LIP ENHANCEMENT

Voluptuous lips are regarded as a sign of beauty and sensuality. Unfortunately, traditional cosmetic procedures such as face lifts have done little to rejuvenate the lip and mouth area.

A variety of materials have been used for the cosmetic enhancement of the lips and the lip area.

Available materials for lip enhancement include fillers such as collagen and fat injections. We also have extensive experience with more permanent implants such as Gore-Tex (r) and AlloDerm (r).

Gore-Tex (r) is a nonreactive porous material which was originally used in the 1970s as a vascular graft. It can be implanted in various thicknesses and sizes and maintains its size once implanted. Dr. Anderson favors Gore-Tex (r) for lower lip enhancements, AlloDerm (r), an implant material manufactured of human skin obtained from tissue banks, is currently our favorite implant for the upper lip. The implant remains soft after implantation and does not migrate.

FAT INJECTIONS FOR LIP AUGMENTATION

Fat injections are available but unfortunately the results are often short lived and must be repeated to maintain improvement.

COLLAGEN

Fillers such as Zyderm and Zyplast have been the gold standard for injectable lip enhancement for many years. Our patients appreciate the expertise of Trisha, our aesthetician who does these injections beautifully. She’s a master Injector!

Hyaluronan

It has been called the platinum standard for injectables.

Dr. Anderson has experience with all of the available materials and methods of lip enhancement. In his series of 400 lip implant patients Dr. Anderson has reported only four minor complications. Dr. Anderson stated the results are very impressive and patients are generally very pleased with the results.

LIP ENHANCEMENT
By Richard D. Anderson, M.D., F.A.C.S.

Full, soft, youthful, and voluptuous lips are signs of beauty and sexuality in our culture. My personal interest in lip enhancement began over 20 years ago and since then I have had the opportunity to treat thousands of lip patients ranging in age from their early 20's to 80 and above. Patients who desire lip enhancement fall into two groups; those seeking larger and fuller lips to improve what they feel are genetically thin lips and those seeking corrections of aging changes including thinning lips and lines (wrinkles) around the lip and mouth area.

What can be done?
Fortunately, several treatments are currently available which provide impressive improvements when properly done by an experienced professional. Lips are all different in size, shape, underlying support structure (teeth and bones) and, of course, patient desires and expectations are different with each person. The available enhancement techniques are subject to the skill and experience of the plastic surgeon and the results reflect of the ability and experience of the doctor performing them. In this article we will review some of the treatment options that most often provide the desired results in my practice experience. I prefer to decide these options into three classifications.

I. Injectable Fillers
For lip enhancement the ideal (or perfect) injectable material would be safe, relatively permanent, easy to use, have no downtime, and be easily reversed (incase the patient does not like the result). Unfortunately, the perfect material is not yet available, but in the meantime, we do have several injectables which do provide improvement. These range from the patients own fat to a long list of synthetic materials which provide temporary improvement and others touted as relatively permanent. The advantages of injectable fillers are minimal downtime and rapid return to normal activity which is so important in today's fast moving and hectic lifestyle.

In Our Practice I recommend that patients first try a temporary injectable such as Collagen (Zyplast, Cosmoplast) or hylaronic acid (Hylaform or Restylane). The temporary feature of these products is an advantage, just incase our patients decide they do not like the result achieved.

Bovine collagen (Zyderm, Zyplast) has been referred to as the "gold standard" for lips since the early 80's. Many thousands of collagen lip injections have been done with a short recovery time and excellent results. The disadvantages are a lack of permanence and the possibility of allergic reactions in 2-4% of treated individuals. With bovine collagen, skin tests are required prior to treatment.

We began using human collagen (Cosmoplast) about 3 years ago and no skin tests are required for this product. The Cosmoplast product is safe but is not permanent.

Our most popular lip injectables are currently Hyalonic acid preparations (Hylaform and Restylane). These products were both approved for use in the USA in 2004 and both are distributed as injectable gels. These products have been used world wide and do not require skin testing. Their advantage over collagen is a longer lasting result; which is about 6 months for lips. Hyaluronic products are now referred to as "the platinum standard" for lips and for wrinkles. Dozens of other injectable filler products are available, although not all of them are approved or recommended for use in the lips. The large number of available products attest to the fact that the ideal and perfect injectable is not yet available.

II. Implants
Implants are enhancement products which require an incision instead of simply a needle. Although no perfect or ideal implant is yet available, my current favorite implant for lips is Alloderm, a product derived from human skin and available to doctors through accredited tissue banks. This material has been used frequently in burn and reconstructive surgeries and more recently for cosmetic lip augmentation.

I find Alloderm to provide a natural appearance and natural feel plus a longer lasting result in several hundred of my patients. Our patients appreciate the improved appearance, the soft and natural feeling, and report good "kissability" with this product.

Unfortunately, however, Alloderm implants are not permanent and the material cost is rather high, especially if the improvement achieved disappears sooner than expected.

Another implant product is Gore Tex (e-PTFE), which has been used for more than 25 years in humans. I have used this material for several hundred lips over the last 15 years and find it to be more permanent than other lip implant materials. Gore Tex, however, can result in a "stiff" and unnatural feeling, in some cases. I recommend Gore Tex only for the lower lip augmentation in selected patients at this time.

Remember it is essential that augmented lips be not only attractive but also natural and "kissable".

III. Other Surgical Procedures
Several surgical procedures are available which are designed to use the patient's own tissue to project and lift the lips, provide more "pout", or shorten a long vertical upper lip.

My favorite lip lift procedure achieves a shorter vertical upper lip and more projection or "pout" of the red vermilion part of the lip in an upward and forward direction. This procedure involves excision of a strip of skin below the base of the nose and is often referred to as the bullhorn excision technique. Fortunately, the scars after this procedure are not usually noticeable, but some postoperative swelling will usually persist for several weeks. Examples of the results of this procedure will be shown on photographs.

Another procedure called "lip advancement" involves excisions and stitches on the inside of the lips and results in an enhanced "pout" and projection of the upper and lower lips, if both are done. The major drawback of this particular procedure is a longer recovery with swelling and numbness, which can persist for up to six months. This procedure is called the V-Y lip advancement and those who do the technique report that the final results are usually satisfactory to their patients.

A number of other surgical procedures for lip enhancement and lip enlargement have been described, but are rarely used in my practice.

Summary:
My goal with lip enlargement and lip enhancement techniques is a short downtime and a rapid return to "kissability" (within a few weeks). Remember, however, any technique is only as good as the ability and the experience of the doctor performing it and no surgical technique is applicable to every patient.

Unfortunately, there is not a prefect injectable product, implantable product, or a perfect surgical technique for every patient seeking lip enhancement. Fortunately, however, satisfactory improvements can be achieved for the majority of realistic patients seeking improvement.

The first step for anyone considering lip enhancement is a consultation with an experienced and knowledgeable plastic surgeon, but remember that not all surgeons have experience with lip enhancement treatments. Ask to see photographs of the doctor's work and ask questions about the expected results for your problem. We also advise our patients to bring along lip photographs of the size, the shape, and the look that they desire.

Computer imaging is helpful to assess our patient's desires and expectations. This allows our patient to see the present and the modified images of changes that might be possible. No one can guarantee that the final result will be identical to the computer imaging result, however.

Temporary injectable techniques should be tried first. If the temporary changes are pleasing to our patients, we then may suggest a more aggressive and longer lasting procedure in the future.