Lip augmentation has become a big part of my injectable practice in Manhattan, Long Island, and Westchester. There is an exciting new product about to be sold in the U.S. that will significantly change the results that can be achieved.

WHAT ARE THE BASIC CONCEPTS WHEN USING LIP FILLERS FOR THE LIPS?

Over the years my experience has taught me not just techniques to make lips larger, but also to refine lip shape and proportions.  Hyaluronic Acid fillers or HLA’s were a fantastic advance for lip enhancement and have now become the standard injectable for this purpose. There are now many varieties of HLA’s made mostly by Galderma and Allergan.  These dermal fillers are under the general category names of Restylane® and Juvederm®.  There are other fillers on the market but Restylane and Juvederm products are used by most plastic surgeons and dermatologists in New York City, Westchester and Long Island the New York region.

WHAT ARE THE PROPERTIES OF DIFFERENT FILLERS USED ON THE FACE? HOW DO YOU DETERMINE THE BEST DERMAL FILLER TYPE TO USE ON THE FACE?

Those of us with large injectable practices in the New York area have learned to appreciate the subtle differences between the variety of available fillers. It has become clear that what are desirable qualities for a filler used to enhance the cheekbone, which is firm and relatively immobile, differ from what is required to give a nice natural result for the lips, which should be full yet soft.  The lips need to retain a natural and full appearance as they move through their extreme range of movement from a smile (where the lips are pulled straight and tight), to a ‘pucker’ (where the lips are pushed toward the center).

It is understandable why a filler for the cheekbone would ideally have the quality of firmness as the goal is to enhance the appearance of the shape of the bone beneath. It’s also understandable why this same filler might not be ideal for the lips.  Initially, most facial fillers were used to inject the nasolabial fold- the crease from the corner of the nose to near the corner of the mouth- sometimes described as the ‘parenthesis’ lines. The original versions of Restylane and Juvederm were firm, but not too firm, and would typically last about 9 months when injected properly.  They were a good choice for these folds.

WHAT ARE THE BEST QUALITIES FOR LIP FILLERS? WHICH DERMAL FILLERS ARE BEST OF THE LIPS?

Lip injections require a filler with very different properties than the original versions of HLA fillers.  Injections with the original Restylane or Juvederm typically results in a nice-looking result, although delicate changes are not possible.  Perhaps the biggest issue of concern to patients is that frequently there is dramatic swelling after injection.  This swelling can last 3-5 days and is a huge drawback to using these products as lip fillers.

Both the Restylane and Juvederm product lines now have additional injectable fillers chemically similar to their original products and, while the original products remain on the market, I feel they have limited use – especially as lip fillers.  I prefer the Restylane product line in general for a variety of reasons so I can discuss their offerings more completely.  I do many lip injections in my practice locations in Manhattan, Yonkers, Roslyn and Greenwich, so I can appreciate the subtleties of the different available options for different facial areas.  For the past few years I’ve been using Restylane Refyne filler for lip enhancement.  The big advantage to Refyne was its elasticity.  Traditional HLA fillers were best for areas that didn’t move much, but for the lips, elasticity is a great advantage.  In addition, patients frequently have minimal or no swelling with Refyne.  Refyne has some drawbacks in how delicately we could contour the lips.  It is also a bit too soft and it doesn’t last as long as some other fillers, with some patients seeing significant loss in only 3-4 months.

WHAT IS RESTYLANE KYSSE AND HOW DOES IT DIFFER FROM OTHER INJECTABLE FILLERS?

The big news is that Restylane is about to release its newest filler, designed specifically for lips.  This new version of Restylane has been used in Europe for about a year now under the name Restylane Emveril. In the US it will be released with the very appropriate name Restylane Kysse! Restylane Kysse was designed to fulfill all the needs as the ultimate lip filler.

HOW LONG WILL MY LIP FILLERS LAST WHEN USING RESTYLANE KYSSE?

Based on the latest studies, results with Kysse were visible for one-year.  It is elastic, similar to Restylane Refyne, and is slightly firmer.  There is typically minimal if any swelling with this product which is also wonderful and similar to Refyne.  In the most recent study, 96% of patients felt their lips looked natural with Restylane Kysse, and patients thought their lips felt more natural.

WHO SHOULD BE INJECTING RESTYLANE KYSSE?

As with any cosmetic treatment, the most important variable is who is doing the injections. You should always be careful when the ‘Injector’ isn’t a Plastic Surgeon or Dermatologist.  This is common in New York and Long Island although I’m seeing this more and more in Westchester and Greenwich. Many doctors in different specialties are doing injections – even GYN’s, Internists and Dentists!  In fact, there is a Pulmonologist in Ardsley, near one of my Westchester, NY offices, who is happy to do your lip injections as well as other dermal filler or Botox injections. Just be careful and do your research. Would you advise your child to have injections by a Dentist or Internist?  If not, then you shouldn’t either.

WHAT ARE THE BEST RECOMMENDATIONS FOR LIP FILLERS NOW?

It’s surprising that most lip injections are still being done with the older fillers. In my practice in Manhattan and Westchester I typically have 4-5 different filler types in stock and available for different uses.  With my experience, the properties of different fillers help me to achieve the ideal result on a patient. I will continue to use Restylane Refyne for some situations, and Restylane Kysse for others.  I expect there will be some cases where I use them both.  Restylane Kysse will be a huge advantage in addition to Refyne.  Restylane Kysse and Refyne are unique products.  No other company makes anything identical.