Lip Lift with Dermal Fat Graft to upper lip

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I had a surgery scheduled on November 8, 2016 on...

I had a surgery scheduled on November 8, 2016 on my neck to fix two herniated discs, so I was going to be out of work for 6 weeks recovering with a neck brace on. I thought to myself, “What a great time to get a little work done!” My spinal doctor said I would feel significantly better at the 3 week mark, so I knew I wanted to wait until then to have something done….and whatever procedure I chose, it would need to be healed in 3 weeks so no one would notice when I returned to work.

I scheduled an appointment with Dr. Jeffrey Spiegel to see what he recommended I have done on my face during my time out of work. He said the “only” thing he could do would be a lip lift, because anything else would require him to turn my neck, which couldn’t be done during this time frame. We also discussed filler in my upper lip as another option. I’m not a good “maintenance” kind of girl. I can’t see myself going every 6 months to have filler. I wanted to be “one and done”. Dr. Spiegel didn’t recommend a lip implant, saying if you can go without having something foreign in your body, that’s always the best option. I opted for a fat transfer, only needing it in my upper lip. He was very honest that while a fat transfer is “permanent”, it’s not really “permanent” and varies person to person. I decided I’d take my chances since I knew for certain I’d never keep up with filler.

My procedure is scheduled for November 28, 2016. I let the patient coordinator know I’m pretty nervous, so they will be giving me a prescription for a valium to relax me.

I'll keep everyone posted!!!!

Lip lift with fat graft

Hi, I know many of you are waiting for my post-op photos. I had the surgery about 2 hours ago (around 4:30PM) and took some photos after about 1 hour. The surgery went well, it wasn't so bad after all. I took a pill they prescribed to relax me, although I don't think it really did anything. Dr. Spiegel played Elvis music for me during the procedure which kept my mind occupied. Several of you wanted to know how much he was going to take off. He said I was starting at 22 or 23 and he took off 9. He then used the skin he cut off and used that as the fat graft to my upper lip. My husband is very nervous that my upper lip will look too big, but I keep reminding him it's swollen, and I told Dr. Spiegel my husband said, "Not too big". I have my follow-up to remove the stitches in one week, December 5th. I'll keep you updated of my progress!

24 hours out

It's now been about 24 hours since the procedure. I'm REALLY swollen, I think more-so than yesterday. There's not "pain", just it feels really uncomfortable. PS told me in 10 days the swelling should be done for the most-part. My husband is really upset by the way I look now. He's concerned it's not going to look natural and I'm going to look like a Kardashian. I keep telling him it's just really swollen and it won't look that way. I'd like to have other procedures done, so fingers crossed we're "both" happy with it or he'll never let me have more work done again! I've gone out of the house a few times to go for walks, but I've been wearing a surgical mask...I'd rather look strange vs scary!

48 hours out

It's now been about 48 hours since the procedure. I feel like the swelling went down a bit today and I can feel most of my lip again. It's still very sore, I can't really move my top lip and I'm still struggling with drinking and it the liquid not pouring out of my mouth! I did my best to take a photo of the stitches. I had to have someone come to our home today to fix something....I wore a surgical mask and told him I had the flu and didn't want to get him sick! I read some other reviews that said it was at the 5 day point that there was a big drop in swelling, so I'm looking forward to it!

72 hours

Swelling has gone down some more!

4 Days out

I hope I'm not boring everyone with my updates, I'm just really excited to see how much swelling goes down daily. Today I noticed a *significant* difference, and even my husband said I don't look so scary :-) I know day 5 is supposed to be the big day to have a drop in swelling, so I'm looking forward to what tomorrow brings! Today I've been *really* happy with how the results are starting to work!

Day 5, looking good!

So today is day 5, the day from other reviews that the swelling is much subsided and the 1/2 way point to the *almost* final product! My husband today is starting to like the look, although he says I look like a totally different person. Hopefully once the swelling goes down I'll look like "me" at my personal best!

The profile of my nose looks different (better). I don't know if this is temporary because of the swelling or if it has permanently changed the shape. Anyone have knowledge of this? I read one thing from a doctor on realself who said it wouldn't change the shape as long as you don't remove more than 25%. Considering he took off 9mm from mine, that's more than 25% so I'm *hoping* my nose stays like this.

I also included of Dr. Speigel's mark-up on my face from the day of my surgery.

Day 6, tomorrow stitches get removed!

Hi, I'm excited to have the stitches come out tomorrow! Today I put some lip gloss on my lips and took a few photos. I'm not big on make-up and really only wear eyeliner and mascara, but I thought it would be fun to try it out. I also included my before and after next to the photos so you can let me know if you see a difference with my nose. It may just be an optical illusion, or if you see a difference, just from swelling.

Stitches out and answers to questions

Hi everyone, I just got back from having my stitches out. It feels really good to have them out, it feels 'less tight'. He said it has healed very well because I've done a good job at keeping it very moist with the Neosporin. He said certainly by the time I go back to work in 2 weeks the swelling will be gone, but he said even if I went back to work in a few days it should be fine. They did have me buy a scar cream for $48. I do feel like after paying $5500 it should just be included in the cost, but whatever, I'm starting to look really great :-)

He was happy to answer the questions raised by everyone, so below are the questions and answers. The theme of the responses is that it's really individualized for each patient, it's not a one lift for all.

"How does the graft work?"
The lip is made of fat, collagen and muscle. To make it fuller in the most natural way, you use those same materials from our body. He takes it and slides it in through the corners of the lip.

"How much of the shaved philtrum is transferred to the upper lip?"
It's adjusted based on the individual's goals of how much fullness she wants.

"If it absorbs to any degree does it do so uniformly across the whole lip length or might it do so irregularly causing a need for filler to even out?"
Since it's the own body tissue, if it is absorbed, it's very minimal and not an issue. Theoretically it can be uneven, but since the amount of absorption is so trivial it wouldn't be noticeable.

"How many mm does the lip drop in the first year?"
Potentially none, ages naturally going forward. Certainly in 20 years it will have dropped some.

"Has he done long term follow up with patients such that he can see what to expect - any increased nostril distortion or enlarged scarring?"
Has been doing lip lifts for 17 years and has not seen distortion or enlarged scarring. He does so many a week, last week alone he did 7 lip lifts. He hasn't seen these issues.

"Why cut up the side of the nose? Does he feel this stabilizes the lift more? Could it lead to more potential side effects and scarring? My guess is that he cuts up the sides of the nose to achieve the corner lift and avoid the rabbit look. In essence he is lifting the entire lip."
He said that's exactly correct. Going up the side the scar will be invisible and you get the best looking results.

"Can you tell us if he shared his anchoring technique? Does he suture the underlying skin to the spetum/bone at the base of the nose so as to ensure the nostrils won't stretch over time?"
On each person he does a deep layer closure as the individual needs so it goes to the right spot and won't stretch.

I know day 10 is the day that "much" of the swelling should be done where someone can go back to work. I'll take photos until day 10 so everyone can see the swelling change and to see if the swelling would still be noticeable to others by that day.

One day after stitches - Less red

Hi, it's one day out from the stitches being removed. It's definitely less red than yesterday, although it's still red and a bit bumpy. I ran some errands today without a surgical mask on. I asked my husband if he thought it looked like I had work done. He thought if he didn't know, he would think I had a cold because of the redness.

Tomorrow is day 10, the day I was told much of the swelling will be down and will have a really good idea of the final look. I still think it looks swollen from the front, and certainly it still feels swollen, so I'm happy I don't have to go back to work for 2 more weeks from today. However, "If" I did have to return to work on day 11 and it looked as it does today, day 9, it would be ok.

I 'do' think whether it's day 11 or even a year from now, those who I work closely with will know something was done. I asked my friend today what she would think, and she thought no one would notice. I do think others will notice, but I think they'll think I had filler put in. I'm fine with that, and I guess even if someone is nervy enough to say my face looks different, either I won't respond, or I'll say "I had filler". If someone is even more nervy to ask what I did, I'll either tell them, "That's a nervy question", or I'll say, "I had some filler...happy to know my personal business?" :-)

My sister went out years ago for a breast reduction and didn't tell anyone why she was taking the time off. She said when she came back it was obvious what she had done, but no one was nervy enough to say anything or ask. I'm "guessing" that's what will happen to me, people might notice and whisper amongst each other, but I'm beautiful and confident enough to not care!

When I went to Dr. Spiegel yesterday I talked about other procedures. I thought about having fat transfer to areas of my face ( nasolabial folds, marionette lines, etc). If anyone has done this and has feedback, I'd appreciate your thoughts on it.

Day 10 - Last update for a few days

Today is the day I was told I would have the 'best idea' of what the 'final' result will be. Over the last few days, the changes day-to-day have been minimal, so the next update I'll give will be on day 14, two weeks from the date of surgery. I don't feel comfortable posting my full face on this site, but I do think you get a better feel of the change seeing the full vs partial face. If you would like to see my full before and 10 day after face, you can drop me a private message with your email and I'd be happy to send photos to you.

I still feel swollen in the philtrum area, and I think it still looks a bit swollen from the front. I don't know if it being swollen still is due to the lift lip or fat transfer. Certainly I'd think by the time I go back to work (a total of 3 weeks from the surgery) the swelling would be gone.

Today is my last day using the Neosporin. Tomorrow I begin using the scar cream the PS had me purchase. It's a little less red today than it was yesterday. I feel fine going out now, I do agree with my husband that someone would probably think I just had a cold because of my nose being red.

2 weeks ago today!

Today is officially 2 weeks since I had my lip lift. It still feels strange in the philtrum area. My husband thinks it still looks a ‘bit' swollen, I tend to agree. I do, however, feel fine going out now w/out covering my face, and there’s no way anyone who doesn’t know me would think I just had work done, even without any makeup. I feel I look more and more like “me” as each day passes and the swelling goes down. I'd be 100% ok going back to work today and I take back what I said previously about people knowing I had work done even if it was 1 year out. After 2 weeks, I think no one would notice a thing, not even think I had lip filler. I know PS say 10 days off from work is sufficient, but my personal experience is that 2 weeks is the magic number for no one thinking something looks "off". I also think there is a difference between my last posting as far as the redness/scar area. It has subsided quite a bit over the past 4 days and looks less like I have a cold. I don’t know if it’s because of ‘time passing’ or because of the scar cream my PS had me purchase.

As far as the scar cream, I’m not a fan. It gets flaky after only one hour. It’s fine since I’m home and not seeing anyone, but it’s not something that makeup could go over because of the flaking. I have one full week left at home due to my cervical spine surgery, so my fingers are crossed for the philtrum area to settle a bit more and to keep up the flaky scar cream so there is zero redness by then.

I’m really happy with the results and now feel strongly I want to do a fat transfer to my face next November even though readers have been emailing me to be careful with that. I think this lip lift makes me look younger, so I want to enhance it even more with a fat transfer to other areas of my face. I’m 45 now, so I feel like if I do a fat transfer next year (at 46), that should take me 10-15 years (I’d think) before I would want a face lift. Who knows….

Some of you were asking more details on how the dermal fat transfer works in the lip and I found this information:

"Dr. Arthur W. Perry, MD
Dermal-fat graft is more durable than other techniques. It has been around for over half a century, and the lip augmentation is simply a new use for an old technique. With dermal-fat grafts, an area of skin somewhere on the body is excised in the shape of an ellipse. The upper skin (epidermis) is removed, leaving the lower level (dermis). The skin is then cut out, keeping a layer of fat attached. The location where the skin was removed is closed as a straight line. Often I remove the skin in a scarred area, in hopes of improving the existing scar, giving a secondary benefit.

The dermal-fat graft is then shaped. For the lips, it is made into a narrow strip. The lips are numbed and tiny incisions are made in the corners on the inside of the lip. A space is made in the lip, under the red lip skin. With a long clamp, the dermal-fat graft is threaded through the lip and the incisions are closed. This type of graft behaves just like any other skin graft. It gets its own blood supply within three days, and becomes part of the lip by three weeks. The percentage of graft that survives should be very high.

Not everyone wants this operation, however. It is most popular in people who already have a scar somewhere. Usually abdominal, back, or buttock scars work well. If your body is scarless, it is unlikely that you will choose to have a five- to seven-centimeter scar created just for this purpose."

I’m “really” happy that I had the dermal fat transfer. I think it looks really natural and I won’t have to worry about wanting fillers in the future.

Because the changes I’m seeing now are minimal day-to-day at this point, I’ll give my next update next Monday (3 weeks out post surgery) and my last day before heading back to work!

3 weeks out - One problem

It was 3 weeks ago today I had my lip done and tomorrow I’m heading back to work after being out a total of 6 weeks from my cervical spine surgery. My scar is still a bit red, nothing make-up can’t cover, and I’m not really even sure make-up is necessary. My skin is so sensitive, for many years now I’ve only work eye make-up. These past few weeks I have ‘not’ felt self-conscious going out with no make-up covering the scar.

Over the past 6 weeks, in addition to the lip surgery, I’ve lost almost 10 pounds and a few days ago turned my light brown hair to dark blonde. I’m hoping between those changes, in addition to the Frankenstein-like scar on my neck from the spinal surgery (which my surgeon said will get much less noticeable over time), everyone will be distracted and no one will notice the lip change.

You can tell from the photos that my profile looks different from right to left…I definitely have a better side, but I also did prior to this procedure. I thought maybe my profile would look the same with both sides, but it still doesn’t. My lower lip still hangs out further than the top lip from my profile, but I think my top lip would need to be enormous not to. It didn't hang lower while it was really swollen, and my profile looked great, but it looked way too big from the front.

There is one problem which I emailed Dr. Speigel’s office about on Friday, late afternoon. I haven’t heard back yet, but it hasn’t even been 24 hours. The issue is when I close my mouth/lips I have mentalist muscle strain (my chin puckers and is strained closing). I didn’t have this previous to the surgery and asked at my consultation if it would be an issue and was told it wouldn't. I also posted the question on this site and both Dr. Spiegel and 2 other doctors responded.

Dr. Spiegel wrote, “Easy answer: No”.
2nd doctor wrote, “Your lip lift will be fine if it is not done too aggressively.”
3rd doctor wrote, “A lip lift should not induce a mentalist muscle strain.”

The philtrum area still feels odd, so I’m hoping that’s why I have the muscle strain and that it will go away once the philtrum area is back to normal. If not, I’m not sure how my feelings about this experience will change. If anyone else experienced this same issue, I’d appreciate hearing from you and if it went away over time.

A few days back to work now.....

Hi everyone, per several of your requests I’m giving an update since I’ve been back to work for a few days to let you know how it went and if anyone noticed.

I tried to make as many changes as possible to distract from my lip:
* Lost about 10lbs
* Went blonde and cut 4 inches
* Wore make-up, including heavy brows (Typically I only wore eyeliner and some mascara)
* Wore a new, absolutely spectacular dress
* Didn’t hide my Frankenstein-like scar on my neck

I work in healthcare, so it's mostly women. Some said Wow! You look great!, a few said I looked like I had lost weight, one woman said I looked beautiful and one woman said I look completely like a different person.

No one stared at my lip, I think between wearing make-up I never wore before, a big scar on my neck, a fabulous dress and with all the other changes, no one knew where to look first. My second day back I saw our Medical Director and I think she may have noticed something. I was having a one-on-one conversation in close proximity, and I think because my lip still doesn’t move 100% normally, she may have picked up on something. She didn’t say anything or stare, but I just had a feeling that she was thinking something was going on with my lip. It doesn’t bother me, I think anyone, if they would think something, would think I had filler.

There were 2 people I told at work I'd be having it, but I didn't mention it to them during the 6 weeks I was out when we spoke. One asked me after 2 minutes of seeing me if I had it done. She said it looked subtle. The second took about 20 minutes to notice and said she only noticed when she saw my profile, but had I not told her she never would have noticed.

I got together with one of my friends who knew I was having my lip done. I asked her if she would notice, and she said because it looks like my lip isn’t moving normal, she notices it, but otherwise wouldn’t if she didn’t know.

I know my lip is still swollen, by how it feels, looks and moves. Flossing my teeth is uncomfortable, the pressure on my lip. I have a dentist appointment to fill a cavity in a few weeks and I'm concerned it's going to be pretty painful. I don't think ANYONE would notice the scar around my nose from the surgery. Even those who knew I had it done asked me how the procedure was completed. I explained how he cut around the nose and they couldn't believe it since they saw nothing. The red is so minor, just wearing a touch of foundation makes it 100% invisible.

I'm still concerned about the chin muscle strain, which you can see in the photos when I close my lips, but I'll put those thoughts in the back of my mind for now until it's healed more since the Patient Coordinator at the surgeon’s office said it would get better.

As far as my neck is concerned, I’m still having the same pre-surgery pain, however, the doctor told me it would take 3-6 for that to go away….Another thing to be patient about!

I posted some photos in different lights. For some reason I think it looks different depending on the lighting around me....

3 Month Update

Hi Everyone,
It was 3 months a few days ago and I wanted to give an update. I've held off a few days because I have a big pimple on my lip! I waited for it to go down a little before taking my photos but you can still see it. Keep that in mind while looking at the photos.

I'm still having some chin strain. I had botox in my jaw recently for TMJ issues. Next time I'm going to ask him to save a bit to put in my chin to help the strain.

As I think I said previously, I wish I had not kept telling Dr. Spiegel "Not to big"!!!! I do wish my upper lip was a bit larger. It's shrunk quite a bit. I'm not sure how much the dermal fat graft has actually done, or if much of the change to my lip is from just the lift.

I still have some tightness. I'm assuming that takes a lot of time to heal. You an only see a scar if I pull my lip down to look for the scar. It's more 'red' than a scar, but it isn't visible unless I pull down my lip for someone to see.

Overall, definitely an improvement, I just wish my top lip was fuller and I didn't have chin strain.


Hi everyone, this will be my final update.
I don't really notice any changes since my 3 month review. Everything is pretty much identical.
Still having the chin strain. I had a bit of botox put in and it helped a bit, but it still feels very uncomfortable to close my mouth. Plus, now I have to pay for Botox for the rest of my life?

On May 19th, I emailed Carol at his office. I wrote:
Hi Carole,
I decided to be patient and give my lip lift a total of 6 months to heal, but I’m still having chin strain. I’m very patient, and if Dr. Spiegel thinks it can take up to a year to heal, I can wait. Can you check with him and ask if it’s normal to still be experiencing it at 6 months?

Here's the response I received, also on May 19th:
Hi Michelle,
He will be in this afternoon and I will certainly ask him and then get back to you.

Well, today is June 2nd and I haven't heard a peep. Very disappointing. I've changed my overall score on Dr. S because of his lack of response. Clearly, I'll never receive a response, because even though I was assured multiple times by him I would not have chin strain, I do, and what can he say? I messed up? No, so I'll just be ignored.

My overall thoughts...Visually, my mouth is improved from where it was, but it's very uncomfortable to close my lips.
Would I do it again? If Dr. S had told me I could get chin strain, I would have made sure he was much more conservative in the length he took. I realize he gave me the 'optimal' length, but obviously it's not the optimal length for me.

For all those ladies who question if the doctor took off enough, trust me, it's enough. When it's too short, good luck closing your lips. You know how when you put on lipstick you rub your lips together to smear it? Well, you all know it, I used to know it, but I can no longer do it.


I wanted to provide an update as to the responsiveness of Dr. Spiegel's office. On June 15th I heard from Dr. Spiegel's office stating they had seen my review on realself and apologized for not getting back to me. They had Dr. Spiegel reach out to me, but we didn't connect (my fault, not his) due to medical appointments my husband had. I changed my overall rating back up more as a result of them getting back with me. I've scheduled an appointment with Dr. Spiegel in a few weeks, but right now the botox is still pretty fresh in my chin, so I may need to reschedule since there isn't much to see right now.
Boston Facial Plastic Surgeon

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