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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We understand there are a lot of choices for you out there when you’re looking to have a cosmetic injection.  So, before you choose your provider based on price, consider the following case.  This case highlights the importance of understanding the risks of a procedure as well as the importance of understanding the experience of whomever you choose for your injections.

We see a fair number of unfortunate and unusual cases where patients come to us from other practices, but this one was particularly striking.  Fortunately, we were able to help this patient, and we wanted to share it with you because it highlights the importance of educating yourself before consenting to any cosmetic treatment.

This patient came to us after she had been treated by another physician with steroid injections to remove Juvederm from her cheek area. Typically, steroids are NOT used for the removal of dermal filler products, but the patient was positive that this was the treatment she was given despite our repeated questioning.

Steroid injections can be very valuable in treating acne cysts, scars, etc., but they do have risks. They work by atrophying or “shrinking” the tissue that they are injected into. While this may be helpful if there is excess or inflamed tissue present, it can be damaging if there isn’t. That is how this patient claimed she developed this large indentation in her cheek.

As you can imagine, she was very unhappy and distressed by the appearance of her cheek and wanted to know if there was a way to help it look more natural and normal again. We discussed using Restylane Lyft in the area. Our experience with this product is that it is a thick, sturdy filler that is ideal for adding volume, especially in the cheek area. After discussing the treatment extensively with the patient, we injected her with 1cc (or one syringe) of Restylane Lyft. As you can see from her photos, she was beyond ecstatic with her results and so were we.

By choosing the correct dermal filler product, we were able to provide soft, natural-looking results. At Celibre Medical, we pledge to you that we will answer all questions that you have regarding your treatment and even tell you if treatment is potentially harmful or not beneficial for your needs and goals. We’ll take the time to listen and we want to develop a lasting relationship.

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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 tired of looking tired under your eyes, maybe it’s time to do something about it. Surgery isn’t always the only option; in fact, for many people with under-eye hollowing or bags, treatment with injectable dermal fillers can provide dramatic and long-lasting improvement and maybe a better choice.  Here’s why:

As we age, the delicate, thin skin around the eye thins even more. We lose precious collagen which triggers the changes of darkness and wrinkling. Time also causes the normal fat that surrounds the eyeball to push through the circular muscle that surrounds the eye, making the lower eyelids look swollen and puffy. Losing volume in the middle part of the face (the cheeks and cheekbones) can also cause the eyes to look aged by accentuating these changes and making the groove or tear trough beneath the eye more prominent.

Restylane is an excellent hyaluronic acid (HA) filler that can be used to correct and camouflage these unwanted changes. It stimulates the production of collagen in the skin, replaces volume for indentations, and helps smooth the transition between a bulging fat pad in the lower lid and the cheek. At Celibre Medical, Restylane is our number one product to use for under-eye bags.

To give you a better idea of what Restylane can do for the eyes, please look at our patient’s photos below. This gentleman could have also chosen under eye surgery, as he has quite a bit of excess skin beneath his eyes. He opted instead for Restylane injections because he wanted immediate results and he didn’t mind the thought of re-treatment in the future. Restylane, coupled with the right injection techniques, gave him some very nice results that he was very pleased with. As you can see, it is possible to achieve dramatic change with a non-surgical approach.

Under Eye Bags Before PhotoUnder Eye Bags After Restylane Photo

Injection Technique Matters for Under Eye Injections

While the skill and technique of your injector are important regardless of the area being treated, we feel it is important to say that proper technique is essential when using dermal filler injections beneath the eyes. It can be the difference between you looking worse and looking amazing afterward!

Injectors at Celibre are all highly trained and experienced in injection techniques that place the filler product “under the muscle” when treating the area beneath the eye. This technique ensures that your filler looks smooth and natural. When done improperly in the incorrect plane of tissue around the eye, dermal HA fillers can bruise severely and look uneven and lumpy.

Make sure to discuss the experience of your injector as well as the techniques that will be used for your under-eye filler before treatment. Before and after photos can help you gauge the skill of your injector as well as help you understand what this treatment can and can’t do for you.

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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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If you’re considering Restylane injections, then you likely want to know what to expect after your injections. Restylane is an injectable dermal filler made up of hyaluronic acid (HA). There are a few other HA fillers available in addition to Restylane (such as Juvederm, Restylane Lyft, and Silk); and while all these products are used in slightly different ways, the recovery period for all is generally the same.

downtime for restylane injections before and after pictures downtime for restylane injections before and after pictures

Restylane Before and after photos

Bruising and swelling are the two most common side effects of Restylane injections. Just like other side effects, the severity can vary from patient to patient. It’s difficult to predict beforehand how any one patient will be affected by bruising or swelling.

We tell all our patients planning to have Restylane injections that they may need a few days of “social downtime” afterward. This means that they will feel fine but may not look exactly right to go out and be around co-workers, friends, or classmates. All patients benefit from the use of cold compresses or small ice packs gently applied off and on to the treated area, and usually, a bit of makeup is all that is necessary to hide a bruise.

All in all, there really isn’t true “downtime” after Restylane injections. But, if you’re planning on having your treatment prior to a big event (wedding, reunion, pictures, etc.), you should schedule your treatment at least two weeks before to make sure you’re looking top-notch for your big day. Read more about Some Facial Shaping Techniques and  Removing Wrinkles.

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We all see changes in our faces as we age. One area that is often overlooked is the chin. Believe it or not, changes in your chin can have a BIG impact on the way your mouth, lips, and smile looks. Have you noticed that your once full, rounded chin looks now looks indented, hollow, or more angular? Chin rejuvenation with a dermal filler such as Restylane may be just what you need to help you and your lower face look full, round, and balanced again.

restylane chin injections los angeles before and after pictures restylane chin injections los angeles before and after pictures

The chin area can lose volume as we age, much like our cheeks, under eyes, and lips. And like these other areas, dermal fillers can be used to help reverse unwanted changes. If your chin is hollow or has convex (like a bowl) depressions on both sides, Restylane can be used in this area to reshape and restore volume here. This not only helps your chin look more rounded, but also provides much-needed support for your lower lip. Restylane here also helps lift the corners of your mouth. This helps you look happier, even when you’re not smiling!

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Restylane is a hyaluronic acid (HA) filler used for the correction of fine lines, folds, and shaping of the face. Restylane injections typically provide good outcomes for anywhere between three to six months with the average length of time being four months for patients new to Restylane treatment.

Experience and research support that Restylane injections may last longer with consistent use of fillers (every 4-6 months). This is related to the body’s response to make collagen in the treated areas – a good thing! Medicis (the manufacturer of Restylane) has now provided research to support that benefits may last as long as eighteen months but only when used consistently. Technique and areas being treated will also have a role in the longevity of the Restylane injections.

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Perlane is a cosmetic dermal filler for correcting deeper folds, adding facial volume, and providing facial shaping. Perlane is from the manufacturer of Restylane, Medicis. Although Perlane is similar to Restylane in that it is a hyaluronic acid filler, it has larger particles than Restylane. This means Perlane injections allow for more volume and increased longevity.

perlane los angeles before and after picturesperlane los angeles before and after picturesGenerally, the effects of Perlane injections will last from six to nine months.

For those patients that utilize more than one syringe or combine Perlane and Restylane, they will most likely experience longer-lasting benefits and/or more dramatic outcomes.

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