Philtral Columns and Mouth Rejuvenation

At Celibre Medical, when it comes to using filler in the lips and mouth, we believe that less is definitely more. Technique and knowledge of optimal lip structure and anatomy trumps “plumping and filling” the lips. This is one area of the face that takes finesse and skill to inject well. When done right, the results are amazing!

First, we want to ensure that any lip filler treatment leaves you with a symmetrical and natural-appearing mouth and lips. To accomplish this, we pay special attention to the philtral columns, the raised, vertical ridges that connect the bottom of the nose to the lips. They are different for everyone—some people have more pronounced philtral columns and others less so. The key is adding just the right amount of structure to this important area with small amounts of filler to get the most natural, youthful appearance.

As we age, the area between the nose and upper lip elongates and flattens. This accentuates a natural flattening of the upper lip that happens over time (double whammy). By using a small touch of dermal filler such as Restylane or Juvederm, we carefully recreate youthful philtral columns that accentuate the border of the upper lip. Building these columns accentuates the natural “V” of the upper lip known as the cupid’s bow. This gives your lips more shape and helps to lift and evert the upper lip (turn outward and upward).

Note that these techniques don’t involve filler in the actual lip itself, but still change the shape and appearance of it.  When an injector doesn’t understand these principles and techniques and just “fills” the lips, the duck-bill or trout-pout results.

If you’re considering lip or mouth injections with dermal filler, we encourage you to discuss what techniques your injector will use. Understand how dermal filler injections can accentuate or enhance your natural beauty—not just give you big lips! Remember it’s quality, not quantity that makes all the difference between being “treated” with dermal filler injections for the lips and mouth and being “filled”.


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Aging is inevitable and happens to everyone. But, some manage to age more gracefully than others. Before you assume that it’s all genetic, we’re here to tell you that “looking good” for your age often involves a secret weapon: a good aesthetic practitioner.

If you asked around, you’d be surprised at just how many people are using Botox and dermal filler treatments to look younger and feel better about the way they look. A good cosmetic practitioner has a “playbook” of minimally invasive techniques that yield big results with little to no downtime. Dermal filler injections are one of them.

An example of an area that responds phenomenally to filler injection is the nasal alar area. This is the area of the inner cheek, just beside the outer edge of your nostril. It is the very top end of your nasolabial fold or “laugh line”.  As we age, this fold or crease becomes more noticeable due to structural changes and volume changes in the cheek itself. Combined with years and years of smiling and laughing (which is good!), this crease indents even further—which is bad! It can lead to a “heavy” look or like your cheek is folding in on itself.

Just a drop or two of a dermal filler product in the area next to the nose can make a big difference. Even if you aren’t bothered by too much “heaviness” in the nasolabial fold, treating this area with dermal filler can help improve your overall look by changing the topography. Without filler, it’s convex (like a bowl) which means that you’ll see a shadow in that area. Once filled, it becomes smooth which takes away the shadow effect and creates the visual effect of smoothness and fullness.

At Celibre, we like to use either Restylane or Juvederm for this area. It’s a small injection that can yield big-time results. And it’s just one of many little “tricks of the trade” that Celibre’s skilled injectors use to help you look your very best.

 

los angeles restylane for laugh lines before and after pictures los angeles restylane for laugh lines before and after pictures
Restylane before and after pictures

We all know and love the famous actress pictured below. Although many stars deny using any type of cosmetic injection treatments to keep them looking young and beautiful, at the end of the day, it is their job to look good. It’s a good bet that almost all of them do! So, back to our friend below. Yes, she is beautiful, but when you look at this picture, you probably think something is a bit off…and you’re right! Let us tell you more about what’s gone wrong with this actress’s look.

Botox: Yep, she’s done more than just “try” Botox. She’s a regular. How do we know? Because she’s developed a tell-tale sign of long-term Botox use known as “bunny lines”. Do you see those little lines on the side of her nose? Notice that the rest of her forehead, between her eyes and even her crow’s feet area looks almost perfectly smooth when she smiles. So, what’s happening exactly?

Remember first how Botox works: it blocks the muscle receptor that is stimulated by the nerve that tells it to contract. Treated muscles stay in a constant state of relaxation, which makes the skin look perfectly smooth instead of wrinkling with contraction (facial expression). Your brain is still telling your muscles to move and they can’t. If certain muscles can’t or won’t move to create facial expressions, others start to take over to get the job done! Bunny lines result from over-activity of the nasalis muscle on both sides of the nose. They usually only appear with a smile, so you won’t see them at rest. They happen when too much Botox has been used or when other facial muscles normally used in facial expression are constantly relaxed.

Filler: It’s no secret that we all lose facial volume as we age. One of the places where these changes can make us look dramatically older is around the mouth. There are many areas that can be injected with dermal fillers here. They include the “white” lip (area between the lip and nose), the vermillion border (the edge of the lip itself) and the lips (or “red” lip). Think of each of these as specific, different pieces of a puzzle that all need to be balanced with each other for it to look complete or right. If one area is out of proportion, the whole thing looks off. That is what’s happened here.

At rest, her lips may look great, but when she smiles, you can see that only the body of the red lip has been treated with filler. Her vermillion border is totally flat. Smiling causes the lip to “stretch” and essentially makes the upper lip look like it’s swollen and “rolled” upward over the teeth. This is not a very natural look.

This picture demonstrates the fact that cosmetic injections can be tricky. There is no one, cookie-cutter approach to any of them, Botox or filler. Your injector needs a trained, skilled and artistic eye that not only sees your natural shape and areas that need improvement, but one that can also judge and mitigate unintended consequences of treatment like the ones discussed here. Your evaluation should include an appraisal of your appearance both at rest and with expression and movement. This is the best way to judge appropriate treatments for you and tweak things that may not look quite right. This takes time, attention to detail and a personalized approach to cosmetic injections. Here at Celibre Medical, we pride ourselves on these things and believe our approach is what gives us an edge over the competition.

If you’re considering dermal filler injections for mouth or lip augmentation, there are several important things you should know before your procedure. First and foremost, you can’t (or shouldn’t) take a photograph of your injector and say, “I want lips like these!”  Unlike haircuts where a certain one may look good on many different people, your facial features are distinctly yours! It’s impossible and just not aesthetically pleasing to simply recreate someone else’s lips, nose, or otherwise on your face.

The goal of mouth and lip augmentation is to make you look like a better version of yourself. Whether that’s restoring lost volume in your lips or around your mouth, correcting/softening lines around your mouth, or restoring features that have changed or been lost over time in this area, the techniques used should help you look more youthful with soft and rounded features—not like a pouty, fish-lipped, obviously over-filled Hollywood celebrity!

At Celibre Medical, we use a combination of both dermal hyaluronic acid (HA) fillers like Restylane and Juvederm with Botox / Dysport to fill and shape the lips and mouth.

 

How Celibre Medical’s Approach is Different

We use HA fillers to add volume and definition to the lips. We can enhance and redefine the lip border with these products and reshape the mouth by carefully placing products just outside the corners, helping to turn them up and giving you just a hint of a smile. If your lips appear “deflated” with wrinkling, HA fillers can help restore soft, natural-looking volume and soften those wrinkles.

The ideal lip proportion is the bottom lip just slightly larger than the top. If your lips have always been disproportionate or if they’ve simply just thinned out over time, HA fillers can restore or establish a more aesthetically pleasing proportion to your lips.

Aging can also trigger changes in facial boney structure and soft tissue which elongates the space between the base of your nose and your upper lip. It can also make your upper lip appear as if it’s turning inward or rolling towards your teeth. HA fillers can help restore your lip volume and return the appearance of the area around your mouth to what it was in your younger days.

One of the most common complaints from patients like you is those little vertical lines that appear around the edges of the mouth. Not so affectionately known as “smoker’s lines”, they can appear on someone who’s never smoked a day in their life! We’ve seen many women mistakenly take to removing all straws and bottles from their daily lives to prevent smoker’s lines, but we’re here to tell you that’s not why they happen either!

It is actually a combination of factors that create a smoker’s lines. Number one, repeated contractions of the circular, purse-string-like muscle around the mouth is the underlying issue, but secondly, the loss of collagen and elastin in the skin just around the lips also contributes greatly.

Many injectors will simply try to place small amounts of filler in these lines, in an attempt to smooth them out. This may work for some, but for many, it just makes the lips look disproportionate and the top lip looks heavy.

Here at Celibre Medical, we address the underlying muscular issue with Botox or Dysport. Subtle relaxation of the muscle will improve the appearance of the lines. We couple this with dermal fillers to redefine the border of the upper lip.  This helps to soften the appearance of these lines, without injecting them directly. Using these combined techniques over the years has also shown us that many patients get a subtle lip eversion. This means the upper lip gently rolls outward and upward. This helps the upper lip look even fuller and shortens the distance between the lip and the base of the nose, a win-win!

As you can tell, there is a lot of artistry, skill, and knowledge that goes into lip and mouth augmentation. Before you book an appointment with an injector, make sure that you look for some before and after photos that demonstrate their skill. Also, make sure you understand the benefits and limitations of this procedure, so that you’re pleased with your results. If you’d like to learn more about Celibre Medical’s philosophy on using injectables and lasers for facial rejuvenation, please visit our laser and injectables for wrinkles page.


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It’s not unusual for patients, both men, to voice concern about their motivation for seeking out aesthetic treatments.

Some curious men will ask, “Do many men get these treatments?” Women, on the other hand, will say, “No one knows that I do these treatments. I’m treating myself today.” A more recent question that I’m asked by patients when receiving their injection treatments is, “do you think I’m being vain?

being vain with botoxI always pause before answering that sincere question. I recognize that the average patient works hard to invest in botox treatments, and I’m very aware that they are trusting me with this investment in themselves.
My answer remains the same. “No, I do not. Wanting to help your frown lines or freshen up your appearance is no different than getting your hair done or working out to maintain physical health.”

If we give attention to our physical health, maintaining our hair, nails, or wardrobe, then wanting to improve an important asset, our face, fits nicely into that routine.

I recognize that in this day of endless selfies, outrageous aesthetic treatments, and a society that is overwhelmingly promoting self-centeredness, it’s no wonder that a patient would pose that question.

I have often repeated a mantra over the years of, “crazy people do not wonder if they are crazy.” We can translate that to, “narcissists do not wonder if they are narcissistic” and finally….Vain people do not wonder if they are being vain.


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Botox $8.00 per unit? Dysport $3.00 per unit? Restylane for $350.00 per syringe? We all recognize that price is important. However, most will agree that cheaper doesn’t necessarily equate to better. In fact, we would even argue that cheaper, in most cases, doesn’t even equal adequate. We often hear stories of Groupon deals wherein the Botox “did not last.” In one serious case, a patient was injected with a dermal filler obtained overseas that resulted in a serious tissue infection.

No business or practice will operate in a manner to lose money. To support pricing that is significantly below the standard in our profession, many corners may be cut. Short- cuts and compromising standards in a medical professional do not bode well for patients and also call into question the ethics of the medical professional.

What consumers may not realize is that it is illegal for a medical practice to purchase, obtain, use, or distribute Botox, Dysport, or any injectable dermal filler from anyone other than the manufacturer in the United States. Because of this widespread problem, regulations and enforcement are finally equipped to catch up with those placing patients at risk and degrading the aesthetic medical profession. See the below link for a widespread operation that targeted numerous local and non-local medical professionals illegally purchasing their products.

You may be wondering right about now if it’s worth the risks vs. the potential benefit of saving money. If the only negative outcome is a short or substandard duration with your Botox, then you are still not saving money. However, please consider that illegally obtained products cannot offer a guarantee of sterility or proper handling, or that you are even receiving a safe product. If something goes wrong, the insurance carrier for the injector will not cover the adverse event. Finally, if we cannot trust our physicians and nurse to obey the law in one area, it calls into question everything as it pertains to ethics and integrity.

We recognize that we are not the cheapest, nor do we strive to be. Our goal is to offer competitive pricing with a safe, appreciable outcome, and most of all… remains a trusted name in aesthetic medicine.

 

https://www.fda.gov/Drugs/DrugSafety/ucm349503.htm

https://www.fda.gov/ICECI/CriminalInvestigations/ucm545872.htm


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We’ve had many requests for Voluma over the past few months in response to the launch of Allergan’s newest dermal filler product. The strategy of our organization has always been to let new products earn their place in our practice by proving, over a year or two in the market, that they are worth the hype.

And that’s what product launches are – hype. The manufacturers of lasers and injection products have to hype their products with huge PR campaigns to try and make a name for their brand in an already cluttered cosmetic dermatology marketplace. They get consumers really excited when appearing on shows like “The Doctors” and “Dr. Oz”. The problem is that the reality of the product is usually quite far off from the hype and Voluma is a perfect example.

In the FDA study used for the approval of Voluma in the cheeks, the AVERAGE patient used 6.5 CC’s of product in the cheeks. Now, if you know anything about injection product, you know it’s very unusual to use this much product. In fact, most patients at our practice get a maximum of 3-4 CC’s in the cheeks. To give you an idea of how much this would cost in today’s market, Voluma is selling for between $750 and $1000 per CC. So that 6.5 CC average patients from Allergan’s study would have paid between $4,875 and $6,500 for their injections. We don’t know many consumers willing to pay that for their injections.

On top of this fact, if you inject 6.5 CC’s of ANY dermal filler, you are going to get a lot of duration, just because there is so much product in the cheeks. Voluma claims a 2-year duration, but Juvederm XC also claimed 18 months when they originally came out and if you know Juvederm, you also know it doesn’t last for 18 months. We believe that it’s very realistic for Voluma to achieve 12 months of duration, but beyond that we are skeptical and will let consumers weight in over the next year as to whether the premium cost of Voluma is worth it.


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When you think about Botox, chances are you think about getting rid of the dreaded “11” frown lines between your brows or smoothing out your forehead wrinkles. While it’s true that Botox is the best fix for these concerns, it also has many other lesser-known uses. We’ll discuss three other common facial concerns that Botox can address in a snap!

The Lateral Brow Lift

Your lateral brow is the outer edge of your eyebrow. As we get older, repeated squinting, squeezing, and blinking of the purse-string-like muscle encircling the eye can pull the outer eyebrow down, and guess what? That makes you look older and your upper eyelid look heavy. Botox can be injected into a part of the muscle that lies just beneath this part of your eyebrow to relax it. This allows the muscles that lift the brow to take over, resulting in a more youthful, awake, and refreshed appearance for your eyes.

botox brow lift los angeles before botox brow lift los angeles after

Upper Lip Wrinkles

These wrinkles are often referred to as “smoker’s lines”, but smoking isn’t the only thing that causes them. If you’ve spent time in the sun or are losing facial volume you may be developing these pesky little lines. Many of us just develop them naturally as we get older due to the everyday movements we use in speaking and facial expression. They can cause that annoying little problem where your lipstick bleeds beyond the lip.  Luckily, Botox can help! The muscle around your mouth is a lot like the one around your eyes. It’s a strong, circular muscle that when contracted, causes your lips to pucker and makes those lines worse.

By injecting a few units of Botox into the muscle of the upper lip, we can soften these lines and dramatically reduce them. The trick here is finding the right dose: too little and you won’t see a change and too much and you may not be able to pucker or pronounce words that require you to contract your upper lip. However, getting it right can really soften those lines and even help your upper lip look smoother and help that lipstick glide on.

smokers lines botox restylane before smokers lines botox restylane after

Pebble Chin

We usually think of dimples as being “cute”. But when they’re on your chin, they’re anything but! Some people just develop an over-active chin muscle (or mentalis muscle) that causes a condition known as pebble chin. By relaxing this chin muscle with Botox, we can restore softness and smoothness to your chin. It usually only takes a few units to see improvement, but the results are impressive!

botox for pebble chin before botox for pebble chin after

More Botox Before and After Pictures


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In 2009, the FDA issued a “Black Box” warning for Botox that has now carried over to all neuromodulators such as Dysport and Xeomin.

A Black Box warning is the most serious warning that the FDA may issue for drugs/medications that have potentially dangerous side effects. Because of the potential spread to distant areas after injection, Botox (and its sister products) was given this warning on its packaging.

Botox black box warningLet’s consider the following:

  • When Botox/Dysport are received directly from the manufacturer and used responsibly by a trained practitioner, treatments are extremely safe.
  • Botox has a higher safety rating than Aspirin.
  • Botox (neuromodulators) is the #1 cosmetic treatment in the world.
  • Reports of distant spread of Botox were associated with very large doses in patients already with compromised health wherein the risks of treatment were outweighed by potential benefits. (ex: cerebral palsy)
  • Cases wherein patients suffered great harm were associated with “bootleg” Botox that was not received directly from the manufacturer.
  • A more recent case of distant spread was related to the use of high doses in the neck for platysmal bands that resulted in compromised swallowing for more than a couple of months. We do NOT use Botox/Dysport in the neck as we believe this is far left off-label wherein benefits are outweighed by potential risks.
  • Finally, there are many common drugs that carry a Black Box warning such as:

Cipro (a common antibiotic), anti-depressants, anti-coagulants, anti-diabetics

Balanced and responsible information in all things…


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We spend a lot of time talking every day, but have you ever wondered what your mouth says about you? We’re not talking about actual words of course, but rather the appearance of your mouth and lips. The lower third of the face often gets overlooked in terms of age-related changes. The truth is though that it says a whole lot more than you might like about your age!

The reverse of this is also true; many women simply plump their lips with fillers such as Restylane or Juvederm, creating an uneven, disproportional, and unnatural-looking mouth. The real truth is that balance and symmetry are essential when treating this area with Botox and fillers. It can be a very fine line to walk, and the insight and skill necessary can take years for an injector to hone in on and develop. This is why who treats you can be just as important if not more than what they treat you with.

los angeles restylane for lips before photolos angeles restylane for lips after photoLet’s use the woman in the photos on this page to demonstrate some of the very common age-related changes that can occur around the mouth and the effective, yet the subtle impact that cosmetic injections can have in this area of the face.

Notice in her pretreatment picture that the area between her nose and upper lip appears flat and elongated. This happens because the muscle that encircles the mouth (like a purse string) repeatedly contracts, pulling the upper lip down and curling it inward, toward the teeth. You don’t see them as much on this patient, but tiny, vertical lines (smoker’s lines) that appear above the upper lip also form in response to this muscle’s repeated contractions as we age. Notice how her mouth is almost turned down at the corners and how her upper lip appears much thinner, smaller, and out of proportion with her lower lip.

Now, take a look at her photo after injections of Botox and dermal fillers. Wow! Big difference, huh? A very small amount of Botox was injected into the muscle around the mouth, softening its downward and inward pull on her upper lip. Hyaluronic acid-based dermal fillers such as Restylane and Juvederm were also used to reshape her mouth by careful injections into the border of the lips (vermillion border). Combined with the Botox, this has the effect of rolling the upper lip out and upward (lip eversion), effectively shortening the distance between the nose and upper lip.

She also had a bit of filler placed in the red part (mucosa) of the lip, restoring the balance between her upper and lower lip as well as the proper proportion. Last but not least, a small amount of filler was added under the corners of her mouth. By replacing this small amount of natural volume that she’d lost with age, the corners turned up slightly. The overall appearance of her lips and mouth area is much more pleasing to the eye and looks totally natural, youthful, and beautiful!

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