Lip augmentation

Lip enhancement is a type of cosmetic surgery that aims to improve the appearance of the lips by increasing their fullness through enlargement.

History

Chittagong, Bangladesh – Medical staff from Operation Smile and the Military Treatment Facility (MTF) aboard the Military Sealift Command (MSC) hospital ship USNS Mercy (T-AH-19), perform a cleft lip surgery during the ship's visit to provide humanitarian and civic assistance to the people of Bangladesh

Full lips with an accentuated border have often been associated with beauty and youth. It has been suggested that this is because the lips occupy both sides of the face and, with the smile, constitute a major focal point of overall facial beauty. Tribal peoples worldwide have introduced various materials into and through the upper and lower lips of both genders to enhance beauty. Unfortunately, one of the effects of human aging is atrophy of facial fat including the lips. In most cultures, this translates as no longer attractive, youthful nor desirable. The procedure to enlarge lips can also reduce the fine lines and wrinkles above the top lip, flaws often referred to as "smoker's lines."

Around 1900, surgeons tried injecting paraffin into the lips without success. Liquid silicone was used for lip enhancement, starting in the early 1960s but was abandoned thirty years later due to general—and later, unfounded—fears about the effects of silicone on general health.

About 1980, injectable bovine collagen was introduced to the cosmetic surgery market and became the standard against which other injectable fillers were measured. However, that collagen does not last very long and requires an allergy test, causing the patient to wait at least three weeks before another appointment, after which more waiting is required to see cosmetic results.

Currently, fillers containing hyaluronic acid like Restylane and Juvederm have captured the attention of consumers and physicians in Europe, North America, South America and Australia.

Materials and techniques

In the late 1990s, with the huge popularity of surgical rejuvenation and concomitant increase of cosmetic surgery procedures worldwide, more substances, along with biocompatible materials commonly used in other medical applications for years, became available to surgeons for use in augmenting thinning or misshapen lips into more plump and attractive features.

Some of the first widely used lip augmentation substances were:

• Autologen, an injectable dermal material made from the patient's own skin. No risk of allergy exists but the results are very temporary because the body quickly absorbs the material.
• Collagen requires an allergy test because the material is extracted from bovine hides. It lasts anywhere from four weeks to three months because it is also absorbed into the body. However, the allergy test must be observed for four weeks.
• Dermalogen is taken from the patient's skin—and through a laboratory process—made into a high concentration collagen that can be injected into the lips. Some studies indicate it lasts somewhat longer than collagen.
• Alloderm is donor tissue taken from cadavers and then denatured, purified and treated to remove viable cells that could pass along disease. Under a local anesthesia, Alloderm is placed into the mucosa, or body, of the lips in small rolls to make them larger. Alloderm can also be placed into the vermillion, the pink area of the lip, to provide definition and a sharper border.
• Radiance, a synthetic, laboratory produced solution containing calcium hydroxylapatite (bone) suspended in a gel that has been safely used in medicine for years. Some studies indicate Radiance can last between three and five years. One researcher (Tzikas) found in a study of Radiance on 90 patients that 59 percent felt when injected, moderate to severe pain which disappeared two to five minutes later. But the substance produced results for an average of two years with a few patients reporting the plumping effects being sustained as long as three to five years. Of the 90 patients, four required surgical intervention due to nodules in the lips.
• Gore-Tex implants. In medical uses, Gore-Tex is known as EPTFE, or expanded polytetrafluoroethylene and, commercially as Advanta, UltraSoft, and SoftForm. The EPTFE is delivered to surgeons in strips that are 1/16 inch (2.4mm) and 3/16 (3.4 mm) diameter tubes.

Current popular procedures

Since 2000, more products and techniques have been developed to make lip augmentation more effective and patient friendly. The relative ease of many injections is due to surgeons using tiny 30 and 31 gauge (about as thick as a dozen human hairs) needles that are used to inject the very sensitive lips. Nonetheless, topical anesthesias are often used for lip enhancement procedures.

Some of these new techniques and substances include.

• Fat transfer. Surgeons harvest through liposuction or excision the patient's fat from places on the body where it can be spared and either injected or surgically placed into the lips. Surgical applications usually require general anesthesia.
• Restylane, a non-animal, clear gel that is reported to be very close to the hyaluronic acid found naturally in the body. According to the American Society of Plastic Surgeons, there were 778,000 cases of Restylane injection in 2006, the most recent year for which statistics are available. The substance usually lasts six months and, sometimes, longer. While Juvederm is extremely chemically close to Restylane; many surgeons report the former is slightly smoother to inject.
• Artecoll. Both Artecoll and ArteFill are not used to inject the body of the lips because the substance is heavy and would show as white through the thin skin of the lips. Additionally, both products contain tiny microspheres known as PMMA (polymethylmethacrylate) which remain in the face permanently. In cases where Artecoll has been used around the edges of the lips to remove fine lines and wrinkles, some patients have reported annoying nodules or small lumps. In a few cases, surgery was required to remove the Artecoll.

Risks and side effects

Most patients are satisfied with their lip augmentation procedure and would undergo the treatment again. Several studies have found fat grafting of the lip to be one of the best methods of maintaining a semi-permanent fuller and softer lip. When the lips are overfilled, the results can be comic, often supplying fodder to tabloid newspapers and offbeat websites. This look is sometimes mockingly called a 'trout pout'. Overaggressive injections can lead to lumpiness while too little can result in ridges.

Common reactions can range from redness, swelling or itching at the injection site(s). Other possible complications include bleeding, uneven lips, movement of the implants or extrusion, when an implant breaks through the outermost surface of the skin. The usual, expected swelling and bruising can last from several days to a week.

Some patients are allergic to the common local anesthetics like lidocaine and probably should not consider lip injections. A few others react badly to the skin test patients must take before receiving collagen, again, because the substance contains animal byproducts. Other patients who should forego procedures to the lip include those who have active skin conditions like cold sores, blood clotting problems, infections, scarring of the lips or certain diseases like diabetes or lupus that cause slower healing. Patients with facial nerve disorders, severe hypertension or recurrent herpes simplex lesions should also eschew lip augmentation. As in all surgeries, smokers complicate completion of their procedure as well as the speed of healing.

Fat transfer can last longer than other injected materials but can have lumping or scarring effects. The length of time a fat transfer may last in the lips is often determined by how much the area moves and how close it is to a major blood supply. In addition, the donor fat must be harvested from another area of the patient's body which leaves another—albeit tiny—surgical wound. However, donor fat harvesting techniques have become extremely well refined.

Gore-tex, despite its impressive rates of success in lip augmentation and other procedures, is nonetheless a foreign body which bears a slight risk of becoming infected or rejected.

Discussion

Cosmetic surgery providers often advise their patients that many options now exist for improving the appearance of the lips. Most practitioners also admit that successful lip augmentation is highly dependent on the skill of the provider, with that skill stemming from many years of experience injecting the lips of many types of patients. Moreover, the surgeon must master the various injection techniques. With many injectables, the benefit to the patient is an immediate return to normal, usual activities. A few surgeons offer a procedure known as surgical flap augmentations in which small sections of skin near the lips or inside the mouth are excised and added to the lips. But the technique does not add volume and achieves only a slight outward protrusion of the lips.

See also

• Oral and maxillofacial surgery
• Otolaryngology
• Plastic surgery
• Lip lift