Considerations in lip augmentation
Article by Lavinia Chong, MD
Orange County Plastic Surgeon
Like any cosmetic surgery, lip augmentation has to compliment not create problems. After taking a patient's history, history of herpes labialis (cold sores), concentrating on what has been done before, what worked, what didn't, get an idea of the patient's dissatisfaction, emphasize their favorable attributes, we jointly formulate a plan. Younger patients, usually have good anatomy (cupid's bow peak, defined philtral colums (ridges which originate below the nose and end in the central upper lip), relative symmetry and youthful teeth. Older patients have "distractions", such as radial (lipstick bleed) lip lines, marionette's lines (shadows extending obliquely from the outside corners of the mouth), labiomental grooves (dents adjacent to the chin fat pad), which need to be "corrected" so that lip augmentation doesn't get eclipsed. HA injections (Restylane, Juvederm) are a great place to start because asymmetries can better be addressed than with a solid implant (Alloderm, Permasil). Starting slowly and establishing that lip volume and shape can be "built up" by staged injections allows the patient to treat and evaluate, without the risk of being ridiculed as having "trout pout" or duck lips. Alloderm lip implants were popular about 15 years ago. The procedure was conducted under regional nerve blocks (local). 3mm incisions were made in the corner of the mouth, a tunnel was made under the dry vermillion, which enabled passage of the implant from right to left. Depending on the requirements, multiple strands could be added for both fullness and anterior projection. Post-procedure restrictions included limited ranging of the mouth (i.e. no yawning) for 2 weeks, use of a pediatric toothbrush and local wound care (antibiotic ointment). Frankly, the longevity of the result with Alloderm was disappointing. After the resolution of the post-op edema (swelling), although the implants were palpable, the volume seemed to resolve. Cost was comparable because Alloderm is pricey. Permasil (shaped solid silicone) implants are more cost effective but generally more applicable for older patients who have literally "lost" their lips, as the fibrofatty tissue "melts" away. Since initiating my HA (hyaluronic acid) filler practice in 2000, patients have shown me that there retention is possible. After treating every 3-4months in the first year, patients generally keep the volume and request retreatment, less frequently. The dermatology literature suggests that HA injection may stimulate collagen formation. This mirrors my experience injecting individuals whose lips have been augmented with HAs. They feel firmer, not gritty and the volume remains. Hope this helps.