The loss of substance and elongation of your lip is the natural progression we see with aging. I have found that a V to Y lip advancement is not useful for this problem. I have also almost stopped using Alloderm augmentations due to its unpredictability. Instead, I either shorten the upper lip, inject it with one of the off-the–shelf fillers (fat has not proven reliable), or both.
Lip shortening can be done one of two ways, removing a strip of lip from either under the nose or just above the vermillion junction (the red-white border.) The resultant scar is almost imperceptible and the lip is restored to a more youthful appearance. To find someone who understands this, ask for total experience with facial rejuvenation.
In my experience the best overall results are obtained with hyaluronic acid (HA) fillers (Juvederm). I don´t offer to my patients permanent techniques for lip augmentation.
Lip augmentation and rejuvenating the perioral area. Try lip shaping procedures.
Great question. Your problem sounds like you have a long upper lip with a thin line of mucosa. Alloderm has really gone out of vogue in the lip, since it is expensive and temporary. V-Y advancement flaps are good for increasing mucosal show (red part of the lip), but should be combined with a filler like a dermal fat graft. This is not a temporary procedure and can lead to scarring and uneveness.
When rejuvenating the perioral (around the mouth area), you usually have to perform a few different modalities to address the problem which involves the skin, muscle and fat of the lip. I would recommend a lip lift to shorten the upper lip, which can be combined with a temporary gel filler for volume increase and then follow with skin resurfacing and/or botox.
It all depends on what you need. Please feel free to reference my article on lip rejuvenation and let me know if you have any further questions.
Alloderm vs VY vs lip augmentation
Alloderm is terrible for lips. I have seen several cases of scarring causing a decrease in mouth size due to Alloderm.
From the problems you mention, a gull wing upper lip lift and lip augmentation with fat fascial grafts (LiveFill) would be better options.
The VY lip procedure is usually reserved for gummy smiles.
Lip Augmentation, Fuller Lips, Beverly Hills Lip Augmentation, Beverly Hills Lip Enhancement
I have performed V to Y Advancement Flaps and used Alloderm for Lip Augmentation, published a scientific paper reviewing the various methods of enhancing the lips using both of these techniques and others and found Alloderm to be the gold standard IMHO for Lip Augmentation which was the conclusion of the scientific paper.
Alloderm lasts about 7 years but is soft and feels natural within the lips after a month or 2 healing time. V to Y advancement flaps can add no more than 10% volume to the lip IMO and are more suitable for spot area correction of lip asymmetries than for overal volume creation.
Surgical procedures for the Lips
My advice to patients seeking lip augmentation is that the best overall results are obtained with hyaluronic acid (HA) fillers (Restylane, Juvederm, etc.). The only potential downsides of HA fillers are the lack of permanence, and the skill (or lack therof) of the injector.
The only technique I offer my patients in the permanent category of lip augmentation is Advanta. Advanta is a very soft form of Goretex which can be placed along the vermillion border. However, placement of this implant is very technique dependent and still has drawbacks even if perfectly placed. These drawbacks include: palpability between finger and thumb when the lip is held, potential for lateral shrinkage, potential for infection (in the first two weeks). The shrinkage of the implant can be addressed with proper stretching and conforming of the implant at the time of the procedure.
If a patient wants to have a permanent solution and opts not to have HA fillers, then Advanta is selected as an option. I do not feel that a V-Y advancement is a very good technique in most patients and Advanta has very little long term benefit
Lip Enhancements - Lip Lift, Alloderm, VY Lip Advancement etc
I fully agree with Drs. Placik, Moelleken and Pearlman. It appears we have all used the methods you describe and have reached the same conclusions.
The VY lip advancement is now of historic interest only. While it did evert the lip and showed more pink, it did so with permanent scarring in the lip and prolonged swelling. Most of us no longer use it. The same is true with Alloderm and other human cadaveric skin scaffolding placed in the lip. The "take" was unpredictable while the swelling, fluid collection, irregularities and cost were significant. Few still use it for this application.
If your lip is too long - a lift lift with scars placed at the underside / base of the nose is the way to go. The scars however are permanent and as a result we need to proceed with caution in ethnic groups that scar heavily.
Lip fullness can be achieved easily and predictably with several fillers on the market such as Juvederm and Restylane. Their cost is reasonable as is their duration. In the future, better and cheaper products will become available.
With all the new fillers available surgery is rarely necessary for lip augmentation
V to Y lip surgery was performed to surgically enhance lips. Sometimes it worked very well but can also cause scarring. Very few doctors really believed in this procedure. AlloDerm was another alternative. It required a surgical procedure to place and then didn't last. With hyaluronic acid fillers, that is really the best method for lip augmentation. It isn't permanent but wont' cause permanent scarring.
I have never used alloderm for lip Augmentation, however it would probably cost much more than other options. The V-Y advancement procedure is very good on the right patient. IF you have thinning lips the use of fillers would probable be better because it will add mass to the thinning lips, if the lips have plenty of mass the V-Y advancement might be a better choice and it would be permanent.
Lip augmentation techniques
There are several options for lip augmentation. I would certainly start with injectable fillers like juvderm or restylane which can last for up to six months. I personally do not like fat augmentation since I have seen many cases of lumpiness and asymmetry that is near impossible to correct. Alloderm is a viable alternative when done correctly I've seen some results last many years.
There are permanent implants that have been used with varying degrees of success. Right now I favor small amounts of silikon which is permanent and safe when used in small amounts microdroplet technique. I still do permanaent augmentation with some implants and in the right patients works very well. Personally I don't recommend the v-to-y procedure except in people with no lip or previous trauma or as a secondary procedure in cleft lips. I do not like the scarring with that procedure. You might wish to look at an article I published many years ago on permanent augmentation. I hope this information helps.