Lip Implant Augmentation Specialist
Lip enhancement patients have visited Dr. Barry Eppley for many years for help in achieving fuller and more beautiful lips. Please visit the lip injection before and after results page to view before and after pictures.
In the past decade, full pouty lips have become the epitome of feminine beauty. In most Caucasians, the size of the upper lip is about two-thirds that of the lower lip. The trend today is to have the upper lip match the lower lip in size. Certain people are born with small thin lips, aging effects can make the lips lose volume and lengthen, and facial expression and smoking contribute to the development of vertical lines around the lips. All of these influences have seen the number of cosmetic lip procedures performed increase dramatically.
LIP AUGMENTATION – It’s All About The Vermilion
In simplicity, lip enhancement is about improving the amount of vermilion (pink part) show. This creates a fuller or ‘pouty’ appearance. It is the vermilion that is responsible for our perception of lip size. Therefore, a variety of approaches exist for achieving this goal. This includes injectable fillers, lip implants, lip advancements, and lip lifts. Which procedure is right for a specific patient is a matter of how much vermilion show (how thin are your lips?) you have and the appeal of the advantages and disadvantages of each lip approach.
INJECTABLE FILLERS FOR LIP AUGMENTATION
Injectable fillers are the most common method of lip enhancement. For the lips, the injectable filler should be composed of hyaluronic-acid, a naturally resorbing sugar-like molecule (e.g., Juvederm, Restylane), that has very few problems and always goes away. While resorbability is not desired by patients, the lips are very reactive to particulated longer-lasting fillers and these should be avoided for lip augmentation. While injectable filler lip enhancement is quick to-do and produces an instant result with virtually no recovery, treatments must be repeated and the cost over time can be significant. Thus, some patients may desire a more permanent solution to their aesthetic lip concerns.
Fat Grafting for Lip Augmentation
The one potentially permanent option for lip injections is the use of fat. Fat is a natural material that is taken from the patient by liposuction, processed into a concentrate and then injected into the lip(s). While fat is very appealing, how well it will survive and its degree of permanency, unfortunately, is not assured.
Implants for Permanent Lip Augmentation
Lip implants are now currently available that offer a permanent solution to increasing the size of the lip vermilion (Permalip implants). A synthetic lip implant offers permanency of size and can be placed in an office procedure under local anesthesia. They are shaped as cylindrical tapered smooth silicone tubes that extend across the lip from one corner of the mouth to the other. For those patients who like the results of lip fillers but want a permanent ‘filler’, lip implants can be a good option.
Subnasal Lip Lifts and Vermilion Advancements
Surgical options exist to change the size and shape of the lip vermilion, procedures known as lifts and advancements. A subnasal lip lift, also known as a bullhorn lip lift because of the shape of the skin excision and resultant scar, is done at the base of the nose and lifts the central lip known as the cupid’s bow area. It does not enhance the vermilion much beyond the vertical limits of the cupid’s bow. Conversely a lip advancement, known as a gull wing lift, removes a strip of skin from one mouth corner to the other and changes the height of the lip vermilion. But does so at the trade-off of a fine line scar along the more visible vermilion-cutaneous border.
Male Lip Advancement and Lip Lifts
While many think that lip enhancement procedures are done exclusively for women, there are some men that have them as well. Men generally have less interest in procedures that require repeated treatments to maintain them (e.g., injectable fillers). Lip advancement and subnasal lip lifts can be done very successfully in men. While scars are always a concern with an permanent skin excisional lip procedure, the beard skin of men make most of these scars superior (even less visible) than what are seen in women.
Corner of Mouth Lift
Another aesthetic lip problem is that of the frowning mouth or downturned corner of the mouth. Aging and the falling of the cheek tissues downward can push the corners of the mouth downward creating a u-shaped smile line. For others, the natural shape of their mouth and smile line is that of a downward slant of their mouth corners. A corner of the mouth lift straightens out the smile line by removing a small triangle of skin above the downturned corners and changes the angle of the mouth corners to a more horizontal one.
Treatment Options For Lip Lines and Wrinkles
Beyond that of the lip size is the pesky problem of vertical lip lines and wrinkles. A variety of skin resurfacing methods exist to partially smooth out lip lines, of which the most common method is fractional laser resurfacing. if lip lines are very deep, the historic use of dermabrasion can also be very effective.
As incredulous as it may seem to some, there are people who feel their lips are too big. The amount of exposed vermilion they have is excessive and the size of their lips is an overwhelming feature of their face. Other people have dry or chapped lip issues on portions of the dry vermilion that would benefit by being removed. Large or excessively dry lips can be reduced through a procedure, appropriately called a lip reduction. This is done by removing tissue from the internal part of the lip at the wet-dry junction where the vermilion (dry) meets the mucosa (wet). This rolls back the outer vermilion inward, reducing the size of the lips and putting the scar in a non-visible location.
CLEFT LIP REPAIR AND CLEFT LIP REVISION
A unique lip shape problem is that of the cleft lip. As a congenital facial defect that affects roughly 1 in every 1,000 births in the U.S., its disruption of the natural merging of the lip tissues creates many well known lip shape issues. While most cleft lip repairs are done in infancy, and this closes the wide gap between the two separated lip halves, it rarely produces a perfect realignment of the natural vermilion-cutaneous border or even adequate lip fullness. Thus many cleft patients need lip revisions later on in life in childhood or their teenage years. Adult cleft lip revision can often also be helpful as older patients often think that their lip can not be further improved… which often is not true.
Unlike aesthetic enhancement of a normal lip, the cleft lip requires a working knowledge of every form of lip reconstruction methods. A wide variety of lip reshaping techniques are needed including narrowing of philtral scars, creation of orbicularis muscle integrity, vermilion cutaneous realignment, enhanced lip fullness and internal vestibular lengthening/scar release.
Lip Enhancement – Before Surgery
Determining the correct procedure for the patient amongst the lip options available is the most important issue preoperatively. The patient must have a clear understanding of the advantage and disadvantages with each type of procedure. For such a small but prominent area of the face, the lips have a diverse number of non-surgical and surgical options from which to choose. The safest and most conservative approach is to try temporary injectable fillers first and only ‘graduate’ to more permanent options if dissatisfied.
Lip Enhancement – Operation
All of the lip procedures can be performed under either local or sedation anesthesia as an outpatient. Often they are combined with other aesthetic facial or body procedures and are done under general anesthesia. The procedures are relatively short to perform. For lip implants, the incisions are placed in the red portion either in the corner of the mouth or in the central aspect of the lip which aids in passing the implant into the correct position. For lip advancements, the skin is removed at the junction of the red and white portions of the lips with the final suture line at this junction. For lip lifts, the skin is removed at the base of the nose with the final suture line at the skin crease at the junction of the upper lip and nose. The corner of the lift is the smallest surgery of the lips, removing a triangle of skin overhanging the mouth corners. In peeling or laser resurfacing, the outer layer of skin surrounding the vermilion is removed, allowing smoother skin to result after healing. Skin resurfacing may be combined with other lip enhancement procedures at the same time.
Lip Enhancement – After Surgery
Only antibiotic ointment is used on the lip and suture lies with no other dressings needed. There is very minimal postoperative discomfort with any of the procedures. More swelling is associated with lip implants than those with skin excision or resurfacing. Bruising is rarely seen. By three weeks after surgery, however, most of the swelling is gone and the result evident. Lip sutures are removed after one week. Lipstick may be worn again after the first week. In resurfacing, the treated areas of the lip must be kept moist with antibiotic ointment. Once healed, it will take several months for the redness of the treated skin to fade.
Complications with lip implants (synthetic) are more frequent than with lip advancement/lifts due to the indwelling material. These include the potential for unnatural palpability, lip stiffness, and infection. When these occur, removal of the implant may be needed or the implant may need to be replaced. In fat injections, most of the fat eventually atrophies and retained lip volume may be unpredictable. For lip advancements/lifts, the only issue is the potential for adverse scarring which seems to be very uncommon. Slight asymmetries may need to have a touch-up procedure for optimal results. In laser resurfacing, pre- and postoperative anti-viral medication needs to be taken to prevent outbreak of herpetic lip infections, even if the patient has never had a prior eruption.