This article was sponsored by Allergan Aesthetics, though the content therein is based on Dr Nicole Kanaris’ professional experience and opinion.

Lately, there’s been a focus on the upper face, which can be attributed to the wearing of facial masks. But then, curiously, there was an influx of patients enquiring about lip fillers. Dr Nicole Kanaris summarises the various factors that are driving this interest spike in lip filler treatments while imparting her professional opinion on how injectors have mastered the art of creating naturally fresh, beautiful lips.

To say that COVID-19 has thrown a huge spanner into the mix is an understatement. As an aesthetic clinic, we initially saw a shift from full facial rejuvenation packages to a major focus on the upper face – particularly around the eye area (this is clearly attributed to the constant wearing of facial masks). But then a curious thing started to happen: we began seeing an influx of patients enquiring about lip fillers.

But why? What is the reasoning behind the sudden interest in this particular treatment?

Well, upon closer inspection of what the various possible factors may be involved in motivating individuals to seriously consider having lip fillers done, there appeared to be a few driving influences.

These being (but not limited to):

Patients being able to hide their swelling and possible bruising from the world now due to mask-wearing and working from home
The introduction of a new Russian lip technique that has taken social media by storm
Or, perhaps, it’s because people are now spending most of their days looking at themselves in Zoom chats, that it has ultimately led them to pay more attention to their mouths

Whatever it may be, there’s no denying that lip filler treatments are on the rise.

Debunking the lip filler myth

For a lot of people, lip filler is synonymous with huge lips… which is really not true of all lip filler cases. Indeed, most medically qualified injectors want their patients to leave with beautiful yet natural-looking lips.

The ageing lips

There are four things to consider that all play a major role in the ageing and structure of the lips:

A loss of bone projection and fat
Change in muscle strength
Thinning of the skin
Dental deficiency

Lip fillers – the real deal

First, lip fillers are a non-surgical procedure done to sculpt, fill, hydrate or enlarge the lips. They can be done to correct asymmetry, improve smoker’s/ barcode lines, and lift the downturned corners. And since they are bona fide medical procedures, lip fillers can only be performed by a trained doctor or dentist in South Africa.

A Danish study found that at first impression, the three attributes that make people appear older were:

The greying of their hair
Their lip height
The wrinkles of their skin

This is why lip enhancement treatments are about more than just beautifying the face: they’re part of how our age is perceived¹. As we age, we start to lose bone (which gradually increases after the age of 35). This ultimately causes the upper lip to lengthen, while the lips invert as well.

Interestingly, women have up to a 31.79% thinner upper lip than men of the same age², thus making for more wrinkles around the mouths of females.

Another important fact: lips do not live in a vacuum

The area concerned is the peri-oral region, which is surrounded by the piriform fossa, the maxilla, the mandible, the chin, as well as the masseter muscle. The interplay between all those anatomical areas does, in fact, exist.

Now, while many clinics talk about a ‘lip filler treatment’, many injectors have recently started to move away from this way of thinking in order to treat the face as a whole.

Often, just injecting one specific area – such as the lips or cheeks – can leave someone looking abnormal or have a knock-on effect in another area (for instance, the lips are too large for the chin). A holistic, anatomical facial assessment that incorporates every part of the face should therefore always be done to achieve a more natural look.

A lip treatment should never be done in isolation

Cosmetic injections are all about creating facial balance – including lips that match your face, rather than leading your way into a room It must be noted that the anatomy of the lip and mouth area is actually rather complex. The lips are composed of several different parts – namely the vermillion border, the body of the lip, and the philtral columns.

The body of the lips also consists of wet and dry sections, with the philtral columns being the vertical ridges that run from the Cupid’s bow to the nose. Each of these areas has a different stiffness and move differently.

Hence, during the assessment of your lips prior to any lip filler injection, the lips should always be examined at rest as well as in movement.

Additionally, lip filler techniques should vary according to lip shape, patient age, dentistry and environmental effects on the face and skin. There is not a one-fits-all mould of treatment for lip fillers.

Individualisation is the keyword

Different analytical tools can be used, such as callipers and the golden ratio of beauty (commonly known as the divine proportion or phi)³. Our perception of beauty is based on the ratio proportions of 1.618. The ideal ratio of upper to lower lip volume is 1:1.6 (the lower lip should have slightly more volume than the upper lip.) But there are some rare cases where people have 1:1 top to bottom lip ratio naturally and yet still look beautiful.

The fine art of injection technique

Injection treatments and injecting techniques are increasingly becoming so sophisticated that it is now regarded as a highly refined skill set. Injectors are gaining superior knowledge and improved injection skills due to the availability of technology and cadaveric dissection. New injecting strategies and variable product choices mean a good injector needs to be both artist and a scientist.

And thanks to the excess of time spent in lockdown worldwide, patients are not only researching products and skillsets, but they have also become choosier about who injects them, as they realise not all injectors or products are alike.

Final thought

We are hoping that in 2021:

We know that bigger isn’t always better
Bigger is out, and balance is in
Treatments are injector-run, where patients are educated on a holistic approach to the face as well as being reminded that the face is 3D. What looks good from the front does not always look great from the side.

Disclaimer: This article was sponsored by Allergan Aesthetics, though the content therein is based on Dr Kanaris’ professional experience and opinion.

References

1 Gunn DA, Rexbye H, Griffiths CEM, Murray PG, Fereday A, et al. (2009) Why Some Women Look Young for Their Age. PLoS ONE 4(12).

2 Bonati LM, Fabi SG.(2017) Treating the Young Aesthetic Patient: Evidence-Based Recommendations. J Drugs Dermatol. 1;16(6)

3 Prokopakis E, Vlastos IM, Picavet V, et al. (2013) The golden ratio in facial symmetry. Rhinology 51:18-21.

Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.

Dr Nicole Kanaris

Med Aesthetique | +27 11 524 0991 | medaesthetique@modedevie.co.za | Website

MBBCH (Wits)

An experienced doctor with a special interest in aesthetic medicine www.medaesthetique.co.za
International speaker, artist, author, international trainer and medical correspondent
Multi-award winning doctor globally
Her current brainchild is her mentorship program, the first of its kind in South Africa. Dr Kanaris trains and inspires young doctors to build a successful career in aesthetic medicine.

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