Expert Doctor

“Bow and Arrow” Technique for Lip Enhancement

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Karan Dhir, MD

Beverly Hills, CA

Bow and Arrow Technique for Lip Enhancement

“Bow and Arrow” technique for lip enhancement is a cosmetic treatment that uses filler injections in the lip area to enhance the size, balance and shape of the lips without producing the appearance of a duck or fish lip. This lip enhancement technique is performed on the Cupid's bow, or the “M” portion of the upper lip, to provide better contour as it grants a fuller lip with a gentle pout. Injections may also occur on the bottom lip. Therefore, this lip enhancement treatment is commonly referred to as Cupid’s bow lip augmentation, lip fillers and lip rejuvenation. The “Bow and Arrow” technique uses a blunt tip needle to gently deliver the dermal filler for a more sensual or prominent lip. Hyaluronic acid fillers are the most common type of lip enhancement filler since hyaluronic acid naturally occurs in the body and is less likely to cause a reaction or be rejected by the body.

Am I a Good Candidate for “Bow and Arrow” Technique for Lip Enhancement?

A GOOD CANDIDATE for “Bow and Arrow” lip enhancement is:

  • Any patient with nicely shaped lips who desires a bolder lip with more volume or fullness
  • Middle aged and older patients with volume or shape loss on the upper and lower lips due to the natural aging process
  • Patients who have thin or disproportionate lips due to genetics
  • Patients considering a more permanent option that want to see how they like the temporary lip enhancement
  • Any patient whose upper lip is drooping due to gravity
  • A patient who is having other facial rejuvenation procedures and wants to have lip augmentation to match the outcome

The following patients are NOT GOOD CANDIDATES for “Bow and Arrow” lip enhancement:

  • Patients with bleeding or blood clotting disorders
  • Patients on certain medications which may thin the blood
  • Patients who suffer from certain health conditions such as diabetes, lupus and connective tissue disorders
  • Patients with active oral herpes or those who are prone to cold sore outbreaks although a treatment with medication can allow the procedure to be performed safely.
  • Some lip fillers are comprised of non-human sources and this includes bovine collagen. Patients who have had lip injections in the past, and suffered from an allergic reaction, may not be ideal for certain types of fillers.

How is “Bow and Arrow” Technique for Lip Enhancement Performed?

Lip fillers can be performed in the doctor’s office and only take a few moments per injection site. The procedure can be performed all at once or gradually over several appointments until the desired look is achieved. The lips can be very sensitive so the doctor will use a dental block to numb the entire lip for a more comfortable procedure. Most dermal fillers already come pre-mixed and contain lidocaine (which is also an anesthetic). The doctor will use a blunt needle to inject the filler into the natural lip border and body of the lip by using six entry points. The injections are performed as two at each corner of the upper lip, two at each corner of the lower lip and one at each point of the Cupid’s bow. During the injections, the doctor will maintain the balance of the lip appearance. This means the lower lip should always be fuller than the upper lip but not so full that it looks puffy. The Cupid’s bow, and columns that extend to the base of the nose, are also enhanced by the injections.

Alternative Techniques

An alternative technique for lip augmentation with injectables involves fat grafting. With fat grafting, the surgeon will remove unwanted fat from another area of the patient’s body via liposuction. This can work well if someone already wants liposuction for body contouring but it can be an excessive procedure to simply enhance the lips. While considered safe, liposuction carries risks and the recovery time depends on the amount of fat being removed. The fat that is grafted into the lips can last longer than fillers but a portion of the fat will not survive the transfer.  

Another alternative treatment for lip augmentation is implants. Implants provide permanent lip augmentation while fillers are temporary. Since implants are surgically placed, they carry a higher potential for risks and a longer recovery time. Implants can shift out of place, and do not age naturally, which can cause them to look abnormal. Furthermore, implants require surgical removal while fillers will naturally be absorbed by the body.

What is the Cost of “Bow and Arrow” Technique for Lip Enhancement?

The cost depends on the amount of filler being injected, type of filler used, the doctor’s fees and the geographic location of the office. Dermal fillers come pre-mixed and are priced per syringe but usually only one syringe is needed for lip enhancement. The cost of lip injections can range from $400 to $900.

Recovery and Downtime

RECOVERY after “Bow and Arrow” lip injections is very minimal. Since this technique only requires six injections, there is less chance of bruising and swelling. Patients are advised to treat the area with a cold pack just after the procedure. Lipstick and balms should not be used after lip injections. Some patients experience redness and slight discomfort during the first 2-5 days. Swelling and discomfort can be managed with over-the-counter pain relievers and keeping the head elevated for the first few days of DOWNTIME at home. Eating soft foods such as yogurt, oatmeal and gelatin can also help minimize the trauma to the lips. Nevertheless, any side effects should subside within a week.


While the results of the “Bow and Arrow” technique for lip enhancement are immediate, it can take up to a week for the filler to settle in. Fat grafting results can take even longer since it can take up to 6 weeks for damaged fat cells to be naturally excreted from the body. Furthermore, redness and swelling can slightly mask the results during the first week. The length of the results depends on the individual patient since some patients absorb the filler faster than others. Filler material comes in various consistencies and certain fillers work better in particular areas. Fillers can last a long time in areas of less motion but the lips tend to be an area of high motion. Lip enhancement via fillers may last as little as 3 months or as long as a year. As the filler is absorbed, patients will need to have repeat injections to maintain the effects. Regular maintenance injections, performed before all the filler has absorbed, can help the filler build on itself and eventually require less filler material. Smoking can alter the results or cause the effects of the filler to not last as long. Therefore, patients should stop smoking at least a few weeks prior to filler injections and they should not smoke after injections.

Limitations of “Bow and Arrow” Technique for Lip Enhancement

The limitations of lip enhancement injections include:

  • The amount of filler that can be injected while maintaining a natural lip appearance
  • The lower lip to upper lip ratio should be slightly more than half the size of the upper lip
  • Age appropriate expectations should be practiced so a 60-year-old should not try to achieve the lips of a 25-year-old

Risks of “Bow and Arrow” Technique for Lip Enhancement

The risks associated with Cupid’s bow lip augmentation include:

  • Allergic reaction
  • Bleeding
  • Tenderness at the injection sites
  • Infection
  • Itching of the lips
  • Reactivation of cold sores or herpes simplex virus
  • Scarring or stiffening of the lip
  • Lip asymmetry
  • Lumps or bumps in the lips
  • Injection into a blood vessel can result in tissue loss

“Bow and Arrow” Provides Lip Augmentation

The “Bow and Arrow” technique for lip enhancement was designed to give patients the best lip augmentation possible with minimal risks of bruising, lumps and swelling. This minimally invasive procedure can be reversed, with a simple injection of an enzyme, if patients change their mind after seeing the results. For that reason, dermal fillers are the best option for a first-time lip augmentation patient. Patients should consult with a board-certified doctor to determine if they are an ideal candidate for the “Bow and Arrow” technique for lip enhancement.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Karan Dhir, MD in Beverly Hills, CA