Hello, Thank you for your question. Congratulations on quitting smoking after 20 years of use. That is a very difficult addiction to break and it’s never too late to quit but a very wise choice you made. You are obviously and rightfully proud of yourself and relieved as you should feel. Now you desire to reverse the signs of aging which have been contributed to from cigarette smoking. I am not going to get into depth regarding the three D’s of of the aging face, however the three D’s of the aging face are decent, deflation and deterioration. In answering your question I am going to focus on the perioral region. The perioral area includes the lips and surrounding region. Besides the “deflation” of your lips, your skin has also taken a beating and “deteriorated”. The skins deterioration manifests by skin dryness, dullness, lines and wrinkles as well as pigmentation abnormalities. I have reviewed your photograph. You are considering a lip lift or lip implants or possibly even both. I understand that you have had fillers and fat transfer but the results have not persisted. I understand that you’re looking for a more permanent result. There are few procedures that we perform that are permanent however the two procedures that you’re talking about, both a lip lift and lip implants are actually potentially permanent procedures. I have answered quite a few questions regarding the subnasal lip lift. If you research my Realself Q and A regarding the subnasal lift lift you can gain more information there. The most important factor regarding a subnasal lip lift is that you have enough skin length measured from the bottom of your nose to the top of your lip in order to be a candidate for this procedure. It certainly appears that you have enough length between the bottom of your nose in the top of your upper lip in order to support a subnasal, bull-horn excision lip lift surgery. Undergoing the procedure will result in a shorter distance between your nose in your lip which will bring your face into greater harmony or better balance and in addition it will give you a more prominent upper lip. One significant downfall to undergo any lip lift is if you begin with not having enough skin from the bottom of your nose to the top of your lip. If you attempt to remove the skin or too much skin is removed there will be an abnormally short distance from your nose to your lip and this will be a defect that is nearly impossible to correct. It will result in disfiguration. The advantage to having the lip lift is to give you a more normal distance between your nose in your lip and at the same time providing you with a full or more prominent upper lip. You can have the lip lift in isolation or you can even do this at the same time as a lip implant. Also, the scar resulting from the lip lift can be noticeable in some people. The current best implant on the market that can be inserted into the lip is made by Surgisil. Unfortunately it is not FDA approved in the United States for lip implantation. It is called Perma facial implant in the United States and it is called Perma lip implants in the UK in Europe where it is CE approved for lip implantation in those countries. So while in my opinion and experience it is very effective and a “permanent” choice for a fuller lip you must understand that when it’s used in your lips in the United States it’s considered an off-label use. That does not mean that it can’t be used in your lip you just have to understand and be aware that it’s not FDA approved for certain reasons which go beyond the scope of this this answer. The clear advantage to the implants is that it is a permanent fullness of your lip. If for any reason you choose you don’t want the implant any longer or you don’t like it it can be relatively, easily removed. I think that the lip implant is an excellent alternative to having to refill your lips with semi-permanent fillers which do not last very long. There are also advantages to the fillers. Essentially having the implant in your lip is like having 1 mL of filler permanently placed into the lip. The implant will correct the deflation component of the aging lip. Potential complications could involve placement issues or potential infection or the rejection of the implant. If that were to happen you would lose the implant. Finally, you might look into CO2 laser resurfacing to correct your skins deterioration from sun exposure and smoking effects. CO2 ablative resurfacing is an fabulous treatment to remove lines, wrinkles and correct some pigmentation abnormalities. You can also resurface the scar created from the subnasal lip lift. I hope that my answer has provided you with some useful information. If you have any questions please reach out to me anytime.Best regards,Dr. Mitchell
