41 Lip Enhancement with Filler Injection

Christopher C. Surek and Roy Kim

This chapter provides a succinct and high-yield approach to comprehensive lip enhancement with filler injection.

Philtrum – cupid’s bow – white roll – dry vermilion – lip tubercles – wet vermilion – wet–dry junction – oral commissure

Key Points

A comprehensive understanding of lip anatomy, specifically subunits and vascular architecture, is paramount prior to performing lip injection.
Age, gender, and ethnic considerations must be noted and discussed in preinjection consultation.
The “youthful” lip and the “aging” lip have unique morphology characteristics that often require customized approaches.
A reproducible and safe algorithm is critical to address the philtrum, white roll, dry vermilion, and wet vermilion in lip enhancement procedures.
A filler injection “crash kit” must be assembled and accessible in your office in the event a vascular occlusion occurs following lip injection.

Inferior labial artery (ILA):
- It is supplied by the main facial artery.
- It most commonly travels medially near the lower lip vermilion border. However, in 10 to 15% of patients the main ILA branch can traverse as low as the labiomental crease.
- Caution should be taken when approaching for labiomental crease augmentation in any patient as it is possible the ILA may be in close proximity.
Superior labial artery (SLA):
- Supplied by the main facial artery.
- Typically branches off the facial artery within an area 1.5 cm lateral to the oral commissure.
- Travels superior to the white roll for the lateral two-thirds of the lip and then traverses inferior to white roll at medial third of the upper lip toward the central tubercle.
  
  Fig. 41.1 The anatomical subunits of the lip: philtrum, cupid’s bow, white roll, dry vermilion, and oral commissure.
  
  Fig. 41.2 Vascular anatomy of the perioral region: facial artery, inferior labial artery, and superior labial artery.

Contraindications:
- Pregnancy.
- Current cold sore outbreak.
- History of sensitivity to hyaluronic acid filler.
The youthful lip (Fig. 41.3a–f):
- The youthful lip is often a true “enhancement” procedure.
- There are minimal aging changes of the skin, orbicularis, fat, and alveolus.
- Objectives are often to create additional shape and volume.
The aging lip (Fig. 41.3a–f):
- The aging lip is often a true “restoration” procedure.
- Depending on the patient, there are various levels of bony and soft tissue loss accompanied by a lengthening and flattening of the orbicularis oculi muscle.
- Objectives are often toward restoration of definition, volume, and shape that have been diminished during the aging process.
Expectations:
- It is important to discuss with the patients their goals and expectations to ensure there is understanding between the patients and the injector.