Fillers-Lips & Perioral

General Information
& Perioral

Who does the injections?

In many offices nurses, interns or other staff perform filler injections.  It is important for our patients to realize that Dr. Niamtu personally does 100% of the filler treatments.  Last year Dr. Niamtu personally injected over 1,760 syringes of filler putting him in the top 10 percent of injectors nationwide.

How Are Fillers Administered?

Fillers are injected through small needles. Dr. Niamtu goes to great lengths to make this procedure painless. All patients are first treated with numbing cream on the areas to be injected, then several small dental injections of local anesthetic are given to totally numb the lips and related areas for a truly painless procedure.  Many surgeons do not take the time to properly their patients and Dr. Niamtu has had many patients switch to his practice because of his painless injection technique.

Dr. Niamtu has written numerous journal articles and textbook chapters on filler technique and local anesthesia techniques for painless filler injection. They can be seen by clicking on Plastic Surgery Products: Voluptuous Lips or on Dr. Niamtu’s Online Library.

The filler is then injected in the lips, wrinkles or folds. The actual injection only takes minutes. Ice is placed on the lips immediately after the injections. The lips generally swell somewhat but most patients are able to return to work the next day. Rarely, some patients experience more significant swelling. For this reason, a first time filler patient may want to be treated on a Friday. It is also a good idea to refrain from aspirin or drugs that delay clotting for 1-2 weeks to decrease bruising when injecting fillers.

Dr. Niamtu recommends having the patient return in two weeks to check the result and make sure everything is symmetric. Occasionally a touch up may be performed at the follow up appointment. It is important to view filler injection as a sculpting process and in some cases multiple appointments are required to provide that special result that patients desire.

Filler injection to plump the lips, Richmond VA
Filler injection to plump the lips.

In the lips, the filler is used to enhance the natural lip outline and definition that is lost with aging. It is also used to plump the lips to actually make them bigger and to show more of the red lip. Careful attention to detail allows very natural enhancement. Patients that have been overdone are quite obvious. Many factors go into making an aesthetic lip. Just making lips bigger is not the answer and can look quite fake. For most patients a single syringe of filler is adequate to plump both lips.

The above image shows the two most common areas of the lips to be enhanced.  The left picture shows a technique to outline the lips. This is done to provide definition for those patients that do not need or want larger lips.  The picture on the right shows the deep fill method and is used for patients that want more “air in the tire” of fuller lips.  Dr. Niamtu may use either of these techniques or frequently combine them depending on the amount of aging and desired augmentation.

The images show a case of filler lip augmentation by Dr. Niamtu

How can you predict what your lips may look like with filler?

One way to get a idea of how your lips may appear when plumped with an injectable filler is to use your fingers and roll out the upper and lower lip as shown below.  This simulates the addition of volume augmentation with fillers.

Technique to "try out" lip enhancement with injectable filler, Richmond VA

I Hate Needles!

Dr. Niamtu has developed a technique to inject lip fillers without using sharp needles.  This technique was published in the journal Dermatologic Surgery in January 2010 and involves using a small blunt device that is known as a cannula.  The cannula is inserted in the lips through a small puncture and since it is blunt, swelling and bruising are rare.  By using the cannula, Dr. Niamtu is able to avoid multiple sharp needle punctures and this technique cuts the treatment time to less than a minute for most lips.  The following pictures are before and immediately after injection with the Niamtu Micro Cannula technique and are evidence of the immediate result without swelling and bruising.

click above to enlarge

Click here to see a video of Dr. Niamtu demonstrating the “needle-less” cannula technique with the Dermasculpt Cannula

The Tulip injector cannula is a very small cannula with a blunt tip that also provides excellent lip filling with less trauma.

Turning the Frown Upside Down

Many patients present with aging changes around the mouth that causes the corners of the mouth to turn down which makes us look older and sad.  Injectable fillers can be  placed in the corners of the mouth to actually uplift the down-turned appearance, giving the patient a more youthful and happy appearance.  Dr. Niamtu numbs the area first to make the procedure painless.  In addition, a small amount of Botox or Dysport can be injected in the muscles that make the frown.  Relaxing these muscles in addition to the filler can turn a frown upside down.

The patients shown above has down-turned corners of the mouth. The left side (L) is shown immediately after filler injection and the right side (R) has not been treated.  The arrows show the down-turned right side and the improved left side.

Lip Lift

As we age our lips become longer and lose form and volume.  Dr. Niamtu can perform a lip lift procedure to shorten the upper lip and roll it out for more youthful volume.  View more on lip lift.

Lip lift with injectable fillers