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|  Face Lift | Eyelid Lift | Brow Lift | Lip Enhancement | Rhinoplasty | Botox Injections | Fat Injection | Restylane / Perlane | Thermage For information on lip lifts, click here. Lip Enhancement There are three general categories of procedures that enhance the lips. These are injections of materials such as collagen, grafting in substances such as gortex or fat, and local flaps and incisions that redistribute the tissues from inside the mouth to outside. The results can be temporary or permanent. All of these have advantages and disadvantages, different types of anesthesia, recovery periods, pain and time off work. Anesthesia ranges from none or very little in an office setting, up to general anesthesia in the hospital as an outpatient. The procedure can take from twenty minutes up to two hours. You can usually bathe and shower as usual the next day. There can be minimal swelling and bruising and no numbness with immediate return to work, up to tremendous swelling and bruising and numbness that last for days to weeks with one to two weeks off work. There can be no stitches or incisions, or a few at the corners, or many inside the mouth. When present, the stitches are usually removed in 7-10 days. Results can be temporary or permanent depending on the technique. No dressings or drains are used. The procedure can be easily combined with other plastic surgery procedures. Injections This method of lip enhancement refers to placing a semi liquid substance into your lip. It is an office procedure requiring a little topical anesthetic applied to the surface of the lips only. Injectable substances are nice because they can provide a beautiful "all-over" enhancement, or, by adding more to one side or area than another, it can also be used nicely to adjust asymmetries or unevenness of the lips. It can be repeated over and over with little or no danger, to "adjust up" the size as the patient likes. Some of the materials are long lasting, and some temporary. Collagen Collagen is a purified preparation of bovine (animal) skin available in different concentrations and compositions. It has been used in humans since 1981. For years collagen has been one of the most popular methods of lip augmentation. Though collagen works very well, its effects are always temporary. I like this very much in the first time patient where this is a real advantage to "try on" the look for a while and even gradually increase it. Remember, this can be a significant body image change and hard to predict until you see it on yourself. There is a slight risk of allergic reactions. This usually takes the form of some redness around the treatment sites that lasts for weeks to months. To avoid this occurrence, prior to treatment patients undergo a skin test. For the test, your doctor will inject a small amount of collagen just beneath the surface of your forearm. You look for redness or reaction in the following two weeks. If this is normal, then it will be from 2-6 weeks from the time of the skin test before the actual administration of the collagen. ,br> The procedure is done in the office using a topically applied local anesthesia. Small needles are used to implant the material. It is mostly painless. There is minimal swelling or bruising and patients can return to work or most activities right away. Make-up can be applied in hours. There is minimal risk or side effects. Collagen nicely enhances the look and size of your lips. The substance is quickly absorbed into the body especially in areas - like the lips - where there exists a lot of motion and lots of blood flow. Your lip augmentation with collagen will last between four weeks and three months. Extra can be added at any time. Dermalogen This is a relatively new product on the market. It is prepared and derived from human skin (dermis) in such a way to not react (non-immunogenic). Its major advantage is that you do not need skin testing and it can be administered right away. Otherwise it is just like Collagen in most all respects. It also is temporary, but some believe it lasts slightly longer than Collagen. It is administered just like Collagen and tolerated just as well. Autologen Autologen is also relatively new but I think very exciting and I use this a lot. It is prepared and derived from a patient's own skin, usually from the excess removed at the time of a facelift or tummy tuck. It is sent to a lab where your own natural collagen is squeezed out of the skin, prepared and preserved. It is stored in freezers and shipped to my office whenever a patient needs it. Because it is made from your own tissue, it shouldn't reabsorb like Collagen or Dermalogen injections do. You should not risk allergic reactions. It is administered, tolerated, and recovered from just as nicely and quickly as in patients who receive Collagen. Patients who have required repetitive Collagen injections should consider the option of Autologen, as its effects seem to be long lasting. I offer this procedure to patients any time I am performing another plastic surgery procedure such as a facelift or eyelift or breast reduction or tummy tuck where I will be removing any skin that can be "recycled" for use in lip enhancement. Fat Injection This procedure is receiving a lot of publicity. The theory is not new but the techniques have advanced a lot in the last few years. It involves extracting some of your own fat from somewhere on your body by a tiny needle using local anesthesia. The fat is usually spun in a centrifuge and the excess fluid separated. Special small needles are then used to place tiny "threads" of your own fat into the lips. It is good for an over-all enhancement and to correct asymmetries. Fat cells are tiny and fragile and are removed and moved from one part of the body to another only with great difficulty. The success depends on only one thing, how well the cells survive and how many have a new blood supply grow into the cells so they can survive and persist. The procedure is extremely technique sensitive and highly individual. I employ a lot of additional things such as supplements and vitamins and even acupuncture to increase the local blood flow with the hopes of increasing fat survival. The problem and criticisms of fat are that it is temporary. The proponents of fat insist at least some of it survives providing long lasting improvement. Both are true. I simply state this to patients as a situation where we do not know the answer until we give it a try and everybody's "body is different". I evaluate everyone after 6-12 weeks. In general, 5-10% of patients have an excellent first time, one time result. 10-20% have no result. The rest have a partial result. If it works at all then I offer repeat procedures and have had many satisfied and pleased patients. In the latter circumstances I describe this as "building a layer cake". Unlike Collagen, you can expect a lot of lip swelling and unsightliness for the first few days after the procedure. There is minimal bruising or pain. There are no stitches. You won't know how well it has worked until at least six weeks afterwards. If there is a partial success then I will perform a fat injection up to three times; if after three times you're not satisfied with the results, I suggest an alternative technique to give you the look you desire. Grafts Alloderm Alloderm essentially is a sheet of human collagen tissue which has been purified and rendered non-immunogenic. It is the relative of Dermalogen which is its injectable form. It is well tolerated and does not cause allergies or need to be pre-tested for allergies. It is inserted as an outpatient procedure performed under a local anesthetic. Incisions are made at the corners of the inside of the lips and Alloderm is rolled up and inserted from one side to the other. A few tiny stitches at the corners in the small incisions are all that is needed. Post-surgery swelling is mild to moderate and disappears mostly within a 3-5 days. It is very soft and natural. There is a tendency for this to become reabsorbed and the result seems to diminish or disappear after about 6-12 months. Gortex This is related to the same material that keeps you dry in a rainstorm. Gortex is desirable because it is a biocompatible material that passes easily through tissue. It comes in sheets or strands. It has been used successfully as a human implant in over 5 million implantations without any allergic reactions. Although commonly used for blood vessel bypasses, it has been approved for tissue augmentation procedures and used in this way since about 1988. There is a slight potential for infection and when this occurs, the material can be easily removed usually with no untoward side effects. It is soft and pliable and the results are permanent. Placement is extremely technique sensitive and if placed less than perfectly, can show or distort especially when smiling broadly. It is much like Alloderm in terms of the incisions and anesthesia. It can be easily surgically "fine-tuned" by adding or removing strands as needed. Dermis-Fat Grafts It has been well known and performed from the 1950s that excising fat from the body with a partial thickness of the skin still attached improves the survival of the fat when implanted elsewhere. This dermis-fat graft procedure is popular for lip enhancement. It requires an incision somewhere on your body - usually in the groin area -to take out a wedge of skin with fat still connected to it. The partial serves to bring in the body's own blood supply to ensure the fat graft's survival. The incisions and the stitches and minimal pain are similar to the procedures described above. The swelling is significant so patients need to plan about a week out of work. Disfavor with this technique centers around the unpredictability of the partial skin attached to the fat. Although the enlargement is good and predictable, the partial skin with its collagen can scar and contract and occasionally distort the mouth and smile. If this happens, your doctor will have to perform a second operation to remove the graft and this can be difficult. |
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