When I began my career as a physician assistant, I had no idea how much the world of dermatology would change. The introduction of Botox Cosmetic started a trend in anti-aging that would never turn back. Since then, collagen stimulators and dermal fillers have become wildly popular. With such advancements in cosmetic dermatology, just about any facial enhancement can be achieved without surgery and with minimal-to-no downtime. Which is what I want to discuss: the art of beautiful lips at any age.
As expected, patients in their 20s have different concerns than patients in their 50s. However, the overall goal is the same: achieve the look that’s best for you. The path to that goal is very individualized, but age plays a role in determining the best treatment options. I would like to take a moment to outline the physiological side of things then give my top recommendations for patients throughout the decades.
Science Doesn’t Lie
As we age, collagen breaks down, and the fat pads that support our features start to gravitate downward. These two processes go hand-in-hand. Without as much collagen (a.k.a. you skin’s support structure), the fat pads have nothing to hold them in their youthful locations. Couple this with bone loss, and you’ve got aging in a nut-shell.
Aesthetically Pleasing Lips
Everyone knows what poorly injected lips look like – stiff, over-filled, widened mouth. My guidelines are simple:
- Your lips should not enter the room first.
- Your lips should not be the topic of gossip.
- Your lips should have natural movement.
As I always say to my patients, “We’re going to start with a mirror, and you’re going to tell me what bothers you about your lips.” Then we determine a plan that addresses your concerns, is age-appropriate, and complements your facial features. While there is no cookie-cutter method for enhancing lips, there are a few guidelines that we adhere to at Premier Dermatology.
Aging affects all of the major attributes of the lip. Applying the rule of thirds, youthful lips are those that have 1/3 of the fullness found in the upper lip and 2/3 in the lower lip. The cupid's bow, philtral columns, and vermillion border all have definition, the oral commissures (corners of our mouths) are straight-lined, and the lips have a healthy, rosy-pink tone.
About Lip Fillers
In an age of being “clean,” there’s no doubt that I get asked this question all the time: are fillers safe to inject into my body? Yes, yes, and yes. My favorite dermal fillers are hyaluronic acid (HA) gels. HAs are naturally occurring in our bodies and are water-loving. They are responsible for keeping our skin cells healthy and plump by drawing water to them. Not surprisingly, HA production slows down as we age. SkinMedica®, a leader in medical grade skincare, has this to say about hyaluronic acid:
"Hyaluronic acid is a natural, "water-loving" substance found in the skin—acting as your body's natural hydrator. HA holds in moisture, keeping skin healthy, resilient, and supple. With age, the amount of HA in the skin decreases, diminishing your skin's ability to remain hydrated. Between the ages of 40-50, your skin has lost 50% of the HA it had at age 20."
To put this in terms of lips, compare lips that are hydrated and lips that are chapped. Which is more aesthetically pleasing? Which looks fuller and more youthful? If you need more visualization, consider a grape to its dehydrated self, the raisin.
As can be imagined, the science behind creating HA gels for injectable treatments is a work of art on the molecular level. The Juvederm® Collection of Fillers and Restylane® products make up about ten of the most commonly used HA injectable gels in the US. Why so many? Each product varies in a few key factors: moldability, g-prime, longevity, etc. In other words, how the product looks, feels, holds, and lasts under your skin is what determines which product is used by the injector.
Lips in the 20s
What patients say: “I want more lip!”
For most 20-year-old patients, it’s all about volume. Patients in their 20s have excellent facial framing, bone density is at its prime, and collagen loss is in the distant future. Basically, 20-year-old patients are desiring lip treatments as an enhancement to their already youthful appearance.
Recommendation
Personally, I am not an advocate of over-filled lips. I prefer to give my younger patients lips that are naturally fuller. My goal is to improve the pout by applying the above-mentioned rule of thirds. Juvederm® Volbella is my favorite product for achieving this goal. The hyaluronic acid based gel is highly moldable and provides movement that is natural.
Lips in the 30s
What patients say: “I feel like I’m starting to lose my lips.”
Turning 30 begins the first of many aging landmarks. After the age of 29, we can expect to start losing 1% of collagen every year and hyaluronic acid production starts to slow. For most patients in this age range, they notice that their lips aren’t quite as plump or as “crisp.” They feel the need to use lip liner and reapply lip color religiously.
Recommendation
My conversation starts with hydration then moves to definition. Since the changes are so subtle during this decade, I suggest filling the lips to a point that provides a hydrated look – not always plumper. In addition, the vermillion border may start to "lose its edge", so to speak. In that case, I recommend relining the lips as well. Juvederm® Volbella is excellent at providing a hydrated look while Juvederm®Ultra or Restylane® is my go-to for vermillion definition.
Lips in the 40s
What patients say: “Where did these lines come from?”
With a bit more collagen loss and a bit less hyaluronic acid, the most obvious side effects of the 40-year-old mouth are fine lines on the cutaneous lip (upper lip). Patients tend to notice that lip liners and lipsticks bleed onto the upper lip and into the fine lines. They start reaching for their lip stains! At this point, the vermillion border is losing significant definition – flattening is occurring – and the lip body is losing volume. Lips even start to lose pigmentation giving a less vibrant appearance.
Recommendation
I like to call Juvederm® Volbella or Restylane® Silk the “line erasers.” These HA gels can be superficially injected and are perfect for etched lines in the cutaneous lip. If fullness is desired, I often couple this upper lip treatment with Juvederm® Ultra or Restylane to restore volume in the lip body.
Lips in the 50s
What patients say: “I’ve lost my lips. I feel like I’m drawing them on every day.”
Same song, different verse: collagen loss is more dramatic, HA production is significantly decreasing, and bone loss begins in the 50s. When the oral cavity experiences bone loss, patients notice that their cutaneous lip appears longer (the distance between the nose and upper vermillion border) and flatter. What’s actually happening is the lips begin to invert slightly causing the lip body to pull inwards and the philtral columns lose their peaks. Collagen loss shows itself in the oral commissures (corners of the mouth) with a downward turning appearance.
Recommendation
Look local. Treat global. Lips may be center stage, but the full face is most likely in need of some rejuvenation. For patients in their 50s, I suggest rebuilding the support structures around the mouth to reverse the effects of aging.
- Start with Upper Face. Juvederm® Voluma is my go-to product for adding significant volume to cheekbones and temples. Lifting these areas ultimately lifts the skin around the mouth, too.
- Next, Mid-Face. The nasal labial folds (the “parentheses” around the mouth) generally start to become more obvious by appearing heavier or sagging. This is a contributing factor to the corners of the mouth appearing downward turned. By filling the nasal labial fold with Juvederm® Ultra or Ultra Plus, the lines are softened and lifted. Similarly, treating the corners of the mouth with Juvederm® Vollure turns the corners upward to their youthful positions.
- Last, Lips. Injecting Juvederm® Volbella or Vollure into the lines on the cutaneous lip and Juvederm® Ultra into the philtral columns restores youthfulness to the upper-lip. Depending on each patient’s desired result, I would also recommend redefining the vermillion border and adding subtle volume to the lip body.
Let’s Wrap this Up
The best advice for keeping youthful lips is to not wait! Continual maintenance and care for your skin will prove beneficial throughout the years. Much like our bodies, our skin requires constant care. You can't expect to go to the gym one time and be in shape for life! The same is true for your skin.
In preparation for lip enhancement, we always recommend stopping the use of any blood thinning agents (ibuprofen, vitamin E, fish oil) seven days prior to help reduce the chance of bruising and minimize swelling (the most common side effects). After about 7-10 days, swelling will subside and the results are in full-effect! With newly treated lips, I always recommend SkinMedica® HA5 Smooth & Plump Lip System to enhance the results.
Regarding any injectable treatment, I never want my patients to return to ground zero. As I tell them, you want to be ahead of the game and maintain your results - not fully metabolize them and start over. Depending on the product and your body's metabolism, you can expect lip fillers to last 6-12 months.
If you are curious about lip enhancement, I encourage you to see me or any of the expert injectors at Premier. Let us find the right lip that is right for you!