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Lip Augmentation
Lip augmentation (enhancement or enlargement) is a term to describe procedures that affect a small change in the appearance of the lips, either surgically or through non-surgical procedures. Many different techniques are used to plump-up or fill-in the lips, some of which are temporary and have to be repeated, while other are more permanent. There are three main categories into which lip augmentation techniques fall: injections, grafting and local flaps.
Injection techniques involve filling the lip with a substance like collagen or fat to create a fuller appearance. The following are the different types of materials used:
Collagen is injected into the lip with small needles. It is made from cow skin and, although it is purified, it may cause allergic reactions and requires a sensitivity test beforehand. The results are temporary and only last one to three months because the body breaks down the material.
Fat harvested from the abdomen or the thighs is purified and then injected through small needles. As with collagen, results are temporary but fat injections have the advantage of no possibility of an allergic reaction.
Restylane, a transparent gel called NASHA (Non Animal Stabilized Hyaluronic Acid) is created from a substance present in all living organisms. As with collagen, results are temporary but there is no risk of transmitting disease or allergic reactions.
Autologen, is collagen extracted from the patient’s own skin, often from excess skin removed in a facelift. Again, there is no risk of an allergic reaction and the results are relatively long lasting.
Dermalogen is extracted from the skin of a human donor. Before it is injected it is screened and processed to avoid the spread of disease. Like collagen, the effects are temporary.
Artecoll, is a new material with long lasting results. It is mainly composed of tiny synthetic “beads” (polymethyl methacrylate) which stimulate the body to produce new collagen and connective tissue to surround each microsphere. Only a few doctors in the U.S. have been trained in this procedure.
What does it cost?
Lip augmentation costs vary according to the technique as well as the individual physician and where he or she practices. Injectable lip augmentation can very depending on the type of material and the amounts used but generally ranges from $300 to $1000 or more. ALLODERM®, GOR-TEX®, SOFTFORM® can cost anywhere from $1000 for one lip; $4000 for both. Dermis-fat graft range from $4000 - $5000 for both lips and Local flaps, $4000 - $7000.
What happens during a procedure?
There are three main categories into which lip augmentation techniques fall: injections, grafting and local flaps. For more information on injection techniques and fat grafting, see injectable fillers.
The most common substances used for grafts are ALLODERM®, GOR-TEX®, SOFTFORM® and dermis-fat. These procedures are all performed under local anesthetic is used to numb the lip. In all instances the incisions are almost never noticeable. Though most lip enhancement procedures take only about 45 minutes and can be performed in a doctor’s office or in an outpatient surgical center, either operated by your doctor or a hospital facility.
ALLODERM® is made of human collagen tissue, which has been purified to minimize the risk of spreading disease and rendered non-immunogenic. It does not require a skin test prior to the procedure. Small incisions are made inside the corners of the mouth, the ALLODERM® is inserted through the body of the lips and the incisions are stitched closed. Because the material is re-absorbed by the body, results are expected to last 6 months to a year at most. Some swelling is expected but it disappears within three to five days. Complete healing occurs after two months, at which time the ALLODERM® softens and is indistinguishable form the rest lip.
GORE-TEX® a biocompatible material, was previously used in vascular bypass surgeries but since the late 80’s, doctors have also been using it for facial implants. When implanted in the lips, GORE-TEX® increases fullness and redness and is permanent, unlike ALLODERM®. A small incision is made at the inside corner of each lip the Gore-Tex implant is "threaded" through the lip. The implant is then trimmed and the incisions sutured up. There is a risk of infection and kinking of the implant, however, the implant material can easily be removed.
SoftForm® implants are made out of the same material as GORE-TEX® (ePTFE) and has been shown to produce better results with fewer complications. SoftForm® does not shrink and is never absorbed into the body. Unlike the GORE-TEX® implant, SoftForm® is more tubal in form and is hollow, allowing your tissue to network and grow "into it". Scar tissue forms on either end of the implant which allows it to remain in place and also allows it to easily be removed if it becomes infected. This type of lip augmentation is permanent but reversible. Insertion involves a small incision in the inside of the lip through which the material is inserted with a special needle. The process is repeated three times in the upper lip, so that three implants are inserted, while usually two implants are inserted in the lower lip.
The dermis-fat graft procedure involves harvesting a wedge of skin with fat attached to from another part of the body, typically the groin area or abdomen through a small incision. Again, small incisions are made and the tissue is threaded through the body of the lip. The tissue continues to nourish the fat after it has been transplanted and brings the body's own blood supply to ensure the graft's survival.
Occasionally, unusual scarring and distortion can occur and another, corrective procedure is required. Although the lips retain their new shape for a long time some patients have complained of hardness. This procedure is not generally recommended.
Local flaps procedures involve taking tissue from inside the mouth to enlarge the lips. An incision is made inside the mouth to push the tissue upward, and outward, into the lip. Alternatively, the incision is along the upper lip line, skin above the lip is removed, and the lip is then stitched along the line of the incision. Often referred to as "Cupid's bow", many plastic surgeons hesitate to make an incision in a completely normal upper lip and to risk an unsightly scar. A Local Flaps procedure is often performed in conjunction with a graft implants like ALLODERM®, GOR-TEX® or SOFTFORM®. There is a lot of swelling and numbness associated with this procedure and in some cases, drooling. Such symptoms are very pronounced in the first three weeks but should diminish over the following three weeks. Stitches are removed in 10 to 14 days.
Are there risks or potential side effects?
Some procedures require preliminary tests like a skin-allergy test, which requires a waiting period of at least six weeks to ensure that there is no allergic reaction to the material.
The appearance of lips is also dependent on the underlying dental structure. A malocclusion like an underbite can make the upper lip look less full. Furthermore, tooth bonding and veneers can alter the surface of the teeth making them push the lips outward which gives the lips a fuller appearance. Before considering lip augmentation, you may need to address your underlying dental architecture and consult an oral surgeon to discuss your options.
Some problems cannot be fixed by lip augmentation, for instance, elongated lips that look very flat, are improved with a lip lift and a crooked mouth or drooping corners are more suited to a mouth lift than any augmentation procedure. Conversely, if you feel that your lips are too big, procedure involving an incision under your nose and along the lip line to remove some tissue can reduce lip fullness.
Lip augmentation procedures carry certain risks including:
- Infection
- Bleeding
- Numbness or nerve damage
- Swelling
- Ulceration
- Scarring
- Asymmetry and/or unnatural movement
- "Kinking" if an implant is used
- Hardening and an unnatural feel to the touch
What to expect post-procedure?
Immediately following the surgery, the lips may swell and hurt. Although minimal discomfort, bruising and swelling can be expected for up to three days following most lip augmentation procedures, pain and more severe swelling and bruising is likely to occur after one of the grafts or the local flaps techniques. Local flaps procedures can produce moderate to severe pain for up to five days following the surgery. Moderate discomfort, swelling, numbness and drooling may persist for up to six weeks post-surgery. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication.
Cold compresses or ice packs can be applied during the first three days to reduce the swelling and pain. Oral pain medications can also be used to control the discomfort. Talking and chewing may be awkward and painful and should be avoided as much as possible.
How soon does normal life resume?
Depending on the procedure and the extent of the brusing and swelling, you can expect to return to work either the same day or two to three days afterward. Those who undergo on of the graft procedures may wait a week or two weeks to return to their normal routine. Non-dissolving stitches may be removed about 7-10 days after the procedure. Some problems with drooling can be expected during recovery and lips can feel unnaturally stiff for 2 to 3 months after the procedure. For dermal graft patients, it can take two to three days or as much as a week to recover. Those who opt for a local flaps technique are advised to wait up to two weeks before returning to work.
Who performs it?
Surgical lip augmentation is usually performed by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).
Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the appearance of your lips, then lip augmentation surgery may be appropriate, but:
- Make sure your doctor is aware of any medical conditions or allergies you may have and any medication you may be taking.
- Make sure you have a good understanding of the limitations of the procedure.
- Make sure you are free of allergies to the implant material used.
How to prepare for surgery?
Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
Are there alternatives to this procedure?
Non-surgical procedures such as micropigmentation, tattooing of the lip line, as well as tooth bonding and veneers can enhance the lips, making them appear fuller. Additionally, there are surgical procedures which are more appropriate for certain types of lips which cannot be corrected with lip augmentation. These include:
- A lip lift, which can shorten the distance from your nose to your upper lip by removing a small crescent of skin right beneath the nose. The lip is then elevated and the incision is hidden in the crease under the nose.
- A V-to-Y procedure, which can make the lips protrude more in the center for a pouty look by making “v” shaped incisions and suturing them to create a “y” shaped suture line.
- A mouth lift, which can counteract the natural drooping at the corners of the mouth, which can develop with age. A triangular incision is made at the corners to curl them back up.
Finally, as the lips are made of soft tissue, their shape is dependent on the underlying dental structure. In some cases it is more appropriate to pursue orthodontics or oral surgery to affect a change in the appearance of the lips.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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