Fill Me In: An Aesthetics Podcast
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
Fill Me In: An Aesthetics Podcast
All About Lip Augmentation | Episode 30
In this episode of the Fill Me In, Jon and Nicole dive deep into the world of lip augmentation. They discuss the evolution of lip injection techniques, the trendy shift from overfilled to more natural-looking lips, and tackling common issues like lip filler migration. Learn about the varying products like Juvederm Ultra and Volbella, as well as nuanced topics such as dealing with scar tissue and harmonizing facial features with lip fillers. This episode is packed with educational insights for new injectors, seasoned practitioners, and lip augmentation patients. Join us for a dynamic conversation on achieving the perfect pout!
On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.
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https://toxandpout.com/
Jonathan LeSuer, MSN, NP-C
Jonathan LeSuer graduated from Le Moyne College with his Bachelor’s in Nursing in 2014 and a Family Nurse Practitioner degree in 2017. He began his career at St. Joseph’s Hospital as a Registered Nurse on a cardiac medical-surgical unit. He transitioned to the Nurse Practitioner role in 2017, working for Hospitalist Medicine, where he became the coordinator for the team’s Physician Assistants and Nurse Practitioners. In 2020, he started his career as an Aesthetic injector and quickly found out that this was his passion. On March 15th, 2022, he opened Tox & Pout Aesthetics. He is now a Master trained injector & National trainer for Allergan Aesthetics, offering Botox, Dysport, Hyaluronic acid fillers, Kybella, SkinViVe skin booster, and Sculptra. Jonathan is known for his empathy, profound bedside manner, and outgoing/warm personality. He has a deep love for aesthetics, and his patients’ confidence is his main priority.
Nicole Bauer, MSN, APRN, FNP-BC.
Family Nurse Practitioner
Nicole graduated with her Associates in Applied Sciences and began her journey as a registered nurse 10 years ago in 2014. She worked hard to combine her love for beauty with her passion for caring and healing others, attending aesthetics school while working as a hospital night nurse. After graduating as a licensed aesthetician, Nicole left the hospital where she had been for 3.5 years and began working as a registered nurse for a plastic surgeon. An experience of over 6 years that would leave her with so much knowledge and respect for the aesthetic world. It was during those 6 years that she pursued her Master’s Degree and obtained her license as a Family Nurse Practitioner, leading the way for where she is now; owning a state of the art medical aesthetic practice and being a national Allergan Trainer. Nicole takes pride in treating her patients holistically, focusing on facial balancing and enhancing one’s natural beauty. She believes education stands as the cornerstone of aesthetics and is why she is dedicated to both training others while always focusing on expanding her own knowledge as well.
Producer of Fill Me In: Joseph Ginexi
Alright guys, welcome back to another episode of the Fill Me In podcast. I'm injector John.
And I'm aesthetic nurse. Nicole,
thanks so much for tuning in. Yes, this week. Um, it's crazy. I feel like every single. Week we get more and more listeners and, um, new people, whether it's patients or just new injectors that come that are coming on the industry.
And it's really exciting.
I know, I know. I can't thank everyone enough for taking the time outta their day to listen to us.
Yes. 'cause to us, this is something so little, but like it's touching a lot of people, which is great. Yeah. Yeah. Um, but this week we're gonna be talking about lip augmentation guys.
Mm-hmm. Which honestly, we haven't talked a lot about lip, lip augmentation. It's honestly one of the most highly requested. Services, I feel like in any med spa. Yep. It's Botox and lip filler, right? Absolutely. It's been like forever, but obviously how we inject lips has totally evolved over the past few years.
And obviously there was the era of the big lips, which, listen there, it's still, we all
fell victim to, we all felt
victim to it. I felt victim to it. I felt like a bad bitch. I'm not gonna lie. Um, I dissolve them. I'm gonna, I'm gonna start doing little bits at a time, but. Um, but it still is an era of lips.
Mm-hmm. Don't you think? Oh, yeah. And I think it's trying to reel people back in to, uh, maybe refine them a little bit more. Mm-hmm. And maybe, um, changing our ways too. 'cause I think some of it is our fault.
As
well. Yep.
Well, if I think back, geez, if I think back to when I started, it was just ultra plus all the time.
Yeah. The smaller the lip you had, the thicker the product we chose. Mm-hmm. Because in our minds it was like we were gonna create more of a difference. Mm-hmm. When in reality it's just. Exclusion outta that lip and literally causing a mustache eye craving everywhere. Yes. Oh my god. You know, but these are things that we learn with time, you know?
A hundred percent. But we
also know with lips, like it's such a huge area for facial harmonization too. Mm-hmm. Like there's some patients that come in and we actually, they're not even coming in for lip filler, but we look at their nose, lip to chin ratio, look at their profile. We notice that they're more, is it concaves?
Uh,
well, comebacks, yeah. More con
Yeah, concave. But like more, um,
like their lips sit more inward. Inward from their chin and their nose.
What would be the term for that?
I think, I think concave.
Yeah.
Yeah. Right. Receded. They're,
they're a little bit more receded in that area. Yeah. Yeah. Like their chin
and their nose stick out, but their lips are inward and sometimes too, I mean, we had a.
Uh, a dentist on remember? Yes. And he was saying sometimes people just need teeth as well. Yeah. Like just giving them bigger teeth that can fit their face a little bit more will help to push their lips forward too. Um, but we sometimes tell patients, listen, if we do a little bit in your lip, it's gonna help you from the side.
It's gonna make your nose and your chin look smaller. It'll make you more harmonized.
And I hear that all the time from patients. And I even notice it on myself. When I did my lips, my nose looked smaller. In proportion.
Sure.
Because you're adding more volume to the, to the lip. Right. And some people with ch like people that feel like they're very like.
Long or they have a lot of chin when you treat their lip. They feel like that looks like it's more in proportion too.
Yeah, a hundred percent. All about balance,
but how about balance? Um, we're also seeing now the dissolving trend. Yep. Yep. Avery Woods, Avery Woods is, is on the top of that right now and I, I really wanna put, uh, have Joey put in her picture because it really actually changed her whole face.
I think the issue with her was they were almost using too much of a robust product and it looked mm-hmm. Unnatural in, in a sense of when she was talking and things of that nature. Um, so I, I, I'll have him put these in. Mm-hmm. But it just, now that she's taken it out, it, she looks so much more herself.
Yeah.
And, and there's a way to do lip filler. There's a, there's a, there's products to use, which this, this whole episode is gonna be mm-hmm. About all of that. Um, and if you have the volume for it, you can do those robust products. Oh, yeah. If you don't mm-hmm. You look a little silly because your lips look plastic, you know?
And the other thing too is, is, is knowing when to stop too. Mm-hmm. I think even if you use, uh, like ology, right? Which is like the chemical makeup of each filler. If you use the filler that's appropriate, like Juvederm Volbella or ultra, right? Like sometimes if you layer filler over filler, over filler. Too, too frequently.
Mm-hmm. Sometimes too, it can kind of like make the lips look heavy. Yeah. Um, and when you smile, you see less of your teeth and it just doesn't look great. It changes the way you express.
And as a practitioner, I feel like that is one of the hardest things to explain and educate to a patient in your chair.
Mm-hmm. Because they just have this picture and they're like, well, why can't I look like this? And we have to respect your anatomy and we can't, we can't change your anatomy fully. Mm-hmm. We can only work with what's there. Mm-hmm. And a lot of the times people want that. Lift and and curl off of that top lip and.
In a lot of people that's surgery. Surgery only, you know, a hundred percent. We're only gonna get that surgical lip lift and mm-hmm. And not everyone's open to that, but filler can only do so much. So that's like a very big educational point, uh, which doesn't always
Yeah.
Hit home with the patients, you know?
Yeah. And the lips. Can only get so big too. Mm-hmm. I think it's really hard. It's, it's frustrating, like when you have like friends that get their lips done and they're like, oh my God. But their lips are like bigger than mine, that they feel like they hold it better, but me, it just doesn't stick. Or I just want mine to look like theirs.
Yeah. But your lip anatomy is totally different. Mm-hmm. Like you might even have, um, good lip shape, like from the outside you're like, oh, okay. Like you. I feel like there's good distance like height already. Yeah. You're thinking, oh, they're gonna hold it well, but then when you go to feel it, sometimes their lips are thin.
Mm-hmm. Like
there's just no lip tissue there. There's no space. Yeah. So there's no space there for the filler to integrate. And if the filler can't integrate, then it's not gonna stay as long
rights.
Right. Right. And you might have issues with lumps and bumps.
Exactly. Yep. And that's, so that's the other thing is the lumps and bumps.
Like why do some people get no bumps, but other people? Uh, that first week to two there. So lumpy and bumpy. Yeah. And I really do think that comes down to the integrity of the tissue. Like some people just have very thin lip skin.
Sure.
And you're just gonna feel the product more. Mm-hmm. It's not so much that it's obvious or evident by, you know, lip skin.
I
can't.
This is like a different type of skin, right?
I listen, yes, it's a different type of skin, but you know what you
like. I almost kind of have, like, when you see those little lines in the lip, you know, you know that maybe you shouldn't do too much tenting because Right. That's gonna pocket, you know, filler, do some more linear threads rather than mm-hmm.
Too much tenting, you know? I know. But, um, it's just everybody is so different and some people just have a high metabolism. Yeah. Like I have a, it's, it's rare, but I have a. A good handful of patients that it's like three months and it's gone. Mm-hmm. And they do it for events and things like that. And they know like, okay, I'm gonna come like a week and a half before my event so that I still have something.
But then I have patients that will go a year or two years without doing any lip filler and, and they hold and it still looks great. And you're like,
ah, I know.
Yeah, yeah,
yeah.
And there's, there's really no great explanation for that besides sometimes lifestyle nicotine. Oh yeah. But really it's just, it's your, it's your, it's your own body.
It's body kind of viewing it as a foreign object and trying to get rid of it. You know,
that's the tough thing is the vaping and the smoking. Mm-hmm. And like, even like, you know, smoking weed, stuff like that. Mm-hmm. Like if you have someone who chronically is smoking, ugh, it's so not good for lip filler.
And it's like, I hate, like, you know, it, it just is just because you're using that muscle so much. Mm-hmm. And especially like during that first week or two, it's so crucial if you're constantly. Person, your lip to smoke or vape or do whatever, you're going to potentially move or migrate some of that filler and it could cause it to lump or bump.
Mm-hmm. So like I always have to tell my patients, like, if you really have to like do it off the side,
that's what I tell 'em too. Yep.
I'm like,
you wanna close like. Straight. You don't wanna be puckering. Yeah, yeah,
yeah. And you might look weird for the next two weeks, but you're gonna protect your investment, you know?
Yeah,
yeah. Because when you think about it, the more you use that muscle, the more it has potential to slide that stuff around.
Oh, yeah. And metabolize it too. Mm-hmm. I feel like any of the, any patient that vapes or smokes, they just, they metabolize it quicker.
Yeah.
Right?
Yep. Absolutely. That nicotine really gets there.
Uh. Heart rate up and then it speeds up that metabolism.
Yeah. And um, just that repetitive motion of the orbicularis Aus too. Just will eat it up.
Yeah. 'cause you don't realize, I mean, if you are a smoker or a vaper, like how many times are you hitting that a day?
Yeah. Know the other thing that I wanted to talk about too, I feel like we've seen, and maybe you've been doing this forever, Nicole, but like, I feel like when I first started six years ago, I was, you know, doing lip, lip, lip.
Mm-hmm. But not incorporating so much lip flip with it.
As well,
or doing Botox above it. Like it's really important to have your patients animate when they smile. Like if they at rest, they're like, beautiful. But when they, you know, beautiful lip shape, whatever. But like when they smile, if it curls under and disappears, you really need to do Botox there to relax it because I.
They have a higher chance, in my opinion, right. Of migrating and also metabolizing that pillar metabolizing.
Yep. Because every time they're smiling, like, it doesn't happen to me or you, but you're like, if, if you tuck under like that.
Yeah.
Yep. It's gonna one, move it around, two, it's gonna break it down quicker because it keeps moving it more and it works so
well though.
Yeah. Doesn't it work so well? And patients love it. Yeah. They're, oh my God. I have an upper lip and I smile now. Plus like, I feel like my filler's lasting longer.
So the lip flip is use basically utilizing a little bit of Botox right at the lip line mm-hmm. To roll the lip forward. So when you smile instead of tucking mm-hmm.
You smile and it comes and it rolls out.
Yes.
Uh, you can also do, like, the gummy smile is a really big one, so hitting that ls sand muscle, that kind of mm-hmm. Comes down and, and pulls the lip up this way. Mm-hmm. Some people, I'm actually one of them, when you smile real vague. You can show a little bit of gum, so you can also do a little bit of like a unit or two right next to the nose very superficially.
And drop that too,
just lowers that a little
bit. Mm-hmm. I do a lot of, uh, like gummy smile with lip flip at the same time. Usually like 10 units, and I do like six along the lip and then the two and two at the, at the LS sand.
Yeah. It's really smart to do it. And, um, it's really just important during your consultation to assess your patients and not if they're just in for lips.
Don't just do their lips, like have them smile, have them animate, take before pictures. Um, because I found now that I'm doing that way more over the past three to four years and really focusing in on their facial features and their animation, it really has changed my treatment plan for them.
Mm-hmm.
Um, and also.
Makes it known to them, like, oh, this is, if you set realistic expectations based on their animation and a good assessment, then they're gonna be happier in the future. And they're also gonna know why things are happening.
Yep.
You know what I mean? Because how,
how many times do you treat someone and then they come back and they're like, I never had this little line before.
Right. And you pull up their pictures and they did, but, and they did. No one looks at their face like someone that has just been treated, you know? Yeah. So if you don't, if you don't po like point these things out beforehand. They're gonna see them after and they're gonna blame me for them
a hundred percent.
Yeah.
Yes. Definitely. Especially
the smiling pictures I think are huge.
Mm-hmm.
People don't realize when they smile that, you know, there might be some asymmetries in the smile. Yeah. Or more tooth is covered on one side than the other. Yeah. Um, a major, huge common thing that I see that I tell patients about all the time is like, we typically, and you can see it on me even right now, we typically have a side that's more rounded.
Mm-hmm. And a side that's more flat. And I see it on probably. 90% of my patients, we all have it. Trying to get this flat side to round out, like this round side, nearly impossible. Mm-hmm. We will try and we will do some tenting and you know, do what we can to match them perfectly, but you're never gonna be a hundred percent symmetric.
And that's something that you have to basically, I. Relate to them beforehand. Yeah. 'cause afterward they're gonna blame you. They're gonna say it's the filler. Like no, it's, it's your lip shape. You know, there was an
injector that just recently I think posted a reel showing like how asymmetry is beautiful.
Mm-hmm. And then I think showed like it was celebrities and if they were symmetrical, what they would look like. It does not look good. And
they look crazy, right? Yeah, yeah, yeah, yeah.
It's crazy like what we see in a mirror.
Mm-hmm.
And like in person, what our friends see.
Yep.
Like, you know, like if I'm looking at you like people just look smashable when you look in a mirror,
right.
Or like, you know, when you take a picture.
If we were to break it down Yeah. With your
camera. Mm-hmm.
Like
forward, you're like, oh. But then if you go on Instagram or Snapchat and take a picture, you're like, Ooh. Yeah. I look, it's just interesting.
The Snapchat cam, uh, camera is my favorite.
It is because it makes you like, I dunno what
it does, but it does something.
It makes everything look symmetric and, yeah. Perfect. I don't know. And it,
it like airbrushes it.
It does,
but it's, it's important too. It's, and it's hard. Again, sometimes I feel like a lot of the. This stuff is a little bit deeper than mm-hmm. Just what we do, but mm-hmm. Getting across to a patient that that's normal and everyone is asymmetric.
Some people just don't believe you. I know. And some people really fall for the face tune and the face app and mm-hmm. You know, even on there you can make your lips bigger. Like, just because that person looks like that does not mean they look like that in person, you know?
Yeah. And you know, also, it's. I also want to like normalize getting your lips dissolved or even spot dissolved.
Mm-hmm. Um, I can't tell you how many patients that, you know, my returning patients that come in, I'm just, every time you're in for your lips or whatever, I'm always assessing them, feeling them looking in the wet border. Mm-hmm. Um, and if there's any type of like little migration there or even above, sometimes doing a spot dissolve.
You know, I'll, I'll do that. You know? Yep.
It's, you don't always have to start a hundred percent from scratch.
No. Mm-hmm. Just maintenance. It's lip maintenance.
Right. And even, I don't know, we were talking about this earlier. I'm not sure if it's the pregnancy and, and me swelling or, yeah. If it's just, I mean, I probably have at least six or seven, maybe even eight syringes of filler in my lips and, and various fillers over time.
But my, uh, bottom lip is starting to, like, if I go like this, mm-hmm. You can see all this old filler just kind of like slowly making its way out. So sometimes you just have to spot dissolve those areas. Yeah, and I, it's funny, I am someone that I have no bottom lip, like I always had a top lip. Mm-hmm. But it, it took us years to build my bottom lip.
So it makes sense that that's the first one to kind of mm-hmm. Need of refresh, you know?
Yeah. No, a hundred percent. And like I said before, that orbicularis or muscle that's around our mouth. Mm-hmm. Like we use it for straws, putting on chapstick talk, use as put a straw on my mouth right now. Literally like we use our, that muscle for everything.
So over time, if it's been four years later and you haven't been dissolved and you have no migration, that's pretty freaking amazing. Yep. But if you do, it's normal. It's normal. I, I feel like we need to get away from. Yes. Is there bad technique? Yes. You know, is there choosing a wrong product for the lips?
Yes. Um, but we can't always just blame the injector. Um, I'm huge on that, especially when patients coming in, you know, some people are quick to blame that person. Mm-hmm. But it's so hard because if you've had filler for four or five years Yeah. And it's now migrating, it's, it's normal.
That is a discussion that I have with all of them too.
Yeah. Like when we do decide to dissolve, like,
yes,
you know, unfortunately this, this can happen again, you know, in, and it may not be in the same timeframe, but yeah. We may be down this road again, having to dissolve again and, and totally. You know, don't be surprised if that does happen because it's, you know, at the end of the day it's just, it's our body.
We're kind of mm-hmm. We're relying on it to heal. Right. Yeah. And it doesn't always, you know, doesn't always work the way we want. Hey guys, just popping in. If you're enjoying our podcast, please subscribe. And don't forget to follow us on Instagram injector John and Aesthetic Nurse Call
Now, Nicole, has your techniques changed over time with lips?
Have they? Yes. Like how would you say, like when you first like start even like the first three, four years, like to now? Yeah. Like what is different? Like what have you done differently?
Well, I would definitely say one product choice, which I really wanna get into. I think we should talk about that for sure.
Uh, but two is really how I'm laying the product. So I, I feel like back in the day, I would start right at the border and I would lay these linear threads right at the border and. Like horizontal or
vertical?
Um, horizontal. Mm-hmm. Yeah. Like I, uh, I do a good amount of tenting now, which is more of those mm-hmm.
Vertical ones. But, um, back in the day I would do one right at the border horizontally, and then I would come into the body of the lift and just do another one. And that, that was it like. That's crazy. Was cookie cutter for everyone is how I learned and I'm telling you, it was always ultra plus. Like I did.
Yes.
Fax it into any other product. It was always Ultra Plus. Wait, it's so
funny. Everybody I feel like says that too. Yeah. They're like Ultra plus. Ultra plus and looks. It was
just what we knew. Yeah. Yeah. It was. And it was, I feel like we were learning from, you know, these surgeons and doctors and, and people that really had their hands on it for so long.
It was for so long it was just ultra and Ultra plus. Yeah. You know, so it was the things that we were learning as coming into the field. So now it's. And this is again, why you continue your education, right? Because things always changed. We're always, we're always learning new techniques. Mm-hmm. But yeah, I always did that.
'cause the thought behind that was that laying two threads like that would roll the lip. So that was what we did. And you know, with the Ultra Plus right at the border like that, God,
and would you say, were you in the Vermilion border?
Oh, yes. A hundred percent. Oh,
oh, mm-hmm. Yeah, yeah, yeah. That's, that was it.
That was normal.
Yeah. Yep.
Yeah.
Yep.
I remember when I first started, it was, you would start literally in the lower Vermilion, you'd go up it, it was creating the definition, right? Yeah. And then you would kind of follow and then do the bottom, and then you would go into the body after that.
Yep. Yeah. And it probably would honestly look great.
Right away, but it placing that it did, yeah. Placing that product in the Vermilion border is what kind of over time caused that mustache, you know? Yeah. Especially a thick product. I still, I still inject the Vermilion border, but with the right products, you know? Yeah, yeah,
yeah, yeah. I feel like now, I mean, I.
I inject just below the vermilion border. Mm-hmm. You know what I mean? Like we kind of always, now we're kind of veering towards injecting more superficial. Yes. Not as deep, right? Yep. Making sure we're above that muscle, right? Mm-hmm. Um, but then also if we're doing those hor, the vertical linear threads to give height, we're starting that injection point in the red of the lip.
Yes. Above and never above. Above, yes. Yeah.
And that's if, if you are starting your injection point above the red, like where that white is, then you're gonna have issues with migration. A hundred percent. And people coming back saying they look more darkish. Exactly. Rather, rather than lifted, is laying top, like on top of the lip.
It's actually gonna weigh that lip down. So when they smile, it's just gonna look more like. Heavy. You know, heavy
I, yeah, they call it the Marge Simpson. Oh yeah. I like to call it, yeah, I call it a shelf. Like you just mm-hmm. It's just gonna go forward. It's not gonna go up. Yeah. And that's why too, adding too much volume, because the more you add, add, add, I know the less definition you have and the less lift you have.
And that's really hard to get across to people too.
I can't preach enough.
Mm-hmm.
You know? You can't shove a whole syringe of filler in every lip.
Yeah.
That's why I offer, and I know you do too. Mm-hmm. I offer half syringes or full syringes. And even when I say full syringes, sometimes I'm not putting that full syringe in, but I'm doing the majority of the syringe.
Right. Yeah. Um, but people that can handle a full syringe or people that have good preexisting lip tissue mm-hmm. They have wide enough lips in diameter. Right. Enough room for that filler to settle. Right. If you have a small mouth. I tend to go more with a half syringe. Yes. Because a half syringe can go a long way and you could always add more.
Yeah. If you're coming in and your, your protocol is just to do one syringe, come back in two months, do another full syringe, if you have the lip mm-hmm. You might be able to support it. It might look beautiful, right? Yeah. But for some people it's not. Especially if you have really thin lips. If you have really thin lips, like if you are literally looking at me and I can't see the right of your lip, and I'm gonna shove a full syringe in there, which we've done before in the past.
Right. It's just you're gonna have a migrated lip.
That's what we used to do. We used to take that thick, thick product. Yeah. And we used to do, we'd be like, okay, you've had one. You're gonna have to come back in three months for another. Yeah. And we were doing such a disservice to these people because.
They just, their anatomy would never handle it.
Right.
Now we know.
Well, now we know. Yeah. Oh my God. Yeah. It's, it's how we were taught it's right. Mm-hmm. And then now we're kinda like, wait. And it was that,
back then it was everyone. It was everyone. There really was, you know, there. Yeah. There really wasn't.
No one new
yet.
Now I feel like too, Nicole, how I inject lips, it's, it's. A little bit more superficial, like I'm not seeing mm-hmm. The gray of my needle, but it's, I'm definitely seeing like foot in a sheet or foot. Mm-hmm. And like, you know it with that mucosa and, and the dry in the dry border. Yes. Yes.
Yeah. Um, and I, at first when I started doing it, I was like, oh God, I hope I'm not gonna get lumps or bumps or, yeah. Too much superficial. Those little bump. It's beautiful.
Yep. And that's why I really take the time too afterwards mm-hmm. To, to heavily massage. Yes. And I know a lot of people are like, oh, well if it's, if it's placed correctly, you shouldn't need to massage, blah blah.
Like, no, you need to massage this stuff. It needs to integrate into the tissue, especially in the lips
before they go home. You need to make sure like, yeah, there's, it's like skin not feeling
anything. Yes. Yes. Right.
You wanna make sure that you really smooth that bump out if you have a little bump.
And I always tell patients, I show them how to massage you.
I always tell them I need to know. And again, they're gonna feel the filler. So if they've never had it before, explaining to them that it's gonna feel. Like a density, like you're gonna know there's something in there. But if it feels like a pebble or a stone and it's an isolated spot and it's hard, that's what I would consider a bump.
And that's what I want you really kind of pinching over and pinching and scratching with some Vaseline or Aquaphor to kind of really flatten it out. But if it's not going anywhere and it's visible, I need to know about it. 'cause then I can usually massage it out for you. Mm-hmm. And you don't even have to worry about dissolving or sometimes we land.
Yeah. You know, we lance them and we express it out if it's, if it's a decent enough bump. Um, but usually if we get it early enough and we massage it, we can mm-hmm. We can flatten it right out. Yeah. So it's kind of, again, about education and, and, and explaining to them how it's gonna feel, what to expect, and what, what to let us know about.
Yeah. Um, what would you say is your number one used lip product?
Ultra, for sure.
Ultra Yes. And say why.
Yeah. Ju so Juvederm Ultra, I, I explain it to my patients like it's the perfect middleman. It's dense enough where it's gonna give you volume, but it's not too dense, like an ultra plus, or like a Voluma or something of that nature where it's gonna be too hard or heavy in the lip.
Um, I think it gives really good definition and it, it has enough of that. Fullness to it, where it holds the shape where something, and it's high cross, right? Yes. Yeah. So you're not Yeah.
Yep. Little less. Yep. So it's not as responsive or not as reactive as well. Reactive, yes. You're
a little less chance of lumping and bumping compared to mm-hmm.
Other products. Um, but I will say another top pick of mine is Ella, which is a V cross. Um, but it is just so soft and like it's so soft and
pretty. Yeah.
And like, honestly, I think it is very fairly moldable. Like if you get in there and, and massage it right away. Uh, I do love that one too.
Like, sometimes I'm like, you know, the patient comes back and I've done a half and I'm like, how are you still this full with Boba?
Yeah, I know. With Boba.
Yeah. I'm like,
but that 'cause it's, it's honestly like the princess of fillers, right? Yeah. It's like, it's what FDA approved for Infraorbital Hollows. Mm-hmm. But like. Yeah. Right. I don't know. I do,
I do think it has something to do with the fact that it's vycross. So like vycross technology for those that don't know, is it's the way that the HA is, is crosslinked linked.
Mm-hmm. And, um, Vycross is meant to last a little bit longer, which is why sometimes comes along with a little bit more of adverse events and things of those nature. Uh, but. I think because of that in the lip, even though it's a very thin product, it holds Well, it does because it's not a highcross, you know, it meant to hold and it's also very,
um, giving.
Mm-hmm. Mm-hmm. Mm-hmm. It's, um, how do I say it? Like if you're looking just to enhance
Yes. It's like internal lip gloss, I call it. Ah, yeah. Beautiful. It's still gonna, it's still gonna give you volume. It will, but it's, it's not gonna be like an ultra, I, I explain it. Ultra's, Doy. Ultra has that Doy pouty look where Volbella is more of that shapely little bit of touch of hydration, hydration, hydration.
Yep. Mm-hmm. And that's, and that's it. Yeah.
Um, I will say too, I agree, I use the majority mm-hmm. Ultra and Volbella in the lips. Occasionally I use Valore. As well. Mm-hmm. Um, which I think is really pretty too. Um, not every lip I use valore, but obviously it has that 18th month longevity to it, which is really great.
So if someone's really looking for that longevity, I, I will use that. But I will say Ultra's my number one go-to.
Mm-hmm. Yeah, me too. I, I also use, so in the lip, I also use versa, refine and define, um, refine and define for Restylane versus its own company, but, uh, from Res, but um, versa gives you that little extra point too.
Mm-hmm. So sometimes if you do have someone that's like a little bit, I. Fuller lip, uh, you know, 'cause the fuller, the lip, the more product you really do need. If you do a half syringe on someone with a really full lip, they're gonna be like, great point. What'd you do? Yeah, great
point. Touch base on that.
Because a lot of people think because they have already really big lips, they lot need a little, they don't lot. Right. But they actually do to see a difference.
Yeah. Yeah. So that's huge. Like that's another big education point to your patients. Yeah. If they have naturally full, full volume, if you do a half syringe, they're gonna call you in a week and be like,
it's gone.
You did nothing. Mm-hmm. So they need a good amount of product. So sometimes I do choose versa for those people because I get that extra little point too. Gives them a little extra something. Um, and then refine and define. I love, refine tends to wear out fairly quickly in my opinion, but I really like it for a lip that I need something forgiving.
Mm-hmm. Like if you have. Paper thin lips and I need to try to tent and give you height. Like I need something that's not gonna lump bump. Mm-hmm. Or you know, so like refine is one of those more forgiving products or like if you're learning refine is a really good one. Um, D fine. I like, it reminds me of ultra in a way, but it definitely takes, I.
A longer time to heal. I've done define in my own lifts, just testing around, messing around with certain things, and I had a bump for six weeks. It eventually did go away, but it, again, it's a, it's a thicker product and, um, you know, it, it's definitely more chance of bumping. So we just have to keep that in mind.
Yeah. Yeah. I love that. Good. Let's talk about radiology a little bit. Mm-hmm. I mean, we kind of touched base a little bit on it, um, but there's obviously certain fillers that are meant for certain areas of the face, um, like Vo, Voluma and Vox technically. Yeah, definitely. Volulux should not be used in Vlo.
Yeah. Uh, I, I
will say I have. In three patients in my whole, almost, what, eight years? Mm-hmm. Done Voluma in the lip.
That's why I'm looking like this, because I've definitely used Voluma in patients' lips, but it's Yes, yes. For certain patients, people, certain people, yes. Mm-hmm.
Yes. You have to be the right candidate.
And I, it's on people that just metabolize like. They metabolize like crazy. They don't hold anything else. It is my last resort. I really probably haven't done it in three years. Uh, but I, I have done it to try to get people a little bit more longevity. Yeah. But you cannot, you cannot mess around with that.
You can't tend, you can't, you have to just do linear threads mm-hmm. Horizontal. Mm-hmm. Because it will, it will lump, it will bump, it will end up in the mucosa. It's a product that's meant to pull water and spread and be thick, you know?
Mm-hmm. I know. So you
have to be careful how you place it.
Yeah. So that's why honestly like the, the lip favorite lip products, I feel like, and this is worldwide, I would, or at least in the United States would be mm-hmm.
Ultra vella, Restylane, ky. Mm-hmm. Um. Resting, refine.
Yeah.
Um, wrestling classic. I see some, some people use. Some people do.
Yes. Yep. I
think beauty by Dr. KI, I feel like I seen it. A big one on that. Yeah. And her lips turned out really pretty.
The RHA collection now is pretty popular for the lifts too, I think.
Oh, yeah. Right. RHA mm-hmm. Density
and then two and, yeah.
Yeah, those are all very popular,
which I've never, I've never used RHA, so I don't, yeah,
no, me, me neither. I like to explain it to patients too, like it's like Coke and Pepsi, you know? Mm-hmm. All these different companies, it's just different brands.
They all have kind of the same thing of, you know, where define might be your Ultra Plus and refine might be a little bit more like your ultra, but it's definitely thinner. But like they all have their things. Yeah. It's really just about, you know, what, what you've learned with and what your hands are comfortable with.
I will say for me. I think Nicole, you, you would agree. I, I, and you remember how I was about a year ago? Mm-hmm. I didn't do as much ultra on the lips. Mm-hmm. I was mostly kiss and contour. Yeah. I was using a lot of wrestling, contour and kiss and, um, I. I've kind of converted a little bit more and I'm using more alter xxy and mm-hmm.
And it's just a personal thing, you know, this is not knocking anything, um, any product, but ultra definitely for me and my patients at least last longer in their list. Yeah, I would agree. Mm-hmm. Um, and I just feel like it's, it's more giving and, um, I felt like I. Kiss for me, some of my patients KISS is beautiful on like, I'm like, wow.
Like we did your lips a year ago. Full syringe. It's still there. Great. You know, well let's stick with it like, and I'll do kiss again on them. Mm-hmm. But I would say the majority of people that I've done kiss on, like it just doesn't last as long. Yeah. And I converted 'em over to to Ultra. And they're really happy with ultra.
Yeah.
Yeah. I will say too, like they definitely just see more of a result and they feel like that result lasts longer.
Yeah.
I've noticed that from my own practice too. 'cause I actually, it's funny that you brought up Restylane El 'cause like I totally forgot that even existed. I
know,
but in, in my early years, I, that was the majority of the lips that I did was Restylane el.
Yep. But it would just, it would be gone.
Yeah. And I actually used Restylane el, or classic only for under eye filler. Mm-hmm. And um, I've kind of stopped it. I've only, I've only used Volbella Yeah. In the under eye. Yep. Um, and it's been great.
I, I. Love bobbell in the under eye's.
Yeah, it's great. It doesn't pull water.
Think it's, it's so soft. Mm-hmm. Yeah. 'cause I did do, again, back when I first started a lot of Restylane l in the under eye too, and, and I just feel like you ran into a little bit more kindling and a little bit more of that swelling after the fact with it.
Mm-hmm.
Um. Crazy. Let, let's talk
techniques. Oh, let's talk techniques.
I love it because I feel like I, go ahead. Yeah.
We, we, well, we talked about how I started, what I, what I started doing versus what I do now. Mm-hmm. What, what would you say is your. Lip technique at the moment.
My, I would say my go-to and every patient's different, but I would say the majority I'm doing, I'm injecting more superficial number one.
Mm-hmm. Um, I think that if they already have good height with their upper lip, um, I am. Actually starting more by the oral commissure in the upper lip. And I'm doing a little horizontal retro, and I'm injecting horizontal retrograde. Mm-hmm. Um, and then I'm coming up and I'm just underneath the vermilion border for these, um, and then that next injection, I'm bringing the needle right up to that.
GK point, um, which is the start of that Cupid's bow on that side that you're on. And I'm doing a little horizontal retrograde coming back, staying in, and then I'm going like a little v
Yep.
Right. Just like this. Mm-hmm. Um, and then seeing how that looks. And then I'll come up and I'll do some, some vertical linear threading to give a little bit of height.
I like to accentuate the V of the Cupid's bow, the GK points. Mm-hmm. Um, I'll do it again on the other side. Uh, sometimes I will, depending on the lip, if they have good height already or they're responding and they're stretching, well, I'll find that wet border and go up just a little bit from that into the dry border.
Mm-hmm. And I'll just kind of. Superficial there, and I'll do a little bit of a layer there to kind of be the base.
Yep.
Just before that wet border. Yeah. But not within the wet border, if that makes sense.
Yeah. Well and some people need, um, like lip support too. Yes. Like your, your older patients. Yes. You can't just do their lip 'cause it's gonna look like indented.
Mm-hmm. So you, you really have to make, use a skin fever of alo to get in there and make sure that everything looks seamless on the, around the lip as well. Yeah.
But I would say I'm doing a combination of horizontal retrograde. Mm-hmm. And, um. Ver vertical linear threads. Mm-hmm. And I'm also doing that in the lower lip as well.
Yeah. However, if they already have a really pouty bottom lip and if we're just trying to improve ratios, um, then I'll work on that upper lip to give it more height. And then once I see that good ratio, I'll go to the bottom and I'll do more horizontal retrograde and just to make sure that I'm not doing the same exact technique in the lower lip.
Then we're like back to square one of like, oh my God, now we have a fat bottom lip and it doesn't look right. Right. The ratio's off. Right. Does that make sense?
Yes, absolutely. Yeah. You don't wanna pull that too forward.
Yeah. So that's what I would say my technique is.
Yeah. And I love that you brought up the Cupid's bow too.
And, and even the bottom lip, like I think it's important to talk to the patients first. Like, are you happy with your ratio? Do you wanna try to change your ratio? Mm-hmm. Do you like your Cupid's bow? 'cause I've done that where I've like, I love the look, love the look of a cupid's bow. Mm-hmm. So I do it on.
Everybody, unless you tell me otherwise. Right. But you know, there's patients who are like, oh, I'm so, they they, they're so pointy now, you know? Yeah. Like some people, some people like it more rounded where you just wouldn't touch it, you know? I know. So you gotta, it's all about that consultation beforehand too.
My thing is that rounded Cupids bow, they want it rounded and mm-hmm. Some people are, if you already have a good cupid bow, there's
no rounding it.
We can't round it. Yep. And if we round it, I explain that
at least two times a day.
Yeah. And if we ground it, it's, it's gonna look migrated. It doesn't look natural.
Yeah. It doesn't look natural.
Yeah. We can inject you where we don't emphasize it further. Yeah. But even, even doing the horizontal filler will fill it up and it, it, it will emphasize it a little bit like
Yeah.
If you have a Cupids bow, unfortunately there's, there's no getting rid of that.
Yeah. Yeah. No, I agree.
I have like, I would say, three or four patients that are extremely fast metabolizers. Mm-hmm. The only thing that works in their lip is Voluma.
Yeah.
Um, but they also have good preexisting lip tissue. Mm-hmm. Like they have the tissue there to like handle it, support that.
Yep.
Um, but even before they're going, I'm like massaging the hell out of them just to make sure and not.
Get the hell outta them too hard to where it's moving it. Right. Right. But I'm just really making sure. Yeah. And we're not lumpy, bumpy. They're
numb. They're numb at that point. Oh God. Yeah. So it's like the perfect time to get in there and do it. Yeah. Yeah. Um, how would you say if you do end up like a lump of, or a bump mm-hmm.
How you handle that situation?
Yeah. I, I generally don't like having my patients massage it at home. Mm-hmm. I, I. Tell 'em the first five days to leave their lips alone. Because during those first five days, that's when you can have some post-injection swelling. And also it's hyaluronic acid gel, right? So it's gonna draw a little bit of water to the lip.
So it's normal for the areas where the filler are to swell a little so you can feel it. It almost sometimes feels like mashed potatoes. So sometimes I say that's not like really whipped. Yeah. And then like a
lump. Like a lump in the mashed potato.
Yes. Yes. Um, and you wanna like chew it like immediately?
Yeah. Yeah. But, and then usually I tell my patients if, if it's someone I can really trust Right. That feels comfortable doing it at, at home. Mm-hmm. I'll tell them after day five, if you continue to feel like a little lump or there, take your thumb and index. Index finger and massage it out.
Exactly. Yeah.
You won't
move or migrate it. It'll, you should smooth out. But if you're nervous to do it, just call the office and we can get you in. And I can have me or Alicia do it.
Yeah.
Yeah.
And massage it out for you. Yeah. Yeah. I think a lot of time, what about. So I, I typically tell 'em 24 hours. Okay. And then if they do feel any hard spots to, I like to use the term like pinch and scratch.
So I show them, you're like, you're holding the lip steady above, you're finding the spot and you're pinching and scratching right over the spot with like a Vaseline or Aquaphor to give you slip. And obviously very clean hands. Um, but I tell them to give it at least a full 24 hours. Um, but sometimes. If, if that doesn't resolve, I'll either have them come in and, and spot treat with Linx, which I don't love to do because Linx is very unpredictable.
Um, so if it's superficial enough, I'll just lance it with a needle and Yeah. And express that because if so filler when placed in the right plane should integrate like. All these little tiny little spots with your tissues. It should. It should be fully integrated with the tissue. If it's too superficial, it doesn't have the opportunity to integrate.
So it almost sits like a little ball at surface. At the surface, and it's kind of
bluish gray. Yep. And then you could just poke it with a knee. It's so easy. Just like
a pimple. Yep, yep.
And then express it. Yeah.
But a patient would never, for patients listening, you would never do that.
No. Don't do that at home.
Leave that to us. Yes. Yeah. A hundred percent leave that
to us. That's, that's for the practitioner. So just, and again, it's, it can happen to anyone like, you know, it's, it's, it's not sometimes the filler in the perfect plane and then it's nothing you did, or maybe you did do a straw or you, you are a vaper or things like that that caused it to move a little forward or it just settled a little bit into a pocket and it's normal.
If we have to do it, we do it and it always heals nice and smooth after the fact.
Right. I agree. I love that. Yeah. What else did we want? Oh, I would, let's just talk about like post-care instructions for lips.
Oh, yes.
Yes. Um, so, and a lot of you that are injectors know this, but, um, post-care, um, the huge thing is to keep those lips clean the first 48 hours.
Mm-hmm. So using, um, like Aquaphor, Vaseline, something new mm-hmm. At home. Don't use any old lip products for two days. Um, technically you're not supposed to wear like lipstick or Yeah. Like lip stain or anything for two days. Um. Yeah, because
it's, it's really, you have to remember these things are in there long term, right?
So even if, 'cause people think like, oh, well I didn't get an infection. Like it doesn't matter in a month, two months, six months, like
seed.
Exactly, you could get a nodule because, because bacteria got in there from the beginning. Mm-hmm. So you really have to make sure that for that first 48 hours, you are babying those things.
Like, don't let your dog lick your face, please, God. You know? Mm-hmm. Any, any old chapsticks. I will usually give people like an alcohol swab or two, because I feel like sometimes they don't always go out and buy a new one. Like, I'm like, all right, at least wipe what you have. Uh, but I prefer clean hands.
Wash your hands and do a Vaseline or aquifer, like you said. Mm-hmm.
I agree. Um, no hot tub or saunas for about two days. Yeah. Um, no working out for two days. Um, electric toothbrush. Do you say anything about that?
I think as long as, have you heard any? As long as you're, no, I think as long as you're, um, there's this, like,
there's this like notion up here in upstate New York that the electric
toothbrush is a problem.
That it's a problem. Funny. Unless you're literally funny. Unless you're literally holding the toothbrush on the lip to vibrate it. Yeah. Like, which you're not, no. Like you're brushing your teeth, I think. Yeah. I think it's fine.
Yeah. I know that it's funny 'cause people ask me like, well, can I eat? I'm like, of course you can eat.
Like, maybe don't pick like a chicken parm sub, but like,
nope, don't eat, starve yourself. My gosh, I know
those spoons, spoons and subs are probably gonna be a little hard. One thing
I'll say too, though, oh my gosh, I, and this one patient of mine, if she is listening to this, she would laugh. Uh, literally it was probably my first year of injecting, so like six years ago I did her lips.
She went to Dinosaur Barbecue, which I don't know if you've heard of that. No. It's this barbecue joint place, which is great. Love it. It's like a staple here in Syracuse. She went there after, had like spicy ribs or spicy something. Oh no. Oh my God. Her lips blew up.
Oh God. Yeah, because like
think with the spice.
Like the cayenne. Yeah. Got in there putting it
right on your lips. Oh my
God. Oh my God. Like it was like. I mean,
like
it was, they were huge. Oh my God. And she of course freaked out. She me. She's like, oh my God, oh my God. Freaking out. Like, what do I do? And I'm like, take it. Take a Benadryl. Yep. You know, by tomorrow it should be fine.
Like it was. And it was, yeah. Yeah. But like that spice, I, I always say try to avoid spicy food. Don't go to Chipotle that night.
It's funny that you bring that up because same thing, a couple years back, I had a patient. Sweetheart. She called me the next morning and was like, my lips are black. And I was like, okay, that is a major issue.
I need to see you immediately. And like, uh, she was older, so sending pictures was like. Not an option, you know, it was a little too, she couldn't take the picture of herself and then email. It was too much. So I was like, okay, I need, I need you to get in here. I need to see your black lips. I put an alcohol swab to them.
Mm-hmm. And um, she had eaten frozen blueberries the night before. Oh my gosh. And it was like, it was like a residue of the frozen blueberries. Oh my God. And she felt so bad. She was like, oh my God. But like, this is why you see your patients, you know? 'cause like in my head I'm like, oh my God, she has an occlusion and it's already too far gone.
And like, oh, you know, oh my God. I know, but it was, it was blueberries. Yeah. So it's like, oh, and, and always just make the time to put people at ease. That's what I always say, like mm-hmm. Even if it's just sending pictures and emailing them back. Yeah. Like just see your patients.
Oh, Nicole, let's talk about cleft lip.
I.
Oh, yes, yes. A clip or even, um, the scars. Just like scars. Yep. Yes,
because Great point, great point. Yeah. I'm sure you get some patients in with those.
Yeah. So I actually have a lot of patients with decent scarring. Um, and scarring can be difficult to work with because Fiddler likes to sit on each side of it.
Rather than integrate with the scar. So you really have to kind of take the time to make sure that you're injecting evenly and, and looking at it, having them express, always having them express while you're injecting. So like, smile, let me see how it's like, you know, looking and making sure that it's not pulling too much one way.
Um, and patients will always definitely be more sensitive there too. Mm-hmm. So that's something to keep in mind. Um, hundred percent.
I know I've had a few patients come in with a cleft lip and, and. One of them I was able to do. Mm-hmm. Like a treatment on, which is great. There's some, you, I just can't, like, it just depends on that scar and
Yep.
How much the tissue's like folded in. Yeah. Right.
And if it's too much folded in, then filler's gonna stay on each side of that scar. And it's just going to look like that curtain. It's gonna make the curtain. Yes.
Yeah. Yeah.
I. I was trying to find a good way to say that. It's the curtain. The
curtain. Yep.
Yes, a hundred
percent. And it felt so bad, like I know. It's like you wanna make it better for them. Yeah. But it's like you also, you can almost make it worse. Yeah, you can. Yeah.
Mm-hmm. Yeah. And it's important too, to explain to those people too, they are definitely considered more high risk because any kind of injury and scarring is going to change how the vascularity is underneath the, underneath the skin.
So
true. So true. So it can
make you more. Susceptible to a vascular occlusion.
It's like a facelift, right? Like any type of like change in your neck. That's, we need to ask like, have you ever had a facelift or any or facial surgeries? Yeah. Yep, yep. That's a good point. Yeah. Love it. All right. This was a great combo.
I know. I feel like I could talk about lips all day because like I know I literally used to be the lip queen.
Yeah.
That's all I did all day for like three years of my career.
Oh my God. I know. I same. I feel like it was just toxin lips and like look at like my practice is toxin power
tox out. Yeah. And obviously
we do way more than just treat lips.
Yes. Like now with like, you know, but it's crazy. It's crazy. Well, and that's
again, let's touch on that real quick. The rebrand, like. It's important, you know, as we start, we all start somewhere. Like I started, if you go back on my Instagram, all I posted was lifts and I did everything and people would DM me like, oh, I wanna come see you to get my lifts done, but do you know anyone that could do my cheeks?
And I'm like, yeah, me. Yeah. Like, you know, but they didn't know that. So it's, it's, you have to be so careful about what you're posting and show. Showcase what you can do. You know? I know. Well,
I think I was telling you the other day, I felt like all I've been posting is stuff about our podcast. Mm-hmm. Um, about facial balancing, about, you know, biostimulators, PDGF, whatever.
And then, uh, someone asked me like, you still do lips, right? And I'm like, oh my God, are you kidding? Yes. I do lips all the time. And I'm like, shoot. I literally look back and I, I think the last 20 posts were not lips. Yeah. Like I'll post 'em on my story. Right. But I almost kind of felt not everyone sees that.
Yeah. Right. And I don't know if you think this way, like I almost think people are sick of seeing lips all the time. Yeah, yeah. And you know, uh, they wanna see kind of everything but which is
so funny 'cause even though I do and you do the same, like so much facial balancing. Yeah. I would say still, oh my God, at least 50% of my practice is just lips.
Oh yeah. It's still such a popular thing and it's, it's also like the younger crowd, people that may not need other things yet. That's kind of how they get their foot in the door and, and a little bit of tox and stuff. But, but, uh, you're right. We, we forget to post it.
Yeah. I think I was looking at my top five services I have like this past, over the past year.
And obviously it's low, it's neurotoxin, right. Um, is number one. And then number two is mini pout. Full pout. Yep. Um, one of the two. And then it's facial balancing s Sculptra. Yeah. Um.
Those bigger things. Yeah, those bigger
things. Yeah. But lip, I think lips are always gonna be very, very popular and they're kind of the gateway to get people in the door.
Yeah.
Too. A hundred
percent. Yep. Yep.
So anyway. Well, well this was a
fun one. Thank you guys for listening. This so
fun. Yes. Thanks for tuning in. If you guys have any questions, shoot us a DM and comment on our reels. We absolutely love it. Um, the engagement with this has been so fun and I feel like it brings people together and we love hearing from you what your techniques are, what you're seeing in your practice.
So, um, love you guys and thanks for tuning into another episode of the Fill Me In Till Next Time.