Performing a lip augmentationwith Juvederm or Restylane is like framing a picture. As with a picture to be framed or matted one must take into consideration the existing size of the picture and the room and or area it is to be hung in. Proportions of the room to the picture determine where you start. With doing a lip augmentation, surrounding facial volume determines what can be "carried" and still look proportionally appropriate. Keeping dimentions of the surrounding "frame" or with the lips the commissure (corners of the mouth) and peri-lip tissue volume is of utmost importance. I was recently watching TV with my wife, I think on Bravo, called "Couples Therapy". At some point I told her I had to leave the room because I could not stand looking at the lips of two women on the show. The woman from "Beverly Hills Housewife" and the young woman from "16 and Pregnant" have without a doubt the most distorted and I am sure very certain most expensive lip augmentation ever performed. The "Beverly Hills Housewife" woman's upper lip has lost any semblance of correct proportions or anatomy. The modest loss of volume to her peri-oral structure and cheeks do not allow her to carry the large (sausage) extruded lip. All previous anatomical zones of cupid's bow are no longer present. The top lip is just amorphous mass devoid of planes and boundaries. This is only amplified by the very obvious loss of volume to her medial zygomatic area (area outside her nose and between her cheeks) as well as some loss of volume to the corners of her mouth. The two most violated areas in both women's lips are the upper middle portion directly beneath the nose or the philtrum. The augmentation was performed by expressing filler from the left side to the right side of the midline. This obliterates the natural chevron, up down lines of cupid's bow and beaks the lip creating a (trout pout) from the facial view and a beak when viewed from the profile. The corners of the mouth were not augmented as well giving what I call the Mrs. Potato Head look. There is no gentle fade of filler to the corners of the mouth. The lips have an almost pinned on look like a Mrs. Potato Head. Now Im not trying to be cruel, however, both of these reality TV show women have very common lip augmentation problems which could have been easily avoided. Lip augmentations with Juvederm or Restylane should start on the outside of the lips first. Augmentation of the marionette lines and corners of the mouth should be done first particularly on a more mature patient where volume loss has occured. I had a patient that wanted her lips augmented and I already felt there was quite a bit of volume there. During her consult I explained the need to augment the surrounding tissues first to "frame" the picture. As I started to augment the corners of her mouth, I have her a hand mirror to see the progress. She immediately stated "my lips look better already but you haven't put any filler in them yet, how is that?" Starting on the outside replaces a very subtle volume loss that was present and allowed her lips to unfurl so to speak. I did of course place Juvederm or filler in her lips but now they could easily "carry" the increased volume. Her lips looked fuller and still had natural plains and most importantly proportion. I have no "Big Ang" lips under my care. My website has immediate before and after photos of a lip augmentation I have performed with Juvederm personally. Both the frontal view and profile look better than before. Check them out and see for yourself. I have performed hundreds of filler procedures and am now certified in "Voluma". This is Allergan's new hyaluronic filler approved for cheek and mid face volume loss. I have before and after photos of cheek and tear trough augmentations but that is a blog for another day. My consult at both offices are always at no charge. My last Juvederm patient stated "she loves to talk to herself in her car rearview mirror before she backs out of her driveway". She told me," I look at myself in the rearview mirror and say those great lips need a little lip gloss". We both laughed and I said, " that's great. Its all about how you feel about yourself". If you feel great, the whole day goes better.