Category Archives: Juvederm

My thoughts on Lip Augmentation

red lips isolated in white

Picture is not of a an actual lip augmentation patient


Lip Augmentation

I perform lip augmentation with fillers such as Restylane and Juvederm ultra.  I have occasionally used Juvederm Ultra plus for more dramating lip augmentation effects.  This write-up serves it’s purpose for me to put down on paper some thoughts flying around my head regarding excellent lip augmentation.   My thoughts on Cannulas for Lip Augmentation.  Much of the info here is considered off-label FDA usage.  Nothing here is meant to be personalized medical advice – just a generalized discussion here.

Does Lip Augmentation Hurt?

The procedure is done in my office in Modesto, CA.  There is no IV sedation or pill sedation or general anesthesia.  There are options of numbing cream, ice, nerve blocks, mucosal blocks, and lidocaine within the product.  Some lip augmentation patients choose all these options so that they feel pretty close to no pain.  Some patients just choose just one of these numbing options as each one does take time and patients at the office visit.


Demonstration of Lip Augmentation with Juvederm, posted with permission from my patient.

My thoughts on  Lip Augmentation

There are several parts of the lip to consider.  First is the ratio of the upper lip tot he lower lip.  Most patients like their lower lip on the larger side.  Then there’s the part around the lip which needs to be considered.  With some extra support of the white areas around the lips – this area can use a half to whole syringe just to expand out the fine line around the lips.  Volume loss has occured here.  Take all these into consideration, then there’s the best part – augmenting the red part of the lip.

There’s three general locations to consider for injecting into the red part of the lip – my own thoughts:

  • injecting filler right at the edge of the lip to add definition
  • injecting into the belly of the lip to add forward projection and fullness
  • injecting near and at the wet-dry border of the lip to create more vertical curl of the lips.

I’ve come up with these thoughts as I’ve gained more and more experience via lips.

How many syringes of fillers needed for the lips?

considering the three locations for injecting into the lip and the white part of the lip.  One could use 2-3 syringes of Juvederm or Restylane for the project already.  However 1 syringe of Juvederm or Restylane has been the choice of many due to cost concerns and also 1 syringe does a wonderful job for many lips, and not everyone wants all aspects of the lips (definition, fullness, and curl plus the perioral lip lines) to be changed.

So quick answer: Most of the time just one syringe of filler.

There’s much more to this subject of Lip Augmentation

But this is a start.  I wrote down this information mainly for myself to help organize my thoughts on the topic of Lip Augmentation.  A personal consultation regarding lip augmentation would reveal specific personalized information which would be much more useful than this article.

I usually use temporary injected fillers for lip enhancement rather than permanent lip implants

There are many options available for lip augmentation.  I normally choose products which can be reversed and also are precise in the results which we are looking for.  Many patients consider getting lip filler placement ever 4-8 months.

Permanent lip implant options exist.  Perhaps we’ll explore those in the future.  For now, we’ve taken out several of these done by others.  I do think that there is a role in the overall lip enhancement world for these permanent products, but I’ve been personally very happy with hyaluronic acid type fillers for the lips such as Juvederm and Restylane.

What makes Lip Augmentation so difficult?


Lip augmentation is somewhat challenging.  But as surgeons we usually like challenges and are very satisfied to get great results.

There are many different ways to achieve lip augmentation.  The three different locations for fillers and in different ratios of material allows for different effects.  The challenge here stems from having so many variables.  But we have to match these variables to:

  • Patient expectations – what is the patient’s definition of duck lips – do they want to avoid that?
  • Lip symmetry – this is a big importance between left and right sides.  Many patients are not symmetrical to begin with.
  • Lip filler product bumpiness – visible and palpable (able to feel).  We want to try to avoid this as much as possible
  • Lip bruising afterwards – this does happen and is a risk of the procedure.  I think it happens a lot more often than not.
  • Lip area tends to have more pain fibers and thus there’s the challenges and difficulties of achieving comfort for the patient.  Everyone is different when it comes to pain sensation.  But almost everyone would agree that lips are particularly more sensitive.  But we have options to include performing nerve blocks – like going to the dentist.
  • Lip lines around the lips should be addressed too.
  • The issues of infections around the lip. The lips are one the least “sterile” areas of the face to work on.  And some patients even have the challenges of cold sores.  We try to anticipate these problems and have prescriptions available at the office for Acyclovir – a drug that helps to shorten the length of active cold sores.
  • Desired ratio between upper lip and lower lip.
  • Some lips can’t take too much product all at once and a staged procedure might have to be done.  We don’t want complications of lip necrosis (dying off).
  • Another interesting challenge:  When doing fillers on the lips we have to deal with the location of the previous fillers done months ago.  Not all of it disappears and we have to be able to work with the previous filler to blend it all together and not allow the old filler to get in the way of the new filler.  For me, sometimes this is the biggest challenge, especially if the previous techniques used for lip augmentation are different from what I’m expecting.
  • This list goes on and on, but I wanted to list a few challenges which I have on my mind when going through the process of lip augmentation.

If you would like, please feel free to contact us:

Surgical Artistry
Calvin Lee, MD
Surgeon who likes to perform lip augmentation
(209) 551-1888.

Dr. Tammy Wu also does lip augmentation, and in addition she also removes permanent lip implants, lip reduction, mucosal reduction, and lip reconstructive surgeries.  But for the most part if on is interested in lip augmentation with injected fillers, Dr. Calvin Lee (me) is in charge of that part of the minimally invasive facial injections.  Lip augmentation is one of the most satisfying procedures that I have.

Experienced Botox and Juvederm Injectors Meeting in Sacramento

Botox Master
Picture of myself and Dr. Yoelin, the Botox
Master of San Diego

Botox injectors meeting

I think in this world the word meeting, course, and program are used interchangeably.

There was a course offering from a prestigious injection course which is offered in various places nationwide.  It’s called the Palette Training program for cosmetic injections – and there are several meetings for different levels of injectors and also specialty sections for things such as tear troughs, cannulas and I believe lip augmentation.  There happened to be a higher level course offered in Sacramento.  Not too far from my location of Modesto, CA.

Botox, Xeomin, Dysport, Juvederm, Perlane, Restylane, Belotero, Radiesse

The word is neuromodulators – which includes Botox, Xeomin, and Dysport.  It’s less brand specific.  This was a 4 hour long CME program (I earn credits for continuing medical education).  The program I selected was led by Dr. Steve Yoelin of San Diego.  He has a super busy Botox and Juvederm (I mean neuromodulator and filler) practice which I’ve heard is booked for many years.  I met him before at the Allergan / Latisse speaker’s training program – this was a training session which guided us through the slide deck for our talks.  I was very impressed by him – he was very supportive which I felt made him the perfect teacher.  While I was on “tour” with my talk for Allergan, I met attendees of my talk who spoke very highly of learning from Dr. Yoelin.  So I figured that I should check this course out for myself.  He teaches all levels of injectors and I selected the highest level which was called a level III course.  I thoroughly enjoyed this course and learned a few tips for my own practice.

Take home pearls on Lip Augmentation and more

I especially appreciated some ideas he gave me for lip augmentation and for filling of temples and lateral eye brow areas.  He did say to use the non-dominant hand to help guide the cannulas in injections.

Another great tip I learned from the Tiger Woods of cosmetic injectors (at my recent trip to Sacramento): While injecting Juvederm, he said I had great control, but would be able to take it to the next level if I used my non-dominant hand more to drive the direction of the cannula (special needle).

Contact us


Marker for Botox Injections

Planning Botox injections – drawing on skin

For some patients, a precise Botox mapping is what I’d like to do as a Botox injector for best results.  However there are some challenges:

  • The marker should be easy to wipe off after the Botox injection because we might not want to agitate the location of the Botox liquid which has been injected under the skin (intradermal or intramuscular).
  • The maker should be fresh so that we have a large supply of the markers.
  • The marker should be visible on the skin and perhaps visible on the lips as well.  Although a green marker might show up better than a red marker on the lips for lip augmentation.

One solution comes from Viscot Medical.

They make a pen alled the Dermarker (Derm-Marker) which is an EZ removal ink skin marker.  Alcohol erases it very easily without much rubbing.

I got a chance to buy a container full of these pens and I’ve tried the markings on my own skin at the Las Vegas Cosmetic Surgery Aesthetic Dermatology Conference.  I think this will work well for me and take my injection skills to the next level.

This marker could be used for areas of filler/Juvederm injection as well.  However, these markers would be a bad idea for Tummy Tuck and Breast Augmentation markings because those are larger areas and require a surgical prep which is going to erase these markers.  The same company makes a pen for these cosmetic surgeries, it’s called the XL prep resistant ink surgical marker.

We’re happy to bring these markers with us home to Modesto, CA from the Las Vegas meeting.

Day 2 Vegas Cosmetic Surgery Aesthetic Dermatology 2013

Advanced Dermatology Section

This was a one of the best days of this educational program for me.  I spent the entire day in the advanced dermatology portion.  There was three sessions going on at the same time.  Most of the lectures I heard were about fillers (Juvederm, Radiesse, Perlane, Restylane, Belotero) and neurotoxins (Botox, Xeomin, Dysport).  This was one of my main goals of this course was to absorb as much as I could about the topic.  I was thrilled to see the European and Russian experiences with Botox, Fillers, etc.  There were also sections on ethnic skin and hyperpigmetation.  It was an eye opener to see a bunch of discussions on the complications of fillers and Botox.  We’re glad we have hyaluronidase in our office as part of a kit for filler emergencies.  There was also a lot of info about hydroquinone and tretinoin.  Did you know that there’s hydroquinone in coffee?  I also saw a lecture where they used ultrasound to help guide decision making regarding filler placement.  There was also a brief discussion of fake filler products.  I liked the idea of using ultra sound gel as a substance to help massage fillers.  There were also a ton of information regarding using blunt cannulas for fillers which is something I’ve been doing.

Factors that affect Different Neurotoxins

  • Dilution
  • Manipulation
  • Physician technique
  • Storage

Key words

  • Retrograde threading
  • Malar flattening
  • Sandwich Volumetry

It’ll be great to bring back all this international information to our cosmetic plastic surgery practice in Modesto, CA.

And after the lectures:

We went to another lecture sponsored by Merz Aesthetics, the makers of Belotero and Xeomin (and Asclera for veins).  The talk was Innovations in Facial Aesthetic Medicine, Mastering the Art and Science of Injectables.  Amazingly it was produced by Paradigm Medical Communications, located in Orangeburg, NY.  Their telephone number is 845-398-5100.  They said they were located on 303.  I have friends who live in Orangeburg, New York and I have a personal connection to that location.  This CME program was 3 credits.

Day 1 Vegas Cosmetic Surgery 2013

First official day of the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference 2013

I particularly got a lot great ideas and info regarding Botox and Fillers (Juvederm).  I was very interested in the way they treated complications.

I also attended sessions that talked about social media, habits of very successful cosmetic practices, blogging, reviews, thank you notes, patient surveys, and the usage of YouTube videos.  I hope to act on much of this.  It was almost info overload.  And this was only day 1.

Plastic Surgery Related Booths we visited

  • Operative headlamp company – about $800 for a head lamp.  3 hour-4 hour battery life. LED bulb!
  • Zein Obagi.  Looked at the differences between Zein Obagi and Obagi
  • Touch MD – incredible stuff indeed.  Touch MD is a technological way to visually share the plastic surgical consultation with the patient.  There’s a program component which resides on the computer and then there’s a “cloud” component where the data resides.  The data can be accessed from many other devices and webpages via secure methods.  This is a great addition to EMR.  And perhaps would be a great addition to our plastic surgical practice in Modesto, CA.  They said that currently they don’t have any doctors in Modesto, CA who have Touch MD.  It also has a back end for picture management.

We were originally going to see a show, but instead we talked with the guys at Touch MD.

TiZO3 and Lip Balm

We found an an amazing Sun Screen for the lips.  It is made by the Fallene company in their Solar Protection Formula line.  TIZO is among one of their products.  Dr. Tammy Wu said that she has been looking for a lip balm that is a physical / mineral based for awhile.  We just found the LipTect product at the Vegas Cosmetic Surgery conference.  Along with this, we also found the  TiZO3 sunscreen for the face.  It has Titanium, Iron, and Zinc.  It is Paraben, Oil, PABA and fragrance free.  It is also tinted and is a very water resistant formula.  We will have the LipTect (Lip balm) and TiZO3 sunscreen available for purchase at Surgical Artistry, Modesto, CA.  Dr. Calvin Lee (me) takes credit for introducing Dr. Tammy Wu to the booth, and Dr. Wu made the decision to make an opening order!  One more reason for this – it would be an great product to protect a lip augmentation investment.