Lip Flips, Duck Lips, and Fillers: Oh My!

Speaker 1 (00:07):
You're listening to the La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome, everyone to the La Jolla Cosmetic Podcast, and I'm your hostess Monique Ramsey. Today we have Julia Jowett, one of our PAs in the med spa. And we're going to talk about lip fillers, lip injections. So welcome to the podcast, Julia.

Julia Jowett (00:31):
Hi, thanks for having me.

Monique Ramsey (00:32):
Hi. So we're going to go through all the different things that you can do to make people's mouths pretty. So how long have you been injecting?

Julia Jowett (00:44):
I have been injecting for about four years now.

Monique Ramsey (00:48):
And how did you get into that?

Julia Jowett (00:50):
Well, I actually have a lot more experience working with lasers, and the clinic that I was working at started offering injectables and had a plastic surgeon come in and give some really good training. And I loved it. And I just realized that this is where I wanted to get more and more experience. I attended a lot of off site trainings, cadaver labs, I just got my hands dirty in any way I possibly could. And when I moved over to La Jolla Cosmetic, I got to train under Lauren and the excellent providers there, and Dr. Smoot and just kept on learning and it just became my passion.

Monique Ramsey (01:27):
So, when somebody wants their lips to be a little fuller, what is their usual complaint?

Julia Jowett (01:34):
I would say in most cases when I talk to somebody, they are just feeling like maybe their lips don't look as full or as plump as they used to. They look at an older picture of themselves and they say, "Why don't my lips look like that anymore?" And that's the majority of people that I talk with. Some people want to build volume or shape, there's things that they actually want to augment about their lips. We can achieve both. So, I have a lot of consultations I'll do with people that say, "I really love my lips. I don't want them to look that different, but I want them to just feel a little bit more plump." And we have options for that treatment plan. I have some patients who want to really build, they bring in a picture and they want to build towards that goal. And we know it'll be a multiple session process, but there's a technique and an approach to that to really get that result.

Monique Ramsey (02:18):
Oh, interesting. So now could you change somebody's shape of their lips? Of that patient who is maybe bringing you a picture of somebody else and a lip goal? How realistic is that?

Julia Jowett (02:32):
We can do a lot of things that create almost the illusion of changing shape. So you are born with your natural lip shape, we're not going to be able to change your anatomy. But the placement and the type of product that we use can definitely add definition or an illusion of a look that you might want. And it can definitely build a border. We can work towards a goal, whether it's volumizing or defining, but it definitely is a little bit of a building process.

Monique Ramsey (03:00):
Which fillers are specifically used for lips, and why are there different kinds and how do you approach that?

Julia Jowett (03:07):
It can be very confusing, especially for somebody who is newer in the world of injectables. There's so many products out there. And fortunately we have all these products that are FDA approved for different areas of the face. And in the world of injecting, we can use things in an, what we call off-label way. So there's maybe a FDA approved, maybe one or two products are indicated for the lips, but we know that the other products in that portfolio are safe and beautiful on the lips as well. So as I explain it, the main two product lines that we use in our clinic are Restylane and Juvederm. I like to think of them say as like Honda and Toyota. They both have their Camry, their Accord. They're different things that are similar, but a little different.

Julia Jowett (03:48):
And I like to use them both with lip filler. I would say it really depends on the patient and the patient's goal of what they are looking to achieve within specifically the Juvederm portfolio. So the products that we mainly use in the clinic in general are Voluma, Vollure, Volbella, Juvederm Ultra and Juvederm Ultra Plus. And so that's already overwhelming as it is. That's just one product line.

Julia Jowett (04:12):
Within that there's, I would say, two main products that I think are really beautiful in the lip because they can be very natural and very long lasting. So Juvederm Vollure and Juvederm Volbella. Those are probably my top two products that I choose. They're very soft. They're very natural feeling, so people that don't want to have something that's like they're aware of when they're kind of rubbing their lips together, we can just give a really nice, subtle approach.

Julia Jowett (04:37):
There's also the older generation of Ultra and Ultra Plus, and those I use when people want a little bit more of a noticeable lip plump. So they need a little bit more shape or defining, and sometimes I'll use both. So say there's a treatment plan and we're trying to build some structure to the lip, I'll use a little firmer product the first session, and now we're achieve that structure that we want we're trying to plump, or just add volume to that, I'll switch to a different product to achieve that.

Monique Ramsey (05:02):
Oh, interesting. And then within the Restylane family, what are kind of the go-tos for lips specifically?

Julia Jowett (05:09):
I would say the top three that I use are Restylane Defyne, Refyne, and Restylane Kysse. Restylane Kysse came into the U.S. marketplace this past year, and it has just been a game changer for lip filler. It is so natural looking, so soft. It really just looks good in everyone. There hasn't been a time where I've used it and wished I'd used a different product instead. It's a really pretty filler. And I think it's a good product line if people have any issues with what we call filler migration. So say the filler tends to go outside of the border of a lip a little bit. I like the Restylane product line because they are a little bit stickier. They kind of tend to stay together, be more cohesive. And that does well with the patients that are a little bit more at risk of that.

Monique Ramsey (05:52):
And is there a certain type of patient who might be more at risk of the filler moving around?

Julia Jowett (05:58):
It really can be patient dependent. I wouldn't say there's a certain category or type of patient. I think that it depends how many times they've had filler injected in the past, the techniques that have been used. People that have maybe smaller lips that are really aiming towards bigger lips, they can run into that issue. So say they have this goal of, they have the tiniest little lips in the world and their goal is Angelina Jolie. And if we do too much too fast or a product that maybe is a little bit more buttery and spreadable, it's not going to kind of stay where it's put, it might migrate out. So there's different factors with that. Some people I think are just prone to it, but it can definitely be technique and product dependent.

Monique Ramsey (06:36):
Now what are fillers mostly made of these days? I know way back in the day, all we had was collagen and it was co-find collagen. So, you had to get tested to make sure you weren't allergic to it and wait 30 days. And I mean, it was really crazy. And so now it's completely different. You can have it the same day. Tell us a little bit about what is the magic in that syringe that we're getting?

Julia Jowett (06:58):
Yeah, absolutely. So it's made of something called hyaluronic acid, which is basically like a sugar. It's something that's natural in your body, but it's produced synthetically in a lab. And the nice thing about this is that it's very predictable in the tissue and it is reversible if for some reason we need to take it out or want to take it out. So that's the really wonderful thing about using these products. In general, I love to use fillers that are dissolvable or reversible, because over time your face is changing. As we know, we're aging. And so if you're putting something in that's long lasting, or that can be there for 20 years, some of the patients that I see that had lip implants or silicone put in 20 years ago, and it doesn't look as good now because you change. So using something that even though it's long lasting, we want it to be shorter term on the lips because we want to be able to look good over time.

Monique Ramsey (07:47):
And make adjustments sort of as.

Julia Jowett (07:49):
Make adjustments. Yeah, your aesthetic might change. It's the same concept with somebody that gets permanent makeup in the '90s and then realizes now they don't want blue eyeliner anymore tattooed on their eyes. You might have one aesthetic and then five years later you may have a different aesthetic and you want to be able to make those changes. And I have some patients that will come in, I actually had one last week, she's been getting lip filler for years. Other clinics, she just kind of jumps around and doesn't know why she doesn't like her lips anymore. Couldn't really put her finger on it. And when we actually looked in the mirror and looked together and looked, she had some distortion, the filler that had maybe either been placed above her vermilion or migrated above there was causing that puffy look that people see and they don't like. It adds a little bit of that Marge Simpson projection, but just was starting to look like diffuse and not defined, you know?

Julia Jowett (08:34):
And I said, "Let's just start fresh and dissolve it." And we just used a couple vials of an enzyme called Hyaluronidase. It takes away the hyaluronic acid molecule, so it helps remove it. So even if filler has been there for years, it can take it away. And that's what's nice. So now we can let that lip go back to its natural baseline, come back in and reinject it with a newer product or a different technique and achieve that goal.

Julia Jowett (08:59):
A lot of people are afraid of lip filler, and be reassured knowing that if for any reason, if you're using a product that's a hyaluronic-based product, so either Juvederm or Restylane in your lips or anywhere in your face, if for some reason you don't like it, it can be reversed. It can be taken out either instantly or in the future at any point.

Monique Ramsey (09:17):
I think that you're bringing up a really good point, because when we ask, "Okay, Julia, how long is this Volbella going to last?" And you say, what is the answer for Volbella?

Julia Jowett (09:30):
I have seen patients who have had filler placed and a year later, two years later, three years later, I can still tell it's there. So on a histological level, I think they're doing some MRI studies now and they're seeing that these products don't necessarily dissolve at this certain magical point that we say it does because that's what the box says on the label. So I think it's really important to be aware of where in your face you're having filler injected and the rate it metabolizes will vary based on that. So your lips, as you can imagine, you're using them every day, talking, eating, every day-

Monique Ramsey (10:03):
Smiling, so.

Julia Jowett (10:04):
Smiling. So that's going to be one of the fastest metabolized areas that you can have. And it also depends on the person's metabolism. So somebody might have a really high metabolism and they work out every single day and they know that they're just somebody that burns through things quickly, whether it's medications, anything. And they might be someone that even though they have a product that's indicated to last for 18 months, they can burn through it in six months.

Monique Ramsey (10:29):
Oh.

Julia Jowett (10:30):
And then there might be somebody else who has that product and I'll see them a year later and it will still look perfect. It will look like nothing has gone away. And so I try not to even pay too close of attention to those timelines because it's almost creating a false sense of what you might be seeing with that result, especially for the lips. So there's definite timelines where it's approximate. But the lips, I think, is the most variable because it really is a higher metabolized area.

Monique Ramsey (10:54):
Well, and the fact that I think most of us as lay people, we would think, "Okay, well, if it was going to last me about a year, a year and a half, and I'm five years out, I'm assuming it's all gone." But you're saying it's not necessarily true?

Julia Jowett (11:08):
It's not. I see people, and they will say, "I haven't had lip filler in three years. It's all gone." And I look, and I can tell, there's ways that we can tell by the way it looks under the skin, the way the tissue feels, that there's still something there. And it metabolizes differently in areas of the lip. So what they found in some of the MRI studies is that the red lip or the pink lip, and this is a very common thing I'll see. So people will say, "All my filler's gone, all my filler's gone." And you'll look at the lip, and the pink lip is deflated. Anything that is above the lip still might look a little puffy. So say they had some filler for lip lines or those wrinkles around the mouth-

Monique Ramsey (11:45):
Like a smoker's line or something?

Julia Jowett (11:46):
Mm-hmm (affirmative). And you'll still see that, but you'll see almost a distortion to where, okay, the lip itself is smaller, but the lip filler that migrated above it or was put above it is still visible. And so it can change at different rates. And so the more we know about this, it's really good to get the best aesthetic outcome to be mindful of this. Because you can start to really create an augmented look in a negative way if you don't keep that perspective in check and really look at the patient each time, what do they need? Where, how much do they need? Not to overdo it, not to put a syringe every six months just because we've always been told that that's when you need it. Really look, is it needed? Do we need to start fresh? Do we need to kind of reassess after a few years?

Monique Ramsey (12:26):
And I think that's part of the process and why you have a consultation and why you go to somebody who's an expert in this, because there's some places where maybe the injector doesn't have a lot of experience and you say, "I want more Juvederm." And they say, "Okay," and they put it in you. Where you don't maybe really need it. Or maybe you need to do a dissolving of whatever's been there before to get, like you said, back to baseline.

Julia Jowett (12:51):
Yeah, it's one of the things I think my colleagues and I, we all are very passionate about. So we are constantly learning the newest techniques and assessing every patient as they are at that moment. I have some patients who will come in and in that exact scenario, they've been having lip filler for years. They just want another syringe of something, fill it up. And if they like that aesthetic, great, I'm happy to complete that treatment plan with them. But when we look at their anatomy and look at their side profiles and look at pictures of what they like and what they don't like, they all of a sudden it clicks and they might realize, "You know what, I see what you're saying. I didn't used to look like that. I didn't used to have this distortion here." And when you take it out and start fresh, it can be such a beautiful long-term option.

Monique Ramsey (13:34):
I know what you mean about having something look just a little bit strange and distorted. And you're like, "Wait, she didn't used to look like that. What's wrong?"

Julia Jowett (13:41):
It's the most subtle thing, our human eyes can pick up on a very subtle distortion to the face. And we know immediately it's unnatural and there's certain just giveaways. And that is one of them. And that is probably the number one fear I have patients consult about. We will talk about their plan and their fear is, "I don't want to look like that. I don't want to have that puffy above my upper lip. I don't want to look like Marge Simpson."

Monique Ramsey (14:05):
Duck lips.

Julia Jowett (14:05):
I don't want to look like XYZ celebrities, duck lips, and that is avoidable. And so it's important to have that talk with your provider and really say what you want to achieve. Because we can achieve a lot of different things. I've had patients who have very specific goals and I'll sit down with a consultation and go through every part of those goals with them to make sure that we can meet that as part of their treatment plan.

Monique Ramsey (14:27):
Do you often get people who want maybe not just their lips, but maybe the area around their lips? Or as we get older, our lips sort of start to point downwards on the corners. So what can you do there?

Julia Jowett (14:44):
Well, there's a lot of anatomical changes that are happening around the mouth and only a small portion of it is directly volume. So there's a scenario where, okay, somebody just wants to have plump lips because it would be fun. And then there's a scenario where people are experiencing age associated changes with their lips and with the tissue around their mouth. And it's happening in the skin layer. So the skin starts to thin, you start to see a little bit of those, what we call the smokers lines, even in people that never smoke. I would say most people never smoke. They get those just from life, from talking, drinking. Then you start to see the muscle activity and the muscle pull a little easier. So the muscles that go from the corner of the mouth down to the jaw line, they're called the depressor anguli oris muscles.

Julia Jowett (15:27):
And they create what we call resting sad face. So people will come in and they'll be like, "I look like I'm frowning when I'm really smiling or I'm happy." And it's the same concern of people that have the scallop between their brows. We can actually use Botox in those areas to help relax and calm those muscles. Same thing with the muscle above the lip or around the lip, the orbicularis. We can use a small amount of Botox in that area. And it's actually called the Botox lip flip, but that is something that can relax that muscle and take away those lines.

Monique Ramsey (15:57):
Yeah, I was going to ask you about the lip flip. So who's a candidate for that?

Julia Jowett (16:02):
Two people mainly, but typically what we're doing is we're injecting a few units of Botox either on the border of the lip or right above it. And people that are candidates are either people that want a slight amount of E-version. And when I say E-version, if you were to take your two fingers and kind of roll your upper lip up a little bit, so if you feel like, "Okay, maybe when I smile my lip kind of tucks into my mouth, or I just want to keep my lip show when I smile." Other people, if they start to have those vertical lines and they're noticing that they're wrinkly there and they don't want to be, they want to kind of quiet that down. Those people love lip flip because it's almost instant. It kicks in within two weeks. There's no downtime with it. It lasts about three to four months, which is the negative, but it's a very easy thing to maintain. So you don't need to commit to a big aggressive laser. You can just quiet those lines down.

Monique Ramsey (16:48):
And how many units did you say normally?

Julia Jowett (16:51):
I usually do between four and six units.

Monique Ramsey (16:53):
Okay. So if it's 12 something or $14 a unit times, it's not very much money that you're talking about? It's sort of like a finishing touch for some people maybe?

Julia Jowett (17:05):
Exactly. So it is either some people that are just nervous in general to do anything. I'll have some patients who are like, "I want to do something to my lips. I don't know what yet. Let's just do a lip flip and let's just see how I like changing a little bit of my anatomy there." Other people will do it in combination with lip fillers. So I'll have them come in, we'll do their filler. And I'll usually assess that on the consultation. I'll say, "You know what? Filler can achieve X, Y, Z. But if we want that finishing touch, if we want to really get that nice lip show of what we're putting in and not have it kind of curl in, let's do a lip flip, and that will help get that show." And then, like we mentioned the patients with a little bit of the aging lip, then that's part of their treatment plan as well.

Julia Jowett (17:43):
The things to be mindful with that. So I always warn people that you have some awareness of the way that this feels, so it can feel a little bit like you can't contract your muscle as well when you're taking a sip of water or coffee, or you're trying to suck through a straw. You are in essence relaxing the very muscle that helps you do those things.

Monique Ramsey (18:00):
Oh.

Julia Jowett (18:01):
Usually it's something that you get used to. So say the first week or two, you're like, "Oh my gosh, I feel a little different on my upper lip." And then you forget about it and it goes away. But that's why we're so conservative with the dose there because you don't want to be too strong. It's a very delicate area.

Monique Ramsey (18:15):
And so it's something that you could, if you put in two units, you could wait a couple weeks and do two more or something?

Julia Jowett (18:22):
Yep. But I have some patients who are like, "Please do the smallest amount ever. I just want to see how this feels." We'll literally do two units, and then they come back and say, "Okay, I feel more comfortable now moving up."

Monique Ramsey (18:32):
And that would be the same with filler. I'm assuming that if you do the injection, a few weeks go by and you want a little bit more, is that something that they can do?

Julia Jowett (18:42):
Yeah. So my most conservative treatment plan, and I do this pretty regularly with first time lip filler patients, is they'll say, "I just want to look like I have lip gloss on. I just want to feel like those little crinkles are gone." And we'll do a half a syringe Juvederm Volbella. You go through a swelling process with lip filler that I think is very indicative for people of like what you might like longer term.

Julia Jowett (19:04):
So anyone that's had lip filler before, you know that you look pretty puffy, almost the look of like the duck-like appearance that you don't want to have long term, you go through that. And sometimes, maybe on that third or fourth day, people will say, "You know what, okay, this I like. I like how swollen this is right now." And so even when the swelling goes down and they say, "You know what, okay, I think I had maybe a 30% increase in my lip volume. I want to get more towards that, like 50 to 60% increase. So let's come back and add more." You can always add more lip filler. And it's definitely great to be a slower building process.

Monique Ramsey (19:33):
You mentioned swelling. How long is somebody going to be swollen for from just the injection?

Julia Jowett (19:40):
Yeah, so even if we did lip injection with a needle and didn't put any filler in, you would have swelling. So the swelling is partially from just a little bit of trauma that we're causing from the injection process. Typically, that can last a couple days. So usually socially you'd want to plan for maybe a long weekend, if you care. Some people don't care, they wear their mask. They go about their day, it is what it is. If you care, I would say the first two days are the most severe with the swelling. And this ranges by person. So I have some patients who are just swellers. They know that as soon as they get lip filler or any type of filler, they're going to look ridiculous within five minutes of getting it, they just puff right up.

Julia Jowett (20:22):
Other people I'll call and check at them the next day. And they're like, "You know what? I was expecting all the swelling. Actually kind of like, it looks good, nobody can tell, maybe a bruiser two." It takes about two weeks to fully settle, so there is a degree of swelling longer than that. Usually you can get by though with a little bit of cover up or something to put on if there's any bruising. So yeah, I think it's the most dramatic the first few days.

Monique Ramsey (20:43):
Just the first few days. And speaking of bruising, I know that you guys have a little secret trick to take care of if you see somebody start to develop a bruise, you can tell when you are injecting, like?

Julia Jowett (20:58):
Yep. We'll be able to tell as we're injecting. And especially if there's some bleeding happening. Sometimes when I do lip filler, the plane of injection, you're not usually targeting where a lot of the blood vessels are, but for some people, whether they had a glass of wine the night before, or they're just prone to bruising, or they're taking an aspirin or something and we didn't stop it ahead of time, you can see a little dark spot kind of form in the lip.

Julia Jowett (21:20):
And we have a laser in the clinic called the Vbeam that I use very often for other issues with like redness or bruises themselves. We offer that complimentary for our injectable patient. So anyone that has Botox or filler at our clinic, if we see a bruise, we can zap it and that will help prevent the bruise from coming in as quickly and as dark. If, say we miss it, so say there's no visible bruising and the next day you wake up and you have one, you can come back into the clinic and we can zap it at point while it's still that dark color and that will help it clear faster.

Monique Ramsey (21:51):
And now, so you're mentioning a little, couple tricks that people can do prior to getting injections. So you said wine, so wine, why is that a ... We love wine.

Julia Jowett (22:03):
I know.

Monique Ramsey (22:03):
What are you saying? We can't have wine?

Julia Jowett (22:04):
So I always tell people, "You can have whatever you want, but just know that you might bruise if you have it." So you can still have your glass of wine the night before, but really any sort of alcohol is going to increase your risk of bruising. So the typical things I like to avoid are alcohol, aspirin, Advil, fish oil, vitamin E, anything that you know that it says on the bottle that might increase your risk of bruising, you want to try to avoid that at least three days before, ideally three days after.

Monique Ramsey (22:31):
Okay.

Julia Jowett (22:31):
A lot of people forget and they have a headache and they take their Advil, or they say, "I just, I like to have my wine with my dinner. Is that okay?" It is, it's fine. It's not contraindicated. It doesn't mean you can't have the treatment. It just means you might get a bruise.

Monique Ramsey (22:44):
And you might get a bruise anyway, right? Even if you didn't have your wine.

Julia Jowett (22:48):
Yeah. So it's not something you have to overly worry about if you forget, the important part for the covering up is just in the immediate after you want to make sure that you're keeping things clean. So you don't want to put on like an old lip gloss or dirty makeup or anything. But once that first 12 to 24 hours have passed, you're okay to put something on. So if you need by the next day to go to work and you want to make sure that you can cover up, you can just put a little cover up. Usually what I'll do is put a little bit of actual skin tone cover up and then put your lipstick on, on top of that. And that can help with that blending of the bruise.

Monique Ramsey (23:20):
Now, how much pain are we talking about for fillers?

Julia Jowett (23:24):
Great question.

Monique Ramsey (23:25):
That's always what people are like, what is it going to hurt? Any, if it does, how much?

Julia Jowett (23:32):
Yeah. It's another one where it's dependent on your pain tolerance. I will say what we always do for lip filler is a really strong numbing cream. So we have a lidocaine tetracaine-based cream that we put on for 20 minutes to 30 minutes before you have lip filler. It's the same one we use for our really aggressive laser, so it's really strong. You're going to feel like, my lips are numb, like when you're at the dentist kind of feeling.

Julia Jowett (23:57):
For some people, they don't like needles. They don't want to look at a needle. They don't want to see it. They don't want to feel it. They don't want to know it's there. We have the option of even doing more pain precaution than that, which is called a nerve block or a dental block. So we can actually inject the lidocaine around the nerves that supply that area. And that can make you feel even more numb. I would say for 90% of people the topical numbing is fine. And you'll feel some of the injections. It is a sensitive area with a lot of nerve endings, but it's a tolerable process I would say. The filler has lidocaine in it. So once we start doing the injections, you go numb from the lidocaine in the filler as well.

Monique Ramsey (24:34):
And one time I saw you guys holding a little, you gave the patient like a little thing to hold. What is that?

Julia Jowett (24:42):
Yeah, so it's basically a vibrating device and it's used in injections when we want to distract a nerve. So the pain and the tactiles fibers travel at different rates. And so if you're having something, holding over an area where it's vibrating on the tissue or on the bone nearby, then that is going to block the painful nerve signal and decrease the pain. It's not going to take it away. I wouldn't do that instead of numbing cream, but I would definitely do that with numbing cream.

Julia Jowett (25:09):
We also have, for our really nervous patients or anxious patients, we have something called ProNox, which is nitrous oxide. And that just makes you not care what's going on. It's basically what you get at the dentist if you have dental work and you want to be loopy. I don't love it for lip filler during the injection, because it does, you are basically sealing your lips around a tube. And that filler, you're injecting this gel that's compressible in the short term. So I wouldn't want people puffing on it, puffing on it, puffing on it every poke. But usually I'll have, if they want to use it, I'll have them take some puffs and then maybe halfway through take some puffs. And it just makes you really calm and relaxed.

Monique Ramsey (25:44):
I love the fact that we kind of have something for everyone, whether it's the distraction technique or it's the numbing cream, or if you need more.

Julia Jowett (25:51):
Yep. The full nerve block, yep.

Monique Ramsey (25:53):
Yeah. And even if it's a full nerve block, they can still drive home, right?

Julia Jowett (25:56):
Exactly.

Monique Ramsey (25:56):
Just like the dentist?

Julia Jowett (25:57):
Well that's, it's like going to the dentist.

Monique Ramsey (25:58):
Okay. How long does an appointment take for the actual injections?

Julia Jowett (26:04):
So usually you're there for about 30 minutes, just prepping. We take your photos. Usually we'll do the consultation portion ahead of time. And then when you come in for the treatment that day of... Confirm everything, confirm the product that we're going to be using, the amount, the placement. Very often I'll talk with patients ahead of time about when we're treating the lips, looking around the mouth as well, because I have some patients who maybe will want to add lip filler, and then we discuss maybe if we put a little bit in their chin, that would compliment the lip filler. So it doesn't create an angle that maybe would not be as pretty from a side profile. And then the injections take about 30 minutes. So then after that, you're free to go. You're there for about an hour total. We usually give a little bit of ice to take with you and you can do some icing as soon as you get out of the office, but you're able to drive yourself home.

Monique Ramsey (26:52):
And then, could they have something else in conjunction with lip filler? Say they also want Botox. Is it something that you can do two things at one appointment?

Julia Jowett (27:01):
Yep. Yep. And so usually if there's injectables happening, we do filler in other areas of the face. We can do the lips and then we can do Botox. Or if they're combining it with a laser, we can do those the same day as well. It just depends on the order, same thing. And we'll kind of sequence that out for the patient. If they say, "Okay, I want to do laser on my face. I want to do laser on my chest. I want to do filler where you think I need it in my face. And then I want to do my Botox." We can do all of that in one day. We just kind of sequence it all out.

Monique Ramsey (27:29):
And you mentioned having the consult at a separate appointment. So how do you do your consults?

Julia Jowett (27:34):
Usually we do those consultations over Zoom ahead of time. The patient will send in photos of their lips, and then we'll look at them over the video camera as well. A lot of times patients don't know what to prepare for, which is fine, that's the purpose of the consultation. But what I'll talk with them about is, maybe if they have any photos, like inspiration photos that they want, to bring those to their actual filler appointments. So we'll go over the tentative plan over Zoom. A patient coordinator gives them the quote of the product that I would recommend. And then I'll say, "You know what? Let's confirm this all in office. We do a little mini consult when you come in."

Julia Jowett (28:05):
And then the photos are helpful because that helps make sure that we're on the same page with the words that they use to describe what they want, comes across. So, and it's happened before. People will say, "I want very subtle, very natural." And then the pictures they show are lips twice the size of what they have. It helps make sure that we're all on the same page and that might even switch gears of what we're doing that day.

Monique Ramsey (28:28):
And then, are there any common side effects that people need to be aware of with fillers?

Julia Jowett (28:33):
So I think the most common are the swelling and the bruising. There's a risk of triggering a cold sore if you have a history of cold sores. So for those patients, we usually screen that at the consultation. And there's a simple prescription medication that we'll send into your pharmacy ahead of time that you can start taking to suppress that from coming in. You can technically have a reaction to the product. So any type of filler that we're using, some patients can build an immune response to it. So, this is a very, very rare side effect. I would say it happens to maybe one to two patients a year in the clinic, but what can happen is you can form little bumps where the filler is. So almost like delayed onset nodules.

Julia Jowett (29:13):
What makes this higher risk is if you had any sort of vaccinations or dental work within two weeks before or after your filler. So that's a screening question we always ask every patient when they're booking their appointment is, "Have you had your flu shot, your COVID vaccine, any teeth cleanings, anything like that two weeks before, two weeks after the filler?" And that's filler anywhere in the face, not just lips. It's very important to just make sure that you have those parameters met. And then if you haven't had any recent infection, so any like a cold, a flu for two weeks before you have the filler injected, anything, you're basically putting something foreign into your body. And if your immune system is already heightened from some sort of illness or a vaccine, then it's going to make it a higher risk for that reaction to happen.

Monique Ramsey (29:55):
So that's your body just kind of reacting to the filler-

Julia Jowett (29:59):
Exactly.

Monique Ramsey (29:59):
... or overreacting almost?

Julia Jowett (30:01):
Overreacting, and it's treatable. So another great reason why we use fillers that are dissolvable. We have a protocol we would follow if this does happen, sometimes it self-resolves. So it just say something like, "Your immune system is a little hyperactive for some reason." And then the filler gets a little bit inflamed and then it goes away. If worst case scenario we needed to, we could also take the filler out.

Monique Ramsey (30:21):
Okay. On average, what does the typical lip injection treatment cost?

Julia Jowett (30:27):
I would say an average price is around $650. The longer lasting syringes are more in the $700 range and then down to 500 or a little less for the half syringes. So it depends on the product used and how long the product lasts.

Monique Ramsey (30:45):
And then, for somebody who's never had lip injections before, what would be the three most important things you'd want them to know?

Julia Jowett (30:55):
I would want them to know that they can feel comfortable and that we've all been there. So I think every provider at our clinic, but myself included, I've had lip filler before. I remember my first time and thinking, "I don't need lip filler, I have big lips. What is that going to do to me? I'm going to look weird." It is all about how much is put in, the type of product used, and the artistic eye of the provider injecting. And so, as long as you have a good communication with that provider about what you want, don't be afraid. I think knowing what the healing process will be like is very important because that is more emotional for people. I think even as soon as the injections are done and I'll say, "Okay, you're starting to swell already. You're going to look really swollen."

Julia Jowett (31:38):
They'll look at themselves in the mirror and they'll go, "Oh my gosh." And I can see the fear in their eyes. And then as soon as it starts to calm down a little bit, they look again and they're like, "Okay, this is good." But it's shocking. It really is shocking to see yourself with bigger lips and other people wouldn't even notice. If they didn't know you, they would see you passing by in the hallway and not say, "You just had your lips done." And I think knowing just the realities of what can be done and what can't be done, we can't change somebody's anatomy. We can do things to augment and to make tweaks with shape and with definition, but we're not going to be able to create something that would otherwise cause a lot of distortions, because it is important to have that natural result.

Monique Ramsey (32:17):
Now, do you ever have people who have, I don't want to call it sticker shock, because what I'm thinking is really volume. Like if you say, "Okay, well to get this result, I'm going to need to do two syringes or three syringes." And then their eyes might be like, "How much is that?" But how much is in it? I know it's like one.

Julia Jowett (32:35):
Yeah. So it's a one milliliter, or one CC a product is in most syringes.

Monique Ramsey (32:40):
Okay.

Julia Jowett (32:41):
And when you squeeze that out, say we were to take a syringe and we just pump it into a spoon, it's a fifth of a teaspoon.

Monique Ramsey (32:46):
Fifth?

Julia Jowett (32:47):
So when you, a fifth of a teaspoon.

Monique Ramsey (32:48):
Oh my gosh.

Julia Jowett (32:49):
So when I describe that for people they say, "Oh, okay." And it's still, I think it's actually in the lips I think it's so commonly discussed to put a syringe of filler. So I actually don't hear that limitation from people as much. And I'll actually try to talk people out of doing a full syringe if they don't need it.

Monique Ramsey (33:03):
Oh.

Julia Jowett (33:04):
I'll say, "You know what, we don't need to put the full syringe in the lips. You actually have some shadows around your mouth and it would look really nice if we put some in your neck crease and your nasal labial fold and to compliment that. But for other areas of the face, I think people, and it's a little more common to say, "We need to do four syringes or five syringes." And people hear that and they're like, "What?"

Monique Ramsey (33:21):
For their cheeks or something-

Julia Jowett (33:23):
Yeah.

Monique Ramsey (33:23):
... or their-

Julia Jowett (33:24):
But, you know, maybe one syringe in the chin and two in the cheeks and one in the lips. And it can start to add up as how many syringes, but it really isn't that much when you're just kind of squeezing that gel out of that syringe and look at it.

Monique Ramsey (33:34):
Actual product, yeah. Now, one thing that I think all of us have been on social media, looking at weird trends.

Julia Jowett (33:43):
Yes.

Monique Ramsey (33:44):
So before we wrap up, so we talked about the lip flip, that's sort of a trend. What could go wrong with a lip flip if there's too much, if it's over-

Julia Jowett (33:54):
Too much.

Monique Ramsey (33:54):
Too much Botox being used?

Julia Jowett (33:56):
So I would say things that could go wrong, if it's too much, you would just feel like you had no control of your upper lip. If it's placed unevenly, so say more was used on one side than the other, that might create some asymmetries. Those are the two main things that could go wrong. With lip flip, it wears off. So as it metabolizes away, your natural anatomy always returns back to normal.

Monique Ramsey (34:18):
And then there's this Russian lip. What is that, and do you do it?

Julia Jowett (34:22):
That's a great question. So it's using a technique to create a very sharp tenting e-version of the lip. And it is, I would say an unnatural looking effect. Beauty's in the eye of the beholder. So if a patient wants a certain look and we really look at pictures and we talk and we discuss that this is their goal, I can achieve that goal. But I would say it's not something that would be done unless somebody requested that specific technique. There's lots of ways to get what we call like really sharp, defined borders or really everted lips. But that isn't actually the most natural look. So for most people there's a combination of techniques that I would use to inject.

Monique Ramsey (35:04):
And then I noticed there's kind of a good trend happening towards definition, maybe versus volume. Are you seeing that happen too? I think people really didn't want to see the puffy Kylie Jenner look anymore?

Julia Jowett (35:19):
Yeah. So it changes every year and you have to really keep up with what the newest injection techniques are. I've gone to trainings that are specifically just focused on lips and with some of the best injectors in the world have flown in for it. And it's really like, you will have a room full of people and they disagree on the best techniques and approaches to lips. So it's something you have to kind of have all the tools and use to give that natural outcome. I think being mindful of how long things can really take to go away in the lips is one of the most important things. Because if you're adding more product where it isn't needed, it's just going to be product on top of product and it's going to create that puffy border and puffy look. So, really looking at what each person needs and adjusting your approach by that.

Monique Ramsey (36:02):
So, where the filler goes, you talk about the border of the lips or that vermilion border that most people have. But what about the middle part? Do you inject in the middle part of the lip also? Or I don't know if you call it the, my layman's term. So, the middle part, the pink part, maybe.

Julia Jowett (36:20):
Exactly. And you can call it the pink lip itself. So typically when you're looking at somebody's lips, you're looking at the border of the lip, which is where the color changes from your skin tone to the pink lip itself. Most people have what we call the cupid's bow. So it's like that little peak, those two little peaks at the top of the upper lip. And then we have natural tubercles, which are kind of where the light hits and you have a little bit more volume and plump. And a natural lip has a defined but subtle defined border. So it doesn't look like the most sharp thing, like you have lip liner on.

Julia Jowett (36:52):
Most of the volume of your lips should be, if you were to take a pencil and kind of draw from the edge of each side of your nostril, so what we call the nare. If you were to draw that down, the majority of your volume should be within that border. So for people that they, and this is a common thing people get nervous about that they're going to have a widened mouth or it's going to look like it's been almost like a joker look, if you're not placing a bunch of filler in the sides of the lips, then that will avoid that look. But that's where the focus is placed, to place it inside the pink lip itself, to give those definition points so that light hits in a certain way. Some people, especially the aged lip, need a little bit more of what we call the filter column, so the little lines that go down from the nose to the lip. This area can get flat and elongated. And if you add a little bit of filler to that area, it can help support the lip itself and turn it up.

Monique Ramsey (37:39):
Yes. I know this from personal experience. It really makes a huge difference. It stings a little bit. It's like a little, "Whoa, what are you doing?" It kind of hits you, spicy, but it really does make a difference.

Julia Jowett (37:52):
Yeah.

Monique Ramsey (37:52):
But truly, you can flatten out there. And I think people don't think about that part of their face as part of their lips, but it sort of is, right?

Julia Jowett (38:01):
You always have to look around the mouth. And with any lip filler, if you don't do that, you're doing your patient a disservice because it's not going to look the best it could look. If you're not looking at all those little considerations of, is there a shadow at the edge of the lip, is there a downturn to the oral commissures? Is their chin a little bit recessed and when you add lip fillers are going to make their chin look more recessed, or?

Monique Ramsey (38:22):
Oh.

Julia Jowett (38:22):
So all these things, we always look above and below and besides, and just making sure that overall outcome is going to be the best it can be.

Monique Ramsey (38:29):
So we have some recommendations on saving a little money on fillers, because every little bit helps, right?

Julia Jowett (38:35):
Yes.

Monique Ramsey (38:36):
So one of the ways that we save our patient's money is with the GLAMfam Loyalty Club. And if you are not a part of the GLAMfam, you should definitely check it out. And it's a membership. So when you buy in every year, sort of like Costco, you buy in, you pay your fee, but then you can go to Costco, right? So you buy into the GLAMfam, that gets you special discounts all year round, every day you come in on products on fillers, treatments, everything. So that's one way to take your price from, let's say 14 to 12 per unit of Botox or some things. But then there's also loyalty programs through the different manufacturers. Those are all going to be through the Allē program, which used to be called Brilliant Distinctions, but it's Allergan's loyalty program and you earn points towards future treatments and you receive special offers.

Monique Ramsey (39:29):
And if you're a GLAMfam, you can also stack your Allē points so you're going to have money back basically and some rebates to do things throughout the whole year. And then there's also, if you're going down the Restylane side of things with the Kysse that we talked about earlier or Refyne or Defyne. So those are made by Galderma, and they have their own loyalty program that's called ASPIRE. So same thing. So you can, that's one or two good ways to save money.

Monique Ramsey (39:59):
And then we always have special offers on our website. So you can always go to the specials page and see what might be happening. Those are usually exclusive to GLAMfam members. So that's why I say join. And then we do publish all our prices on our website. So you can go under the pricing menu and take a look and see how much is each syringe if you were getting it without the GLAMfam and with the GLAMfam. And really the GLAMfam will pay for itself, I think within one or two visits. And if it doesn't, we give you your money back. Because we're so sure that you're going to make your $120 back.

Monique Ramsey (40:37):
So if you're listening today, we want to ask you all for a special favor. If you love the La Jolla Cosmetic Podcast, if you've learned something from it, if it's helped you make a decision, tell your friends and write a review for us, whether you're listening on Apple Podcast or Goodpods or wherever you're listening, we love reviews. We want to hear from you.

Monique Ramsey (40:56):
Likewise, if you're a happy patient and you want to be on the podcast, you can come on the podcast. I'd love to interview you, love to hear about your experience with La Jolla Cosmetic or any of the procedures that you're thinking about doing, or you've done in the past. Let's talk, let's talk about it. And if you're listening today and you have questions or need information about setting up a consult, financing, reviews, photos, check our show notes for links. We just redid our website. So everybody, I think you'll really like it and you'll find a lot of-

Julia Jowett (41:26):
That's so good.

Monique Ramsey (41:27):
... really good content on there, really valuable content. And of course, we have other podcasts you can listen to that Julia has done and all of our other providers. So be sure to scroll through our podcast list, because there's lots of good stuff in there. The last thing is, if you show that you're a subscriber to the La Jolla Cosmetic Podcast, we have a special offer where we'll give you $25 off of $50 or more on anything you want. Well, thanks for joining us, Julia.

Julia Jowett (42:01):
Well, thank you for having me. This was so fun. This is, like I said, my passion. So it's so fun to talk about all the little details to this that go into every single injection that we do every day.

Monique Ramsey (42:11):
And we'll see you all next time.

Speaker 1 (42:20):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com, or follow the team on Instagram, @ljcsc.com. The La Jolla Cosmetic Podcast is a production of The Axis. theaxis.io.