Facial aesthetics – techniques to avoid the ‘trout pout’

Achieving aesthetic ideals – techniques to avoid the ‘trout pout’ Dr Teuta Berisha and Dr Benji Dhillon, of Define Clinic, talk through the importance of understanding and respecting aesthetic ideals when treating patients.

Lip fillers are one of the most common non-surgical injectable treatments carried out in the UK.

When performed correctly, they can aid in beautifying a young face or can help to gracefully rejuvenate the perioral region in a mature patient. However, there is still a worryingly amount of poor lip filler results visible in the general population.

Consequently, one of the biggest fears amongst new patients considering this treatment tends to be the fear of an unnatural result. It is not uncommon to hear phrases such as ‘I don’t want duck lips’ or ‘I’m scared of looking fake’ during the consultation process.

Understanding and respecting aesthetic ideals, correct patient selection and choosing an appropriate dermal filler product are all key aspects in helping clinicians to achieve a beautiful lip filler result with which they and their patients will be pleased.

Aesthetic ideals

In young Caucasian patients, the ideal upper to lower lip ratio is considered 1:1.6. In Afro-Caribbean patients this ratio is 1:1. The Burstone line is one way that can be used to assess the lips on lateral profile.

For this, a straight line is drawn from the subnasion to the pogonion. The upper lip should project 3.5mm anterior to this line and the lower lip 2.2mm. Furthermore, on lateral profile, the upper lip should project approximately 2mm in front of the lower lip.

Not respecting these ratios or exaggerating these proportions can lead to the dreaded ‘trout pout’ lips. To help avoid this, it is also particularly useful to stop and reassess the patient throughout their treatment.

Ask the patient to sit up and assess them from all angles. This will ensure that the lips look good. Not only from the frontal view but also on the profile and oblique views. It is also important to ask the patient to smile and pout so you can check for any animation deformities.

Patient selection

A comprehensive consultation is critical to ensure correct patient selection. But it is also to educate your patient on why you are recommending the proposed treatment plan.

An example of when this is particularly useful is when females present in the clinic and ask for filler in the upper lip only. It is our responsibility as a practitioner to educate the patient on the ideal ratios mentioned above.

Explain to them the importance of treating both lips to ensure a balance between the upper and lower lip.

Using visual aids, such as photos of patients that you have treated (who have consented to sharing their photos), can further help in aiding your patients’ understanding.

A crucial skill of any good injector is recognising when to say no to treating a patient. If you assess a patient and find that they naturally have adequate lip volume already or they have recently had filler and you deem it too soon for another session, then treating these patients risks creating an unnatural overfilled result.

It is important to say no to treatment at this stage. It is valuable for the patient-clinician relationship that you take the time to communicate to the patient your reasons as to why.

As clinicians, we often fear that by saying no, we will disappoint or upset our patients. But on the contrary, you will find that most patients will be grateful for your honesty. They will quickly realise and appreciate that you have their best interests at heart.

Patient assessment

Another common mistake is treating the lips in isolation. Conducting a comprehensive assessment of the entire face will help you to build an aesthetic treatment plan that will favour a natural result when compared to simply treating the lips in isolation.

Similarly, the patient’s age should also be considered when planning for lip fillers. You must carefully assess and plan treatment for the whole perioral region and not just the lips alone.

Aside from the loss of fullness and projection, the ageing lip tends to present with perioral rhytids and a downward tilt of the oral commissures. You must discuss these features with the patient.

It is worth considering treating these perioral lines and oral commissures along with the lip filler. By approaching your treatment this way, you will help to ensure global harmony of the perioral region. Thus, a more natural outcome.

Attention should be also given to the underlying dentition. Some patients have a naturally projected upper lip, due to their underlying skeletal structure and/or dentition.

There should be adequate caution when treating these patients. It is easy to cause a pseudo-overfilled appearance of the upper lip. Usually, in these cases, most of the product should be focused on the lower lip.

Product selection

Selecting the right product plays a key part in the lip filler outcome. The safest layer to place the dermal filler product in the lips is superficially.

As such, an elastic, cohesive product that will allow smooth integration into the tissues will translate into natural-looking lip filler results when compared to using a highly cross-linked, stiff product.


As clinicians, we have a joint responsibility to reverse the commonly misinformed notion amongst patients that having lip augmentation procedures will give them a ‘trout pout’ or ‘duck lip’ appearance.

We do this not only by educating our patients but by also ensuring that the lip filler treatments that we create follow aesthetic ideals and are created using the appropriate products to give natural-like results.

To find out more about Define Clinic visit www.defineclinic.com

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