Q. Is there a noticeable difference between Juvederm and Juvederm Ultra Plus on lips?
A. There are 2 major producers of hyaluronic acid (HA) gel fillers in the US, Galderma and Allergan. Each pharmaceutic makes the same molecule and cleaves or filters the molecules to different sizes and shapes providing various nuances in their hydrophilic absorption (water attraction), fill, projection and stiffness.
Each of the various anatomic areas of the lips to be filled requires different attributes of rejuvenation and therefore different gels to achieve the look you want based on the aging anatomy of each person. So, each filler does best with different filler depending on the patients desired lip fill, white line appearance, projection, poutiness, lipstick lines perioral lines and commissures.
Regarding the lip area:
- Lip fill includes the dry pink vermillion and the oral wet vermillion:
- Dry Pink Vermillion: It is this area that most injectors use gel fillers. Unfortunately, this is what leads to the oversized, celebrity styled and unusual “trout pout” or over-sized bee-sting lips. I find that smaller amounts of Restylane or Juvederm Ultra achieve a plumping pillow effect expanding the pink-lip lines to smoothness.
- Oral Wet Vermillion: for those patients with an “over-bite” of the upper teeth, small chin and small or lost lower lip, Restylane Lyft and Juvederm Ultra Plus (JUP) provide the fill and projection of the internal lip to push off the bottom teeth creating lower lip prominence and rolling the lip over for added poutiness.
- The White Line or White Roll is the bead-like edge of white projection along the outside of the dry vermillion. This “bead” thins and breaks up with sun-damage, aging and pursing the lips (like with kissing or smoking). The filler best used to restore this line requires more stiffness to project and stay longer and firmer. I use Lyft and JUP and continue onto the commissure folds which require substantial resistance against the folding of the cheek/jowl skin.
- The bilateral commissures are created by the effects of gravity along the cheek/jowl and chin and the dermal thinning effects along the corners of the mouth. A larger filler molecule providing skin projection and resistance against the skin fold and gravity are best in this area; such as Lyft and JUP.
- Outside of the white line and radiating like the rays of a sunburst are the lipstick lines. Too little filler and pursing causes them to wrinkle. Too much filler and they project to far off the skin surface appearing washboard like. Too much fill and the pink lip retracts inward while the outer lip is puffy. The best filler in this area is Restylane Silk. This HA gel has millions of tiny molecule fragments and attracts more water than the others. Using it sparingly in a radial and cross-hatched technique provides excellent reduction in line appearance, good resistance to pursing lines and no puffiness.
