How to Use Fillers to the most Natural, Youthful Appearance


Lips send a message even when they’re not moving. To create beautiful natural lips I often combine devices such as lasers and radiofrequency or ultrasound, products that contain antioxidants, neuromodulators such as Botox, Dysport or Xeomin and hyaluronic acid fillers. And, of course always, always, always use sun protection to defend against collagen breakdown and damage to this very delicate area of the face. Before I address the lips I evaluate the face as a whole and the teeth and area around the mouth, including the chin in particular.

Considerations: For beautiful lips take into account: Your Genetics, Your Age Group , Your Personality & Life Style, Your Race – Culture – Gender. It’s About Attention to details – It’s the little difference that makes the big difference.

Nefertiti is a perfect example of “phi” the golden ratio balance and proportion.

The green line that goes from one inner eyelid to the other is called the intercanthal distance, it is unique to you and it stays the same from 9 months to 90 years. It determines the perfect balance and proportions for the rest of your face, including your lips.

Start with the area around the lips:

I always start with looking at the teeth. Very often when lips are flat or uneven, it’s due to the lack of support of underlying teeth. I often see a strong overbite, crooked teeth or teeth that are angled inward and therefore not supporting the overlying lip. We can try to correct the lips, but the results won’t be as good or as long lasting if we don’t address the underlying cause distracts from the area.

Gummy Smile: I always study the lips at rest and the lips in animation. Some people have beautiful full lips at rest but they become small and flat or roll under when they smile, exposing their gums. This can be corrected with a neuromodulator like Botox and the results are fantastic. It is an area of advanced injection technique because there are different types of gummy smiles causing the changes you see and also because the treatment can affect the way you speak and pronounce certain sounds like the letter ‘p” or “o”. The results are fabulous when done well and unfortunately last too long when not done correctly. The basic rules for the lips is that the left and right sides should be identical. In white skin people, the balance of the upper to lower lip is 1:1.618. The center “bow” to the outer lip should also be 1.1.618. The majority of the product should fit in the area as wide as the sides of the nose (see image below).

Dr Day explains how lips benefit from fillers

The center “bow” to the outer lip should be the correct ratio.


Consider the image below as being like the frame  of a painting. The upper white roll is more pronounced, the lower white roll is more subtle.
Vermillion: This is the red and main part of the lips. There are different products we use for different purposes and sometimes we layer product for best effect. The most common product used for lip filler is hyaluronic acid, but there are many different types and brands and it can make a very big difference in how the end result looks and how long the results last. Some fillers are thicker and give more of a fill or augmentation while others are softer and more flexible and help enhance.


Dr Day lip illustration after fillers

The most common product used for lip filler is hyaluronic acid, but there are many different types and brands and it can make a very big difference in how the end result looks and how long the results last.



Step 1.

The doctor may apply a topical anesthetic to help minimize discomfort.

Step 2.

They may use a needle or a cannula (blunt needle) to inject the proper product into the lips to augment (make bigger) or enhance (make more beautiful and balanced).

If you have relatively smaller lips be prepared to be patient and allow for several sessions with small amounts of a more robust filler to reach the final result and avoid having too much projection and that dreaded “duck lip” look.

After desired volume is reached the doctor may use a softer filler to enhance and balance the lips and surrounding area. It takes time for the product to settle and there may be swelling for a few hours to a few days after the treatment. There can also be bruising, which can be treated with a laser to speed healing if needed.

Dr Day explains lip anatomy

The majority of the lip product should sit between the nasal ala one side of the nose to the other as in the photo above.

Dr Day demonstrates intercanthal distance

Lower lip: The lower lip should be slightly larger than the upper lip, except for African American and Asians where the natural proportion is for them to be the same size. Also, the bulk of the filler should be within the lines that would drop straight down from one inner eyelid to the other (called the intercanthal distance as seen in the photo above).

Oral Commissure (aka corners of the mouth): as we age the corners of the mouth can drop and droop and give the appearance of a frown even though you’re not sad or angry!

A firm filler can give an excellent lift to this area and instantly reframe the lips. A little Botox into the muscles along the jawline that pull the corners down can also have an excellent impact in helping to lift the corners.

Dr Day before and after dermal fillers photoAs women age, our chin recedes and gets smaller. By adding a filler right into the center of the chin, we can help bring this area back into balance and change the look of the lips before even injecting any product there at all.


Chin: As women age, our chin recedes and gets smaller. This can make the lower lip slip back and look smaller and it can make it more difficult to keep the lips together, which forces us to use the muscles that surround the mouth more to push our lips together. This ends up creating those dreaded upper lip lines. Filling the lower lip without addressing this area makes the lips look unnaturally larger and out of proportion to the face.

By adding a filler right into the center of the chin, we can help bring this area back into balance and change the look of the lips before even injecting any product there at all. This has to be done carefully in order to create the proper look. Injected too low it can make the face longer, injected too high and it will look like a bump. There is a sweet spot to inject that looks beautiful and natural and gives lasting results.

Upper lip line creases: These are usually caused from sun exposure over years, from repetitive motion of the area and from volume loss. It is best addressed with a softer more flexible hyaluronic acid filler to give support to the delicate skin around the lips and to stimulate collagen production. Sometimes a laser treatment, radiofrequency or other in-office treatment along with topicals containing retinol and growth factors are also needed to help restore and enhance the skin around the lips.

The best way to proceed is to see a board certified aesthetic physician like a dermatologist or plastic surgeon so you get a proper consultation and the right products are chosen for you. It often takes 2-3 sessions for optimal results and to avoid getting that over projected “duck lip” look.

Tools: There are different ways to deliver the filler. The doctor may use a needle directly into the area or they may use a blunt needle called a cannula. Both are excellent options. The cannula lowers the risk of bruising and is becoming a more popular technique for injections.

Bottom Line: The goal is to have balance and harmony of the lips and the face. A proper aesthetic evaluation along with using the right filler for the right area is very important to restore, reflate and rejuvenate this very sensitive and important part of the face. There is a science to the art of lip injections and for beautiful lasting results see a doctor trained in aesthetics, such as a dermatologist or plastic surgeon.