The Only Naturally Red Place on the Body: The Lips

When you look at patients' faces every day — and I mean really look, twenty or thirty minutes at a time with the MarkVu imaging up on the screen — you start to notice something obvious that still strikes you as remarkable.

There is exactly one place on our skin that is naturally red to begin with. The lips.

In an earlier column I wrote about how I approach treatment: you have to erase the marks on the paper first. Clear the pigment, smooth the texture. After fourteen weeks of that careful work, once the skin has become a clean white page, that is when the overall contour and vitality of the face start to come into view.

And on that clean page, the first thing that draws the eye is the one place that is red — the lips. I consider the lips the area where facial dimension and vitality can be brought back most noticeably. In my own experience treating them, they are also where patients tend to be most pleased with the result.

Why lip filler becomes more necessary with age, not less

Patients in their twenties usually come in wanting to change the shape — to lift the corners, to add fullness. From the late thirties and into the forties, the concern is a different one.

"Doctor, these days if I skip lipstick everyone asks whether I'm unwell."

Lips age too. As collagen is lost they roll inward and thin out, and as they hold less moisture that characteristic clear red turns dull. Fine vertical lines set in. When the lips thin, the philtrum looks longer and the whole expression reads a little downcast, a little older.

So the need for lip filler grows with age rather than shrinking. In your twenties it is a treatment that makes something you already have prettier. After forty it becomes a treatment that recovers something you used to have and lost.

What filler is actually for — restoring vitality, not volume

Mention lip filler and most people immediately picture duck lips. I don't care for overdone work either. The real purpose of lip filler, as I see it, is not to make lips bigger but to restore the vitality that has drained away.

Hyaluronic acid filler draws in far more water than its own mass. Laid into the lips thinly and precisely, it does not simply thicken them — as moisture fills in, the clear red the lips originally had comes back, and the dry vertical lines ease on their own. The result is dimension across the whole face and an impression noticeably more alive than the one that walked in.

A difficult area, which is why it has to be precise

Lips carry a great many vessels and never stop moving — we talk, we eat. That makes them a demanding area to treat, and a sensitive one for pain. Just as I take enough time over anaesthesia for skin procedures, I keep discomfort as low as I can here and design in very small increments, always against the proportions of the whole face.

Above all, because lips are constantly in motion, the goal is a shape that holds without ever feeling like something foreign is in there. That is why I completed the master certification for Restylane Kysse, a filler made specifically for lips. Restoring vitality in step with how lips actually move — rather than simply packing in volume — requires both a product built for it and precise technique.

Just a little — and the smile changes

Around the time a fourteen-session package is drawing to a close, the skin has cleared but something in the way of vitality can still feel missing. At that point, without adding anything conspicuous, a small amount of moisture and colour in the lips changes the whole impression of a smile.

You remember my view that a change on the outside builds confidence on the inside. A clear face with one bright, living red at the centre of it gives people more confidence than you would expect — in forming relationships, in meeting people.

Suitability, results and how long they last depend on lip shape, skin condition and existing volume, and vary from person to person. Please decide on treatment only after consulting a physician directly.