Lips to Love

Dr. Furnas (00:03):
In the 1996 classic comedy First Wives Club, Goldie Hawn had her lips over plumped with saline as she played one of three women seeking revenge against their husbands who left them for younger women. Back then her lips were comic, and now you can find them on TikTok. Is this a good thing? Welcome to Skintuition. I'm Heather Furnas.

Dr. Korman (00:30):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the nonsurgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:43):
So Goldie Hawn's overfilled lips represented her desperation to look younger as a reaction to losing her husband to a younger woman, and also as an actress who wanted to continue to get those juicy rolls. Why the lips?

Dr. Korman (01:02):
Yes. Oh, the lips. Well, young women and not so young women, and some men also want full plump lips. Angelina Jolie's lips with a defined lip border, and older women who love full lips if they can get them, but often their main concern is getting rid of those vertical lines that a lot of people call smokers lines, even though they're not always from being smokers. It mostly has to do with, as we age, we lose some of the volume and that creates some of those lines.

Dr. Furnas (01:35):
So there are really two distinct patient populations with lip filler and lip treatments, and those are the young people really looking for. They've got youthful lips, obviously because they're young, but they want fuller lips. And then as we age, that circular muscle that allows us to pucker up and kiss or sip from a straw or whistle, that muscle acts on our skin repeatedly through the years until primarily in women, because we don't have thickness, thick dermis with the hair follicles of a beard. Women tend to get those fine lip lines and they want to get rid of them, so they go for filler.

Dr. Korman (02:21):
So I think it's really, the muscles a big part of it. The skin covers it. And then of course there's the pink mucosa, and that covers the lip part. And the mucosa, which is the part that's, it's skin, but there's the inside, that's what's called the wet mucosa and the part that's exposed to the air, that's the outside and that's the dry mucosa. And all of these components go into the lips. And it's also important about the lips to understand that there's a word called the homunculus, which is a big long, but basically it's the part of the brain that has the nerve endings. And the biggest part of the brain that has the biggest homunculus is for the tips of the fingers and for the lips. So it's not just for how they look, but also how they feel, what the sensation is.

Dr. Furnas (03:19):
So we use our lips for eating, speaking. I mentioned sipping on straws and kissing. And so we depend on the fine function of our lips when we treat the lips to either plump them up or to get rid of lines. We can alter the appearance during animation. So when we're moving our lips around, if the treatment is done so that there's too much filler or too much of a neurotoxin like Botox, the lips can look a little odd, maybe feel a little odd, and in some instances may not bend the way that we like. So treatment of the lips really takes an artistic eye and someone who really understands anatomy and also has more than one way to treat lips.

Dr. Korman (04:19):
Yeah, I think it's also that, as we mentioned in a previous episode, we talk about diversity and different types of people and skin lips are different based on certain ethnicities, and it's really important for both the patients and the practitioners to get on the same page to understand the different shapes of different ethnicities and also what the patient would like. I think it's always a question that the practitioner wants to get a sense from the patient. What would you like? It's also important for the practitioner to be able to, at some level, explain to them whether it's too much or give them some suggestions. But lips have a lot of shape to them and not just fullness. And it is important to, as much as possible, look at your lips and think about what you think you'd like so that you can convey that to the practitioner.

Dr. Furnas (05:22):
So when we see people with wanting some sort of lip treatment, we'll look at several things. Josh talked about the shape of the lip. We look at how much of that pink mucosa show there is. We call that the vermilion, that pink mucosa where you have the cupid's bow, that's the vermilion, and it comes from the word meaning red in color. And we look at the cupid's bow, the philtrum column. So the two little peaks of the lip that go towards the nose. We look at the lip lines, we look at the volume of the upper and lower lips, and we look at the length of the upper lip.

Dr. Korman (06:05):
Yeah, the upper lip is an interesting in terms of, I think partly because of gravity and partly because of volume. But as the lip lengthens as we age, and sometimes people don't, there's something that bothers them, but they don't really know what. And what that is is a lip getting long, and there are things you can do about that, both with nonsurgical and surgical ways to approach it. But it is like everything in medicine, it's always good to diagnose before you treat it. So it's good to understand about the volume. You can imagine if you put volume in a lip, how the length may give the appearance of being a little shorter, but may also give it even more length. So it is really good to study your lips and convey that to the people who are helping to make you look more youthful or more rejuvenated or just fix things to a time when you liked your lips better.

Dr. Furnas (07:13):
One thing that we will see from time to time is an older woman, so somebody who has lip lines getting a lot of filler so that the lip lines no longer show and the patient is probably really happy with that. But as Josh just said, too much filler ends up actually lengthening a long lip. And so the lip can be distracting in its very large size and its length. And one thing that in a patient like that that really should be in the conversation is a lip lift. And this is a non-surgical podcast, non-surgical cosmetic treatments podcast. But I do want to mention a lip lift. It's a way of lifting the upper lip. The incision is hidden in the shadows at the base of the nose, and you can give the muscle itself a little bit of a lift to define the cupid's bow better. It shortens that long lip and makes it look more youthful in a very subtle way. And because I think when your tools are limited to the nonsurgical fillers and laser and neurotoxins, it may not cross a practitioner's mind that there actually is a treatment that ends up looking much more natural. Not that people with a lip lift will never need to use those other modalities, but it can really give a much more natural look to that lip.

Dr. Korman (08:50):
Yeah, I think it's important, a lip lifts are wonderful operations. It also tends to, a long lip has more lip to have a wrinkle. So having a shorter lip, it means that it's shorter, so there's less wrinkles to do that. I think it's also important to understand that wrinkles are essentially are hills and valleys. So they're the valleys next to the hills. So when you treat them, you can either build up the valleys or take down the hills. So fillers basically fill in the valleys and Botox and other neurotoxins tend to soften the lines. But the other nonsurgical treatment is laser resurfacing, which is essentially an electronic sandpaper machine, and that takes down the hills. Now, if the lines or the wrinkles are pretty deep, then no amount of laser resurfacing can go deep enough to make it seem that you can get to the bottom of the wrinkle because you won't have any skin left. So it's a dance, but it is important to realize that there are several, as Heather mentioned, there's surgical and there's nonsurgical ways and combinations to make the lips better.

Dr. Furnas (10:08):
There are different thicknesses or viscosities of filler, and so within the lip, you may want one viscosity for the lip lines, another for what we call the white line or border of the lip, and then another to fill the lip to give it volume. And so you want to go to a practitioner who really has the ability to have an eye for what is really the best filler for each part of the lip. And then a neurotoxin can also relax the lip, which can allow the pink part of the lip to actually rotate up because it's relaxing that sphincter muscle. Remember the sphincter muscle is what you whistle with. It draws the lip down. So if you weaken that muscle selectively, you can shorten the lip a little bit and get that lip border to rotate up and relax the muscle so that the lip actually looks a little bit fuller. That can be associated with sort of a difficulty saying P and B initially. But after that, after about two or three weeks, then that wears off and you've got a nice lip shape. Filler is a way to volumize. And also there's a new filler with micro droplets called Skinvive that doesn't really volumize, but it does smooth out the skin, and that's a great treatment for just the regular skin where the lip lines are.

Dr. Korman (11:44):
And it's also good to know that all these lip fillers essentially are dissolvable, so that if you don't like it, you can do something about it. One thing that I think, let's move on a little bit to this a little bit, the practical natures of it, of fillers. So for example, fillers come in a syringe, and sometimes patients think they only want a little when they need more than a little, and similarly, sometimes they really only need a little, and there is more in the syringe than what is in the amount they need for their lips. So Heather, how do you instruct your staff to manage one patient's expectations and also putting the right amount of filler when you have a certain amount in a syringe relative to either too little or too much in the lip?

Dr. Furnas (12:45):
Good question. For the person who just needs a little bit less than a syringe and where a full syringe is going to look distractingly, anatomic, then I would tell the patient that we can put a little bit in another part of the face. There are so many ways to use filler that oftentimes, whether it's the chin or nasal labial fold, we could give a whole lecture on the ways to use filler, but I would not just for the heck of it, get your money's worth and finish the syringe. On the other hand, if you have somebody that needs a lot of volume and they don't want to have more than just a little bit like one syringe, maybe they need two syringes, then if it's really going to not address what their concerns are and deliver the result that they want, then I would say save your money and come back when you can get the treatment that's going to give you the result that you want. Otherwise, they'll be disappointed and actually throwing their money away for that syringe that they did decide to have. How about you, Josh?

Dr. Korman (14:02):
Yeah, I think in general, I always say the most important thing about the filler is the filler, not the stuff, but the person who injects it. And I think that's an important, really important concept for anybody who's looking for where to go to have the fillers. I think it is good to have a consult with fillers really to get a sense so that you, I've seen way too many patients who've gone other places and then they have too much put in and they're unhappy and things like that. It's really good to have a good conversation with whoever's going to inject your lips to have a sense of what you're hoping for. It's also that we live in a kind of surreal world with the world of social media and TikToks and other platforms where what people see on a screen is not necessarily what human beings look like in nature.

(15:06):
And so it is important to look at yourself in the mirror, and obviously you have pictures of what it is that you would like, but recognize that you're looking that Photographs are essentially three dimensional objects squashed into two dimensions and saying stars, they're just like us. If you look at pictures of people who have no wrinkles at all, like no wrinkles at all, that certainly is a characteristic of very young humans. But we're all watching the same movie and wrinkles come along and we want to look normal. We want to look normal, we want to look good, we want to look attractive, but we want to look normal.

Dr. Furnas (15:52):
So a lot of people do have overfilled lips, and sometimes people, if I suggest a lip filler, say somebody is having a facelift or something, I suggest lip filler after surgery. And they say, oh, I don't want that look as if anybody getting lip filler has that overdone look. Why do so many people get overfilled lips do you think Josh?

Dr. Korman (16:18):
One is, I think sometimes because of the number of syringes or size of the syringes, but I also think it reminds me a little bit of,

Dr. Furnas (16:27):
Josh, I'm going to interrupt, because that's a really good point. Because the charge is by syringe. And so sometimes a med spa will want to sell as many syringes as possible, and so they overfill.

Dr. Korman (16:42):
Right. Although I would say that's many med spas charge by the syringe, but there is also some practitioners that charge by the area. And so it's important to understand, which again, what's the lay of the land wherever you're going. So that's one, as you point out, Heather, that is one reason why people have too much in their lips. I think another reason is that, I dunno, when I get my hair cut and I'm sitting and I get my hair cut at the end, after my hair is cut already, the person who cuts my hair swivels the chair around and gives me the mirror. What am I supposed to do? Say no, put some back. I mean, it's not really practical. So when it comes with lip fillers, I think sometimes it's put in because it's maybe what the practitioner thinks is the right thing. I also think that people really want their wrinkles gone, and so they want the wrinkles gone. And so sometimes the only way to get those wrinkles to go away is to fill, probably to put too much filler in. It will make the wrinkles go away, but it will not necessarily make it look better. So that's what I find.

Dr. Furnas (18:04):
And that's one reason you want to go to a practitioner who has different tricks, like you can get some benefit from a filler and get to the point where it looks better, still not great. Maybe add some neurotoxin and certainly laser. And oftentimes you'll start with laser, see, see the kind of tightening that we can get with laser, and then maybe use neurotoxin and also use filler. And then as we mentioned, the lip lift for the elongated lip.

Dr. Korman (18:38):
Yeah, I think one thing that we've talked about on another episode is that there are four different ways, at least, that we age. And the lip is no exception. There's the volume that we lose. There's dynamic wrinkles, meaning the wrinkles that are formed when we animate, when we smile, when we frown, when we whistle, when we suck from a straw. There's also the skin texture, the lines that are in what we call repose, meaning when you're not moving. So it's a multifactorial, as we like to say, in the medical profession of how lips age. And of course then there's gravity as it's part of the rest of the face. So I think it's important to understand that the corners of the mouth of which the lips are an integral part of the mouth, they also have a medical term. It's called the modiolus, I guess if there's two of them, one on each side, it's the modioli, but whatever. Anyway, the point is that that is the intersection of many, many muscles in the face. And so how our lips move is really a combination. It's a fairly complex motion, and so it's often hard to make the lips look the same in all their configurations when you smile, when you whistle, when you're not doing anything. So you need to balance how you treat the lips so that they will look good in as many of the combinations as possible.

Dr. Furnas (20:10):
We tend to just see before and after photos to see the results of these various treatments. But would be, what would be lovely one day would be to have people speaking so that you can see what those lips look like in animation, because sometimes they don't look so good in motion when they look gorgeous just as a still photo. Now, we've been talking a lot about more women, but a lot of men get lip filler as well. We don't tend to see the super overfilled lips in men unless people exaggerate other features as well. But if you look at male movie stars and really look at study their lips, you'll see that they have, a lot of them will have just a subtle amount at the border of their upper lip is where I see it most. Maybe a little bit of volume, but very subtly done. But it is rejuvenating in men as well as women.

Dr. Korman (21:13):
Yeah, I think because they have thicker dermis layers because of the hair follicles, they tend to have less fine lines in their upper lip. But volume and loss of volume definitely plays a role in men as well.

Dr. Furnas (21:29):
So if we look at everything we've talked about, I think subtlety is key. Going to somebody who really has experience with different modalities so that they can use different things to achieve one goal, I think relying on just one thing means that that one thing can be overdone.

Dr. Korman (21:49):
Well, I think it's just if we come back to the beginning with the First Wives Club that I'm not really sure where, First Wives Club was really funny at the time that was made in 1996, which is almost 30 years ago. I don't know how it would go over today because I think it's like the new normal, what people consider is attractive or looking good, and I think it's also a little bit geographical. There's certain parts of the country that different aesthetics play a role. So I think in general, there's a lot to the lips, and take them seriously, and really look in the mirror, see what you don't like about your lips that you would like enhanced or corrected so that you can properly convey that to the practitioner you go to visit.

Dr. Furnas (22:38):
And we've been emphasizing subtlety, but there are people who hang around with people with overfilled lips, and so that really shifts their sort of normal, like Josh said, is this the new normal? And there is something to that. It's like implant sizes will vary by era. Sometimes they're smaller, sometimes they're bigger. They were very big. They're starting to get a little bit smaller. And so a lot of things that we don't think have fashions actually do. And one is size of lips.

Dr. Korman (23:10):
Yeah, and size of breast implants.

Dr. Furnas (23:13):
Exactly.

Dr. Korman (23:14):
Not lip implants.

Dr. Furnas (23:17):
We did do those once.

Dr. Korman (23:19):
Yes. Yes. Yeah, exactly. Well, we hope you've enjoyed the podcast. Join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles, discovering new ways to feel better about ourselves.

Dr. Furnas (23:33):
If you enjoyed this podcast, please rate us, review us, and share. If you have an idea for a topic, we'd love to hear from you. Theme music by Diego Canales, production and engineering by The Axis. See you next time.