INTRODUCTION
Over the past 25 years, rejuvenation of the aging face with the use of soft tissue fillers has seen a significant rise in popularity. This minimally invasive procedure at a relatively modest price point has become increasingly desirable to both male and female patients in their efforts to attain a more youthful appearance and modify existing facial features. The lips in particular have historically been a major component of the face that contributes to overall attractiveness and youthful appearance.1,2 As a result, requests for lip augmentation are common in dermatology practice.
Although a variety of injectables exist for facial rejuvenation, hyaluronic acid (HA) fillers have become a mainstay of minimally invasive soft tissue augmentation, in particular for the lips, due to their versatility, biocompatibility, and reversibility with hyaluronidase. In order to provide successful and pleasing lip augmentation for patients, a thorough understanding of lip and perioral anatomy, the properties of the various HA fillers, and injection techniques are critical. Here we review relevant anatomical components of the lip and perioral area, the properties of HA fillers that are approved by the US Food & Drug Administration (FDA) for lip augmentation, and the most frequently described and efficacious injection techniques based on the area of the lip being enhanced.
Although a variety of injectables exist for facial rejuvenation, hyaluronic acid (HA) fillers have become a mainstay of minimally invasive soft tissue augmentation, in particular for the lips, due to their versatility, biocompatibility, and reversibility with hyaluronidase. In order to provide successful and pleasing lip augmentation for patients, a thorough understanding of lip and perioral anatomy, the properties of the various HA fillers, and injection techniques are critical. Here we review relevant anatomical components of the lip and perioral area, the properties of HA fillers that are approved by the US Food & Drug Administration (FDA) for lip augmentation, and the most frequently described and efficacious injection techniques based on the area of the lip being enhanced.
DISCUSSION
Lip and Perioral Anatomy, Lip Metrics
Successful lip and perioral augmentation begins with a thorough understanding of anatomy as a firm knowledge base leads to reduced risk of adverse events and maximizes successful enhancement of lip and perioral structures. The anatomical boundaries of the upper lip consist of the base of the nose superiorly, the mucosa inferiorly, and the nasolabial folds laterally. The boundaries of the lower lip include the mucosa superiorly and the mandible inferiorly, with the oral commissures comprising the lateral borders.3 There are features of the lip and perioral area that define its aesthetic: the white roll, the Cupid's bow, the philtral columns that flank the philtrum, and the tubercles of the upper and lower lip (Figure 1).3 It is paramount to preserve and accentuate these structures when using injectable fillers.
Successful lip and perioral augmentation begins with a thorough understanding of anatomy as a firm knowledge base leads to reduced risk of adverse events and maximizes successful enhancement of lip and perioral structures. The anatomical boundaries of the upper lip consist of the base of the nose superiorly, the mucosa inferiorly, and the nasolabial folds laterally. The boundaries of the lower lip include the mucosa superiorly and the mandible inferiorly, with the oral commissures comprising the lateral borders.3 There are features of the lip and perioral area that define its aesthetic: the white roll, the Cupid's bow, the philtral columns that flank the philtrum, and the tubercles of the upper and lower lip (Figure 1).3 It is paramount to preserve and accentuate these structures when using injectable fillers.
