised or otherwise, having an unpleasant or problematic experience.
Doing this type of work with consistent quality outcomes requires patience and I usually schedule lip filler sessions as a 45 minute procedure.
Rushing and getting the procedure over with is the wrong approach.
Taking your time and making sure the patient has minimal discomfort using proper technique with appropriate medication’s is critical to maintain quality positive experience with consistent, excellent outcomes.
My personal product of choice has been Voluma ever since it came out.
To get a reference of what can be accomplished, using facial enhancement with fillers, I suggest you consider checking out the website of Dr. David Mabrie MD. This website doesn’t allow me to add website links so you’ll need to look up his website.
He’s located in San Francisco.
He has an impressive collection of before and after pictures.
His work with facial fillers is the best I’ve ever seen.
I consider his work to be the gold standard.
Before I closed my private practice in San Francisco, I used to offer to refer patients to his practice for those who wanted quality midface, volume augmentation if they were willing to pay the price.
I acknowledged my work, simply could not keep up with what he was able to do.
I do think my Lip augmentation results have been consistently on par with what he is able to do.
In the world of cosmetic treatments, there are a handful of truly awful providers. many mediocre providers, a moderate amount of good providers, and a very small select group of truly exceptional providers, who have a deep understanding and commitment to excellence.
The number of providers, lacking skill and experience is obvious to anyone who has an aesthetic eye, and spends any time with the general public.
When vetting providers, I recommend asking for as many before, and after pictures as possible.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider.
This is one of the reasons I’m so impressed by the work of Dr. Mabrie. His website literally has hundreds of before and after pictures showing consistent quality results again and again.
Obviously, everybody has some results that we all wish Turned out a little better.
Sometimes the best providers don’t have large online presence. 
Don’t go chasing after the providers with the most number of reviews.
In my experience, there is an inverse correlation between skill and fame in this type of work.
The best providers are focused on patient care not self promotion.
It continues to amaze me how many people do not go through a proper vetting process before selecting providers for cosmetic procedures.
This becomes even more fascinating when speaking of permanent irreversible surgery.
From my perspective, I think having five or six consultations, seems appropriate for anybody considering cosmetic surgery.
Fillers is generally quite forgiving, even if the results are less than perfect.I’ve seen more and more people post on this website about permanent changes after chronic use of filler, especially situations were the procedure was done, poorly ending up with patients reversing the filler.
There is definitely evidence that fillers can create long-term permanent change.
The chance of this happening with negative consequences is inevitably related to provider selection in the first place. 
Good luck with your research on finding the right provider for facial aesthetics.
Best,
Mats Hagstrom, MD

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