There are so many dermal fillers on the market that it is often times difficult to sort out what to use where and when. This short article will focus on some trends in dermal fillers used for the lip and perioral region. Each injector has their own preference, but this will just outline some of the more common perioral fillers.
In my opinion, hyaluronic acids are the best fillers for the lip area. They are more forgiving and can be “erased” if there are resulting asymmetries or lumps.
One of the newest hyaluronic acids on the market is Juvederm Volbella®, manufactured by Allergan. This is a unique product because it is much less concentrated than the average filler, being only 15mg/ml. Hence, it is a very soft and easy to inject product. Volbella comes in a 0.55 cc syringe and is indicated for the lip and perioral region. This product is useful for defining the lip region, rather than volumizing. Injectors need to get used to the lack of resistance while injecting this product, since it is so soft. It is easy to initially inject too much volume.
If a patient wishes to have more volume in their lips, Restylane® Silk, Restylane L, Juvederm® Ultra XC or Belotero Balance® are great products. These products can be used to define the vermillion border, but also to enhance the volume of the body of the lips.
Belotero is a great product for the vertical lip lines, because it can be injected very superficially. There is no lidocaine in this product and this can be a painful area to inject, so consider mixing with 0.2cc of lidocaine.
Each injector has their preferred technique, but the main perioral regions to inject are the vermillion border, the body of the lip at the wet to dry border, the oral commissures to turn up the corners of the mouth, and the vertical lip lines. It is important to maintain the normal ratio of the upper to lower lip, which is approximately 1:1.6 (the lower lip should be about 60 percent fuller than the upper lip).