Your Questions

Q: Dr. Eppley, What is the most natural lip augmentation filler that you offer?

A: When someone speaks of a ‘natural’ lip augmentation result or procedure, they could mean two distinctly different things…that the material that is implanted is natural or that they want a natural-looking result. For lip injections, the most natural filler is fat. (although by far the most common lip filler materials used are hyaluron-based like Juvederm for example) Fat may be the most natural injectable filler for the lips but it has a poor track record of graft take and requires more of a surgical procedure to do it. (liposuction harvest)

A natural result in lip augmentation is generally one that is not overdone or has had too much filler placed. It is unnatural when the upper lip becomes bigger than the lower lip. Most of the time patients want an upper lip augmentation whose size (vertical vermilion height) matches that of the larger lower lip. That is influenced as much by the technique and volume of injectable filler material added than it is by any specific injectable filler material.

Most likely you are referring to the latter where the result does not appear as if ‘something had be done’ or the dreaded ‘duck lip’ result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’ve been looking for a more permanent solution for a lip augmentation. I was looking into fat grafting, but I understand that that procedure may not turn out as well as I would like if not done by a surgeon who is very experienced in that procedure. I’ve also been looking into permalip, but I don’t know if that would be for me because my top lip is uneven (as you can see in the picture I’ve attached). In your opinion, which procedure would be better for me? Roughly, how many times have you done each procedure? And what are your prices for both procedures?

A: There are multiple options for lip augmentation from fat injections, implants and mucosal advancement procedures. (V-Y lip lengthening) There are advantages and disadvantages to all of these procedures and none of them are perfect. They all have flaws such an unpredictability of volume retention (fat injections), asymmetry and palpability (implants) and longer recovery. (mucosal advancements) While they all can be effective, it simply depends on which of their flaws you find most acceptable. I have performed many of all of these and I think the ‘safest’ (less risk of complications) is fat injections. Permalip implants are the easiest and can always be replaced by fat grafts should one not like their feel.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the FATMA lip augmentation procedure. I was born with a strawberry mark on my top lip. I had two surgeries to remove it, one at 6 months old and the other one at six years old. This has left me with a notch deformity in my upper lip. I am now looking into the FATMA procedure to help enhance the top lip to look more even and natural.

A: The FATMA lip procedure, as you undoubtably know, is an acronym for combining fat grafting with a mucosal advancement. While the acronym makes it sounds like it new and novel, the reality is that such lip reshaping procedures have been done for decades. The most common use of these two procedures historically is in reconstruction of the cleft lip deformity of which there is often a notch deformity at the vermilion. An internal V-Y mucosal advancement/roll out is done to lengthen and level the deficient vermilion edge and then a fat graft is added underneath it for volume. In this case the fat graft is usually a solid composite dermal-fat graft. The so named FATMA aesthetic lip reshaping procedure applies these same principles to a small but normal shaped lip using two internal muscosal advacements and fat injections. Whether your lip deformity should be treated by which variation of the FATMA procedure awaits seeing some pictures of it.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some lip augmentation procedures. My lips are getting thin with lines above them and the sides of lips are turning downward. So I would also want to have lip enhancement like implants which are permanent. And a treatment to reduce the lines above my lips.  Can I have these procedures on the same day? I have attached some pictures of my lips close-up.

A: Your lip augmentation will require a composite of procedures to get the best overall result. You actually do have some reasonable vermilion height although the upper lip is thinner than the lower. Your upper lip is also very long. Putting these lip issues together the best approach for your upper lip is a subnasal lip lift (to shorten the length of the upper lip), lip implant (for permanent volume), extended corner of mouth lifts (to lift up the corners and to make the tail ends of the upper lip thicker) and laser resurfacing of the upper lip. (to reduce the depth and number of vertical lip lines) These combined lip procedures can be combined with a lower facelift which is commonly done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a very small upper lip which is substantially smaller than my lower lip. I have had several consultations and the recommendations have ranged from injectable fillers, implants to a lip lift.  I am confused by these different recommendations as there doesn’t appear to be a consensus as to the best thing to do. I have attached a picture of my lips for you to see  and give me your recommendation.

A:  As you have discovered there is a variety of lip enhancement procedures that approach making the lips more attractive in a variety of ways. In the end, they all have the same objective, making the vermilion of the lips more pronounced. (increased vertical height and fuller) Think of these procedures as minimally-invasive (non-surgical) to surgical. As a general rule, most patients should always start with injectable fillers because this treatment is the simplest and is completely reversible. What this tells you is whether the existing size of your vermilion can be adequately inflated to achieve the look you want. If it does, then you can ponder whether fat injections or implants may be a better long-term solution. If expanding the existing vermilion is inadequate or produces an undesired look (duck lips), then the location of the vermilion needs to be removed. This is where vermilion advancements and lip lifts have a role to change the vermilion-cutaneous junction and the amount of lip skin.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am thrilled about which intervention I have to have done to my lips. They are both thin and fillers give me a duck look. I can’t decide if a vermilion advancement or a V-Y plasty is the best for me. Thank you for taking the time to answer me!

A: Usually the vermilion advancement  or lip advancement works best in very thin lips because they lack adequate vermilion height for exposure. The V-Y advancement is an internal mucosal roll procedure that primarily creates greater central lip pout and increased vertical lip length, in essence a greater effect on mucosa than the vermilion. They actually are quite different procedures on their effect on creating lip size and shape. The vermilion advancement is also much more versatile in shaping the cupid’s bow area of the central upper lip which the V-Y advancement can not do.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I want lip enhancement, exactly like the Robert Pattinson picture which I have sent to you. I have sent three additional pictures also. Is it possible to make my lips look exactly like that?

A: The simple answer is no. It is not possible to make you or anyone else’s facial features look exactly like someone else. This is not a realistic goal in plastic surgery. And undergoing a lip enhancement procedure with the belief that such a result will be the outcome is a setup for disappointment afterwards.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in getting my upper lip made bigger. It is very thin and it barely shows at all. It is very embarrassing to have such a thin upper lip when so many women have nice full lips. I think a bigger lip would make me look better and more attractive. I want to get injectable fillers into it because that seems to work well for most people. But I don’t want to look like I have a big fat upper lip or have duck lips. How can I get injectable fillers without causing that problem?l

A: Most lip augmentation patients want a natural look. Very few want their lips too look like they have had something done, although some people do end up looking that way.The success of having a natural looking result in the upper lip with injectable fillers is based on how much native vermilion tissue (pink part of the lips) you have. The most common reason one ends up with the infamous duck lips is that too much filler has been placed into the lips. A more full upper lip can take more filler and still loko natural. But a thin upper lip can take very little without creating a pufffy look.  This is because in the thin upper lip the injectable filler does more pushing out rathe than up because there is not enough tissue. When it comes to injectable fillers in athin lip like yours, you have to realize that you can never really end up with a nice full lip look that many women desire. You just don’t have enough vermilion to do it.

What you would more ideally benefit from is an upper lip advancement which directly treats the actual problem and is permanent. But because that involves a fine line scar, I would recommend that you first do an injectable filler treatment and see of you like the results. If you do, then just continue with periodic filler treatments. If you don’t, then you know that there is another option which can give a much fuller lip that is permanent.

Dr. Barry Eppley

Indianapolis Indiana

One of the images highly associated with Valentine’s Day are lips…big, red and full lips. They are as synonymous with this day as much as chocolate and flowers. While big lips may be highly visible on this one day, they are actually sought out every other day of the year as well. Lip enhancement has been one of the popular office procedures in plastic surgery for nearly a decade and there is no sign of the demand slowing down.

Many women want fuller lips, some motivated by the look of Hollywood stars like Angelina Jolie which is more of an extreme look. But women of all ages seek lips that are larger, even if it just a little bit more. They want to add volume to their lips or improve the shape of their lips so that they can have more of an attractive pout. There are numerous injectable fillers that can make an instantaneous change, albeit temporary, and even some more surgical procedures and implants that offer a permanent result.

But plastic surgery technology aside, why is it that women want fuller lips? What is the deep-seated reason for this facial enhancement? Men do not ask for it and I have never had a single male request compared to thousands of female lip enlargements performed.

Some, of course, would say that bigger lips are an enticement to be kissed and therefore makes one more attractive. Kissing in not an exact science, although there is some interesting factoids about it. When you give your loved one a smooch, the majority of people tilt their head to the right. It requires six major muscles around the mouth to pucker up for a kiss. Our pupils dilate while we kiss, which is why we often close our eyes. A good sloppy wet kiss can transfer up to 100 million bacteria (not very romantic, but scientific fact nonetheless).

There is no question that lips are an erogenous zone for women in both appearance and function. Anthropologists tell us that a woman’s lips are a visible expression of her fertility. Studies have shown that a woman’s facial and sexual attractiveness is closely linked to her hormonal makeup during puberty and development. A woman’s estrogen levels helps maintain a youthful facial appearance in which the lips are fuller. Full lips are therefore attractive to men because they serve as marker of a woman’s health and fertility. They certainly seem to make women feel more attractive and sexy.

With this understanding, putting injectable fillers into the lips (or the more common application of lipstick) takes advantage of this innate biology. Bigger lips ‘fool’ men into thinking that a woman has more estrogen than she actually has and thus is more fertile and attractive. I have always said men are easy creatures to motivate…and this is one time again we don’t mind being fooled. Pucker up !

Dr. Barry Eppley

Indianapolis, Indiana