Permanent Lip Augmentation Complications

What is the most permanent lip augmentation method available that has had the least complications? Which method/s may cause complications?

Doctor Answers 10

LiveFill permanent lip augmentation

We prefer permanent autologous nontraumatized fat-fascial grafts, LiveFill (TM), for the lip. This is a new concept; it is very different from fat injection for lip augmentation. We believe that completely nontraumatized grafts that are fashioned specifically for the area and them atraumatically inserted have much better viability (i.e. more is alive) than with fat injections. Also the injection process for fat injection involves placing the fat through a needle or small canula, further traumatizing the fat.

When fat is examined, as you would expect, fat injection specimens are much more traumatized than LiveFill specimens. The viability of the grafts is much lower. Dead cells predispose to granuloma formation and swelling as the body tries to dissolve the free fat vacuoles and the dead cells (histology shows this nicely).

Our technique has been presented at ASAPS, ASPS and in the journal Plastic and Reconstructive Surgery.

I won't even talk about silicone implants for the lips, which are silicone prosthetic devices placed into the lips and are readily palpable, or Gortex grafts, which are palpable and stiff. I have seen extremely severe scarring causing microstomia (small mouth opening) in patients with Alloderm, a cadaver graft.

While all the problems above are correctable (except for Alloderm, where the scarring is severe and widespread), semi-permanent fillers such as Artecoll, Artefill, Radiesse, etc. or of silicone injections, are not always reversible. I would put silicone in any form in the worst of the worst category. Some patients who have had microdroplet silicone injections slowly develop blunting of the vermillion border, almost as though the lips had been sanded down. These techniques have a high complication rate due to granuloma formation and chronic swelling that distorts the tissues, often to monstrous proportions. None of them is FDA approved for placement in the lips.

Fat injection is a good technique and often achieves very nice results. We prefer LiveFill due to less initial swelling, more predictability of the graft survival, and a soft, natural result. We have never had a single case of fat necrosis in over 300 cases. Overall survival by 3-D CT scan is about 75%, hence our designation permanent.

An artistic eye and conservative hand are necessary with lip augmentation. The lip has a certain distensibility, beyond which distortion occurs (i.e. sausage, trout or duck lips), so surgeons and their patients should have realistic expectations if they want to avoid artifact.

Lip augmentation should maximally enhance the existing lip, not produce a distorted version of it.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 169 reviews

Permanent Lip Enhancement

my Raleigh, North Carolina Plastic Surgery Practice I use Fat Grafting to tprovide permanent fullness to the lips. . Juvederm is my filler of choice for temporary lip enhancement. 

For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.

A fat transfer technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Permanent lip augmentation

First there are no injectable fillers that offer permanent lip augmentation, silicon and silicon products are illegal and full of complications. Fat, injected or transplanted is also temporary. Implants such as softform or gor-tex are permanent but over the long term also have numerous complications. I invented a proceedure 15 years ago for placing dermal-fat grafts from the lower abdomen (supra pubic area) into the lips, these are permanent, natural looking and your tissue. You can see examples of this at

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

The safest implant material for lip augmentation is your own tissue.

I have never had a complication with lip augmentation when using the patients own tissue.  No patient has ever asked me to remove the permanent filler.  I have had patients that wished I'd put in more.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 34 reviews

Dermal grafts for lip enlargement are the best for permanent, soft, natural results!

All of the fillers presently in use, except for liquid silicone (not recommended--see Lisa Rinna's experience), are temporary, and can give very nice results when skillfully injected by an experienced doctor. But once you decide you like that look, re-injection every 6-12 months is both uncomfortable and expensive.

Use of your own tissue provides a soft, natural, non-lumpy, and permanent enlargement that allows sensory nerves to remain intact (or heal through your graft tissues). This procedure can be repeated for more enlargement, if desired.

I use a 5-6mm strip of your own skin adjacent to an old scar (any scar about as long as your lip--about 7 or 8cm), or when necessary a new suprapubic scar. This is easily obtained under local anesthetic. The ellipse of skin is de-epithelialized, and a nice smooth dermal graft (perhaps with a few globules of fat attached) is obtained. The donor site is closed with dissolving, under-the-skin sutures, and the scar is no different from the old one, or a minimal new suprapubic one. Your lip(s) are numbed with local anesthesia as well, and the graft is placed into a tunnel created by a blunt 4mm instrument to gently separate the tissues (less bleeding and bruising) via tiny incisions in the corners of your mouth. The graft is secured to the tip of the probe, drawn gently into the lip tissues as the probe is withdrawn, and the incisons closed with dissolving sutures. The graft is uniform, and if not overly large, heals and survives entirely in its new position, much as a skin graft does, though this graft is entirely within the nutrient tissues.

Fat injections can work, though fat globules are very fragile, more than one session is often needed, and still some lumpiness often remains. I have abandoned fat injection for these reasons, and have done the dermal graft procedure successfully for 2 decades!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 250 reviews

Lip contouring

Dear OrangeCupCakeMaster- great name

Lip Shaping requires a lot of detail. Fine Detail can be achieved with fillers- smaller molecules placed by injection- for the most part this would be Restylane- used with various sized needles - to allow precise contouring.

Another filler avaialble in Canada is Evolence Breeze- this is a collagen based filler that has amazing properties for lip shaping.

"Permanent" lip shaping is difficult- particularly if you are concerned about precise shape and long term complications. The lips change with age and so do the soft tissues around the mouth- so adjustments will be needed over time.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 113 reviews

Try a different approach.

There is no such thing as a procedure without complications. Those procedures with the least problems are those done by physicians with a lot of experience. Even with significance experience, there is nothing that can be used as a permanent filler to augment the lip that does not either have problems or the potential to absorb, and, thus, not be permanent. Fortunately, for those people with an aging lip which has elongated, there are procedures that can effectively improve the appearance of the lip without putting anything in the lip. These basically involve removing a strip of skin either along the border of the lip or under the nose. They turn the lip out and give the impression of an augmentation, and the scar generally disappears. For younger people without an elongated lip, there really is nothing truly satisfactory.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Permanent lip augmentation

Right now there is no one great permanent lip augmentation product. Gortex can cause problems, silicon can cause problems, artefill is off the market. While autologous fat is available, it is not reliable as a long term filler. I have used SMAS tissue from facelifts to augment the lip. This has worked pretty well but is only done in conjunction with facelifts.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

Permanent lip enhancement with Silikon-1000 requires physician expertise.

If you're looking for permanent lip enhancement, you could consult a dermatologist or facial plastic surgeon experienced in the micro-droplet application of Silikon-1000.

When administered properly, Silikon-1000 may lead to natural, safe, and permanent lip enahacement. Several treatments are usually necessary, and sometimes bumps or nodules can develop at the sites of injection. In my hands, the likelihood of getting a bump is 3%. If they occur, bumps tend to respond well to dilute triamcinolone (steroid) injections; occasionally they will need to be removed.

You should discuss the position of the FDA and Silikon-1000 injections with your doctor. I cannot over-emphasize the importance of physician-expertise in the proper administration of Silikon-1000.

The overwhelming majority of my patients are thrilled with their results.

Here's a link to FAQs regarding Silikon-1000:

I also attached a link to my gallery of lip enhancement photos.

I hope this helps, and best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 413 reviews

Permanent Lip Augmentation

The procedure devoid of complications has NOT yet been invented and does not exist.

While lip augmentation capabilities have greatly improved in the past 5 years, predictably, permanent lip augmentation has remained stationary for several reasons.

The lip has multiple structural, textural and sensual requirements. An ideal lip filler would have to cause minimal to no lip inflammation and stiffening, create no foreign body sensation in the lip, leave the lip feeling soft and allow it to move without crinkling and folding unnaturally as we animate and move our lips. Finally, it would be great if such an implant aged at the same rate of the lip, changing its shape as the aging lip changes its shape. OBVIOUSLY, such an implant does not exist.

Having been a Plastic surgeon for quite a few years, I have seen implants come and go. They ALWAYS come in with great fanfare, ads in all the ladies journal, well-paid shills both doctors and celebrities touting the newest magical lip plumper - only to slowly retreat into obscurity as newer and better, yet STILL imperfect fillers appear.

For the doubters among you, research the use of paraffin (candle wax) and engine silicone lubricant - both as fillers. The first at the turn of the 20th century. The latter after WWII to die by the late 70's (Only to unfortunately come alive again as "micro droplet technique").

The only kind thing I could advise you if you are intent on putting a permanent implant in your lip is to make sure it can be readily removed. Some present day fillers are firmly distributed within your lip tissues and cannot be totally removed if you do not like the result.

To play it safe, for the time being, go with either Juvederm or Restylane.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 105 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.