The growing fascination with lip treatments

lip fillerSharon Bennett discusses patients’ growing fascination with lip treatments and considers how to offer them safely, effectively and appropriately.

What percentage of your business is focused on lips?

Of my HA injectables, I would say 65% of my business is lip fillers. However, there would definitely be people who would say 90% because lips may be their primary focus. Lips are a massive market and it’s growing every day.

Have you seen a rise in people wanting lip fillers? What do you think has fuelled this?

Yes, I would say we have absolutely seen a rise, and we’ve seen this rise over the last ten years.

Our demographic has widened considerably – now it’s all the way from 18 up to much more mature patients of 70.

What’s causing this in the younger patients is the presence of aesthetic treatment on social media and reality TV programmes. Shows such as Geordie Shore and Love Island, as well as on the internet, and its acceptability as a fashion statement. Constantly being exposed to this information is hugely influential, especially to the young population.

In the older age group, there’s a trend of being aware of ageing. The awareness that there are solutions, has prompted people to come forwards to seek treatment.

People are a lot more open with their anti-ageing strategies than they used to be. Many products out there, like Restylane portfolio, are displaying a much higher level of safety and transparency with data.

I would say, across the demographics, the improved safety of products and the education available to people of all ages is increasing the growth of the market.

How does the anatomy of the lip vary across patient profiles?

Textbook anatomy is always the same from one person to the next.

However, we know that no two people are the same. If you do a cadaver dissection you are going to see different structures and layouts in the anatomy from person to person.

In terms of looking at the patient in the clinic, every patient has a different bone structure, a different disposition, a different profile, different harmony between the upper and lower lips, and they will have different requirements.

So while we all have the same arteries, veins and tissue, their exact positioning often varies. Our bony base, facial shape, hereditary factors, the way we move, and our muscular dynamics all shape our lips.

Every single person is different, and this does affect how we treat – and what product we choose to obtain the best outcome, or the outcome the patient desires. 

What are the main styles of lip that people look for, and how does this affect your approach?

The styles tend to be very different between different age and/or social factor demographics.

Younger patients generally want fuller lips. I do try to direct them away from getting large volumes of filler that give them a kind of ‘shelf’, and towards a more natural look.

Although volume is generally a very popular request from younger patients I would say 75% of our patients are looking for something that is hydrating, gentle uplifting, rejuvenating and natural.

Most people aren’t looking for that obviously injected lip.

In mature patients, who have thin wrinkled lips, we would use something from the Restylane OBT range (like Refyne or Kysse) that gives them soft, gentle, natural lips.

If we are looking at someone younger who wants a plumper, more lifted and augmented lip then I reach for the Restylane NASHA (non-animal stabilised hyaluronic acid) range and use Classic or Lyft.

Do you have any tips for safe and successful treatment?

I think the important thing is to know the anatomy of the lip.

Another tip is injecting the appropriate product, because the lips are not like the rest of the face.

Lips swell, they require very precise placement at the correct depth. They are not as forgiving as areas such as cheeks.

We must remember that lips are mobile, and we use them constantly to eat, speak, smile, kiss, whistle, blow, drink.

We need to use products with smaller particles. Ones that are more homogenous to give a more natural-looking lip and to allow movement and flow. Rather than compressing the movement with inappropriate or too much filler.

Another tip is looking at the profile. Don’t just look at the front of their face with an anterior posterior approach. Look at an oblique view and measure angles.

It is very important to get a balance, and photographs are a must.

A thorough lip consultation before treatment, pointing out the idiosyncrasies clearly, is very important. Patients might come back saying they have uneven lips or that ‘they weren’t this way before’.

Your photographic evidence is required then.

Look at animations. Look at the patient smiling, pouting, with their lips at rest, the side view, pigments, wrinkles and piercings. Take into consideration their Cupid’s bow, the shape of one side of the lip to the other. Compare the bottom and top lip, look at the inside of the lip and see if there are any abnormalities.

People are moving away from the ‘perfect’ two-thirds bottom lip to one-third top lip ratio.

Nowadays we are looking more at the culture, the fashion at the time and what is appropriate to the patient.

We need to be considerate about the age of the patient. You have to make sure that after a treatment, the result is a natural-looking lip. It shouldn’t stand out too much in the face.

A pan-facially aged wrinkly person with filled, young, luscious-looking lips may appear incongruous and very obvious.

Consider the whole perioral area and the skin.

Many people don’t want others to know they have had an aesthetic treatment. So, this is an important factor.

How do you avoid and manage lip complications such as bruising, pain and lumps?

It is important to manage people before you start treating.

Often a thorough consultation and explanation can help with patients’ expectations. Their understanding of potential complications, how you personally avoid them and how you would manage them should they occur. Confidence with this comes with experience and training.

Ensure you give a patient plenty of time, both in consultation and for treatment: never treat in a hurry.

Galderma has great trainers that really hold your hand and are there to help. I am always on the end of the phone to the many delegates that we train.

I will sometimes use a cannula which is less likely to damage a vessel. These are being utilised far more nowadays and are regarded as a safer delivery of product.

I’m more at ease with a needle though, and I minimise bruising by injecting very slowly, carefully, and superficially.

As far as discomfort is concerned, I use a topical lidocaine gel. This works well and settles down in 20 minutes allowing patients to leave with normal function.

I’m not hugely keen on nerve blocks when treating lips. I want the patient to be able to smile and pout during the procedure. This knocks out the ability of the patient to do so.

Lumps are caused by inaccurate placements or incorrect products.

You get lumps when you may have put too much filler in one area. Also if it has been injected too superficially and has collected. Lastly, if the plane of injection has not been maintained causing the skin to concertina, or the product has too large a particle for the job.

A little bit of massage can often help. Although, I don’t massage vigorously as I think it causes too much trauma, swelling and bruising to the patient.

With bruising a cool pack is helpful. It is also preferable to avoid products with alcohol before or after treatment.

You should also take into consideration whether the patient is on any medication that could give rise to bruising.

Elderly people are more likely to bruise than younger people so it’s important that people know what to expect.

Anti-coagulants or aspirin can increase bruising and bleeding, but this doesn’t negate them having a treatment. However, the likelihood of bruising is higher and should not be cause for alarm if it happens.

Are there any occasions when you choose not to treat someone?

Yes. I choose not to treat someone if alarm bells ring when I’m consulting them. If their expectations are too high and certainly if they are too young.

I would never automatically treat an 18-year-old if they already have beautiful lips.

We have an in-depth consultation form. We also use Galderma’s harmony consultation form which helps us run through expectations. It has a series of questions designed to help us flag any potential problems.

If in doubt don’t treat – and don’t be persuaded to treat. Sometimes you need to follow a gut feeling and say ‘no’.

Which marketing tools do you think are the most effective in promoting your lip business?

I think the two tools that make the most difference are social media and word of mouth. Social media is so powerful now, and certainly so amongst the younger patients.

We find that Instagram and Facebook are the strongest for us. We have someone dedicated to social media who takes care of it for us. But, if you have access to the Galderma social media toolkits, use them: it’s a no-brainer.

Word of mouth is hugely important because patients talk to patients, especially with lips. You can’t buy word of mouth, it’s a wonderful medium.

I don’t have a strong view about advertising, but I think that there is limited value in paying for adverts in magazines. I think online interviews, advertorial and editorial content that mention you is of very high value.

Awards are always a great marketing asset. Even being shortlisted is a social media item that looks great on a website.

Website content needs updating regularly and it’s difficult at times to manage all these extras.

Have you been on any training courses to learn about techniques and products focusing on the lips that you can recommend?

I don’t go on many training courses now. However I do attend masterclasses and workshops to update and refresh myself. In order to see if there is a new technique I may have missed. Or, any tips and new evidence I can incorporate into my training and practice. 

I’m fortunate to be a trainer with Galderma so I have access to global workshops and teaching from international experts. It’s interesting too how techniques and patient management differ from country to country and culturally.

I also read a lot and watch a lot of online videos and peer-to-peer discussions.

Everyone practises in a different way, and there many different techniques for different indications.

Some lips demand a certain technique; however, I would say focus initially on a couple of techniques that you are comfortable with. You can then develop to become an expert in this.

Do you have any tips for those who are looking to grow their lip business?

For growing your lip business, or any cosmetic business, you will need to use social media and have a website.

You must attend as much as you can in terms of training and invest in training.

There is little point in undertaking any initial training without having an immediate list of patients to treat. Confidence will be lost, and you are in danger of forgetting what you have been taught.

Make sure your phone is always answered during office hours and have support in place for out of hours.

My patients call a landline, not a mobile number. If the phone is busy it’s picked up by a call answering service that informs us immediately by email.

This means a new enquiry is not left talking to a machine or ignored.

Many prospective patients are lost if the phone is not answered. Many potential problems can be swiftly addressed by an efficient service.

Hold demonstration evenings and open days, as people love to watch treatments. Offer skincare and other treatments to enhance the patient experience.

Short videos of what a treatment entails are a great tool for promoting your business. 

Live video on Facebook is very popular. People want to know that it’s a comfortable and safe procedure, and that you are professional. Highlight the fact that you are working in the correct environment and hygienically. Tie your hair back and don’t have it hanging over the patient. Get consent to use patient photos and be sure that your consent clearly states where the photos will be used. Watermark the photos so they cannot be promoted elsewhere as someone else’s work. 

Surround yourself with a support network of expert colleagues.

Managing your own complications and not relying on others to solve problems for you is key. Be sure that your training includes attending workshops in complication management. 

Be familiar with the protocols for managing the various complications that may present and have a referral service in place.

You must make sure that you are available to the patient when things don’t go as smoothly as you’d like.

Your reputation as a serious, caring professional will stand you in good stead – ensure patients return and spread the word.

This article first appeared in Aesthetic Dentistry Today. You can read the latest issue here.

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