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Dr Tim Pearce
Restoration of lips, more commonly used in older patients, is different to augmentation of younger lips. The goal is always a natural result, by definition, and relies on a wide range of injection techniques and approaches, including those interventions traditionally used for beautification and augmentation of the lips. The aim is to restore the lips back to a more youthful aspect.
In this blog, Dr Tim Pearce will share some expert tips on how to treat ageing lips with restorative techniques. This educational piece is based on content from the world’s first online lip training with interactive 3D anatomy and injection animation – introducing the 8D Lip Design training course.
How to understand and restore ageing lips
Following a medical model, the interventions used to restore lips should be applied sequentially and with discretion, depending on the degree of restoration required. To get to grips with how this should be approached, you need to understand the ageing of the lip, and then you can design your treatment plan.
As aesthetic clinicians we must be aware of both the aesthetic and underlying anatomical changes that occur in the ageing lip, many of which your patients will be unaware of until you explain them during the consultation.
- Volume loss
The ageing sequence of the lips starts with the earliest signs of volume loss in the lips. A slow reduction in cell turnover and metabolism may result in a reduction in hyaluronic acid and other glycosaminoglycans, combined with intrinsic ageing and UV-related damage to collagen and elastin causes the lips to slowly deflate. - Contour loss
Next hit are the contours of the lip. Lips may start to look less hydrated, compared to when youthful, and lose some of the curvature and colour-contrast. This can start to happen to patients in their mid-30s, but of course at that age, they are unlikely to openly state that they have ‘ageing lips’ or take kindly to your use of such terminology; be discrete in your explanation. The definition of the lip will remain good, but there is complexity and small lines in the lip body. - Proportion loss
Beyond the first stage of lip deflation, there may be a reduction in the proportion of the lips relative to other structures. The contraction of the orbicularis oris muscle at rest and slight involution of the lip, usually in the top lip first, may result in an overall reduction in the dominance of the lips relative to their surroundings. - Detail loss
Features and details including curves, lower lip angles, the vermillion border, and the Cupid’s bow tend to all become softer and less sharp as the lip ages. Along with the relative curves and contours of the vermillion lip, tubercles are less defined, the lip shrinks and loses shape. - Structure loss
Eventually, the loss of volume leads to an overall loss of structure – projection, volume, proportion, and the details. Lines and shadows disrupt the vermillion and the skin surface around the lips. There is continued loss of height and width in the vermillion and elongation of the upper lip occurs. Lips become hyperdynamic with extremes of compression and stretch of the oral aperture during normal expression. There is an overall decrease in the volume of the whole face at this stage, including the lip envelope, which leads to stark loss of definition and projection, most noted in profile view. The lower lip may project more than the upper lip, and the philtrum may become elongated. - Skin quality
Glycation of the skin may result in deeper wrinkles around the lips that cannot be targeted with dermal fillers, necessitating skin resurfacing.
Treatment approaches for the ageing lip
Anti-ageing dermal filler treatments are highly dependent on the stage of the ageing process – volume loss, contour loss, proportion loss, detail loss, structure loss, and skin quality – with different strategies required to treat the different elements. This starts with slight volume replacement, followed by treating proportion, details, structure, and severe volume loss as part of a comprehensive restoration of the lips.
Consider reading another of Dr Tim’s blogs on the best filler injection techniques for older lips.
Treating vertical lip lines
Patients will often present complaining of creases in the upper and lower lip, despite it often being a later part of the lip ageing process. During the consultation, a skilled aesthetic clinician can educate and inform their patient why structure, details, and the definition of the lips must be treated instead of focusing on individual lines. If you attempt to treat the vertical lines in isolation with parallel injections, you will inadvertently augment the dermis of the lip increasing its dominance over the vermilion lip and creating a Homer Simpson or simian appearance. Both patients and practitioners must understand that a more holistic approach is required which may include more volume in total, but will result in a more natural result.
Patients with vertical lip lines are best treated in a prescribed approach which includes serial puncture with very low volumes of filler, horizontal injections to resist muscle activity (starting, if indicated, with defining injections in the vermillion border and including some volume in the lip body), horizontal injections (with needle or cannula) under the dermis of the upper lip, and rarely volumising of the lip beneath the orbicularis oris muscle, done usually with a full face treatment for harmony. The full breakdown is explained and demonstrated in Dr Tim’s 8D Lip Design training course.
Treating mild volume loss
In patients with subtle signs of lip ageing, good proportion, definition, and details, with no loss of structure, a hydrating-like dermal filler treatment is sufficient using low volumes of a low G-prime product.
Treating contour loss
Beyond hydration, it may be appropriate to add back some of the lost contours to the upper and lower lip tubercles which have a bias towards volume in the medial section. When looking in profile view, there should be a round, curved surface between the vermillion border and the wet-dry border which may benefit from restoration with a higher G-prime dermal filler. There are several approaches to achieving this within the 8D lip design parameters.
Treating proportion loss
If the patient’s lips have become proportionally smaller with age, it becomes more appropriate to add volume across the entire length of the lip, as well as the tubercles, using linear threads or elongated boluses of product. The goal is to add additional height and occasionally a small amount of width to the lips.
Treating details and definition loss
If, alongside volume and proportion loss, there is a loss of definition and detail of the vermillion border, lower lip angles, and Cupid’s bow, it becomes appropriate to treat these areas with dermal filler using sculpting techniques such as horizontal injections along the vermillion border, bolus injections at the GK (Glogau-Klein) point, and treatment of the philtral columns.
Any lines that remail after the main restorative approach can be treated conservatively using a serial puncture or micro-bolus technique into each crease with a low G-Prime product. This is a tricky technique which is thoroughly explained and demonstrated in Dr Tim’s 8D Lip Design training course, alongside other techniques to strengthen the area for persistent lines.
Treating structure loss
In the most severe cases of volume loss in the lips in older patients, it can be appropriate to attempt to restore volume underneath the orbicularis oris muscle. Due to the presence of the superior and inferior labial arteries, this should be approached cautiously using a cannula and with advanced training and skill.
The take home for treating ageing lips is to start with the areas that require significant treatment and the areas which are foundational. Follow a path that treats loss of structure, volume, definition, detail, and then consider any fine lines and wrinkles – that is, if they are still there after you have addressed all the losses.
8D Lip Design
With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.
If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.
