Your Questions

Q: Dr. Eppley, I am interested in getting a chin reduction in the near future. However, I have been considering having lip implants (Permalip) before surgery on my chin. I was wondering if the implants would in any way hinder a chin reduction surgery? Would it also depend on whether an intraoral method was used? Thank you.

A: You are correct in making the connection between lip implants and intraoral chin reduction surgery. If you were having a submental type of chin reduction (an incision done on the underside of the chin) then having lip implants done at the same time would not matter. But if you were going to have the chin reduction done intraorally it would be advised to either do the implants at the time of the chin reduction ( chin reduction first and the lip implants as the second part of the procedure) or afterwards… but not before.

Permalip lip implants can be an effective and permanent method of lip augmentation. But they require careful placement in the lip tissues and should not be disturbed by traumatic stretching after their implantation until well healed. Thus it is best that they be surgically placed after other oral or facial procedures have been performed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had Permalip lip implants placed in the top and bottom lip. My smile is horrid. And can’t even open my mouth wide enough for the dentist. My lips are extremely tight. I still want larger lips but not tight distorted lips.

A: The most common complications from Permalip lip implants is that of implant asymmetry or an inability to achieve the lip size increase that one wants. I have not had the experience of these lip implants causing extreme lip tightness or significant interference with one’s smile. But based on your lip symptoms it is clear that these implants needs to be removed and should bone replaced by fat injections. You need to get rid of what is causing the tightness (the implants) and replace them with a material that can help relieve some of the tightness and still provide significant augmentation. While it is true that fat injections into the lips have variable amounts of take and unpredictable volume retention outcomes, they are the best solution for relieving lip scar contractures. The residual capsules from the lip implants do provide a more favorable site for fat placement and graft retention.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I have been diagnosed with a mild midface deficiency.  I would like to have this corrected to end up with the most aesthetic appearance possible. I have been reading about facial implants and the work you have done with them. I would like to achieve a reduction of the depressions on either side of the nose, reduction of the heavy creases going down to the corners of my mouth and better projections of my face to make it look less wide and flat. In addition I am also interested in lip implants. I already have some lip implants placed. They were the type that look like spaghetti and the size was 4mm top and bottom. I would like to add to these to make my lips bigger. Specifically I would like to show more of the pink lipstick area rather than just make them stick out more. I would also like to bring the implants out to the edges of my mouth to make the lips and mouth appear wider.

A: When it comes to facial implants, there are a lot of facial changes that they can make…and there some changes that they can not. For a mild midface deficiency, consideration can be given to paranasal implants to bring out the base of the nose and anterior submalar implants to provide some upper midface projection. The lower nasolabial folds as they approach the corners of the mouth will not be affected by any bone-based implant. This area is best treated by fat injections.

In regards to the lips, you either have more recent Permalip silicone implants or older style Advanta lip implants. Either way it is not a good idea to double stack lip implants as there will be a great tendencey to have them roll or twist on one another. You may exchange them for the largest 5mm implants but, for the sake of a 1mm increase, that is not likely to make much of a difference. Furthermore, some of the lip changes you desire can not be achieved by lip implants. No implant will increase the vertical height of the vermilion (pink lipstick area) nor will they make the corners of the lip appear fuller or wider, they are too thin in this area. To make these kind of lip changes, you will need to consider a vermilion or lip advancement procedure which directly changes the location of the vermilion…which is what is needed to make the type of lip changes you desire.

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 want to put something inside my upper lip,  a piece of jewelry I have. I also have big lips so this should work. What I’m using is a tiny Christian cross. I want to litterally implant it into my lip through the pink part of the lip, meaning you would not see it at all as it would be inside my upper lip. Could you do that or would having a piece of metal jewelry inside my lip cause an infection like tetanus?

A: A small metal implant can be implanted inside the lip as long as it is not too big and is placed in a sterile fashion. This also means that the implant must be sterilized before its surgical implantation as well. There is always the lifelong risk of infection or extrusion as long as the lip implant is in place although it is impossible to predict exactly how significant that risk is. That would be based on how deep or superficial it is placed and what the metal composition of the implant is.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley,  It is getting closer to my surgery date in June. I have a few questions.  If I were to get abdominoplasty prior to getting my facial surgeries, (paranasal, premaxillary, chin tuck up and labiomental implant).  How long would I have to wait after I got my abdominoplasty before I could get my facial surgeries.  I went back to my old tummy tuck doctor from ten years ago and had him have a close look.  He said he wouldn’t tighten the muscle, he would only remove skin during a mini tuck.  I thought about trying to travel all the way to you and back with the seriousness, healing, and limitations of a tummy tuck and I am a little concerned about the travel distance. Would I have to wait a long time in between the two surgeries?

A:  I would agree with your old doctor, only skin should be removed. That is all you can do which is common after someone has had a tummy tuck previously. That is a much different postoperative experience than the first time because it is much more limited. There is a reason it is called a mini- because it is so much smaller in magnitude. The incision makes you think it is the same but it is far different.

But if you were going to space multiple facial implants and a mini-tummy tuck apart it is just an issue of recovery/travel between the two. I wouldn’t think more than a few weeks would be necessary either way.

When you have good lips like you do to start with (adequate vermilion) implants work really well. I am not sure how to answer how that would look without the submental tuck-up because I don’t think one really affects the other that much. I would say it would not look strange.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hello Doctor, I just had juverderm ultra injected into my lips several weeks ago. But I am not happy with the amount of lip size that I got from it. I am interested in having more filler put in and want to change to Aquamid.  Is it safe to use Aquamid a few weeks after having a Juvederm treatment ? What are the potential problems that could happen?

A: There are no studies that provide comfort that the mixing of different injectable fillers is safe. In fact, a recent report that looked at multiple different injectable fillers used in the same patient indicates that complications do arise from doing so. It may be one thing to mix and match different hyaluronic-acid based fillers (such as Juvaderm and Restylane, for example), but putting two completely different chemical compounds into the same facial site is unknown in terms of their compatibility and asks for problems. No facial area is more sensitive to  inflammation and granulomatous reactions from injectable materials than the lips.

I would highly recommend that you want at least 6 months before considering injecting another filler into your lips because of these concerns.

I would also not recommend the use of any semi-permanent or particulated injectable filler be placed into the lips. Fillers, such as Radiesse, Artefill and Aquamid, are comprised of a mixture of polymer beads suspended in some form of a more liquid carrier vehicle. In the lips, these particles have been shown to have a higher incidence of foreign-body reactions, lumps, and even infection. The injectable fillers with the best track record of safety in the lips are of hyaluronic-acid derivation. Do not risk long-lasting results at the price of soft tissue problems. This is a particularly poor trade-off in the lips. 

Dr. Barry Eppley

Indianapolis, Indiana