Your Questions
Your Questions
Q: Dr. Eppley, I am interested in vermilion border advancement (lip advancement) in the sides/ corners of my upper and lower lips. I would also like to pair this with large permalip implants. I have several questions. Can these two procedures be done at the same time? What would the down time be? What is the cost? Finally, I am not looking for a “natural look”. I have had my lips quite full using injections for several years and like this look but do not enjoy the costly upkeep since they wear off in two to three months in my lips. I can pictures of my lips without injections and a photo of what I want to achieve to see if you think it is achievable using the Permalip implants and vermilion border advancement in the sides/ corners. Thanks!
A: Your description of the lip procedures you would need to achieve your goals is correct. It would be necessary to do an upper lip[ advancement but spare the central cupid’s bow area. Permalip implants could be placed at the same time as the lip advancements. As you might image there will be some considerable lip swelling that will take several weeks to subside but that is more of a social issue not a physical limiting one from a recovery standpoint.
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, you have done some Botox for me in the past. We discussed that I was one of the few people who didn't respond very well to the Botox. You said maybe because my forehead muscles are too strong or some other reason. Whatever the case may be, I would like to know what option I have to get rid of the deep “angry eyebrow” wrinkle. Is the only option to go under the knife?? Thanks.
A: To review your forehead/glabellar furrow issue, it is not that Botox didn't work. Botox always works but its mechanism of action (muscle weakening) was unlikely to correct what is now the main problem with your furrow, it is so deeply indented from years of muscle overactiivty that the skin is now permanently etched or grooved. This is beyond being ideally treated by muscle weakening (although it was worth seeing how much of a difference that could make) but now requires some form of skin management for improvement. For patients with these very deep grooves or furrows in which Botox fails to provide any significant improvement, the furrow can be treated by a variety of options. The simplest and most common is an injectable filler (e.g., Juvederm) to plump it out and soften its depth. This is often done either after Botox has 'failed' or in combination with it. (the filler lasts longer if it is not pounded on by the muscle movement that caused the problem in the first place) All current injectible fillers are temporary and do not create a permanent filling result. Another filler approach is to place a small tubed implant under the skin to create a permanent filler. The tubed implant, Permalip, is the same type of permanent implant that is used in the lips, nasolabial or labiomental folds. Another permanent option is to excise the furrow and treat it like a geometric scar revision. By cutting it out and putting the skin back together in an irregular fashion, the furrow is made smooth. All of these treatment options can be done in the office under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana