Lip Enhancement

Plastic surgeons have been enhancing lips for decades, but more and more people are considering lip enhancement.  Fuller lips, younger lips, less grumpy lips, and improved smiles are the goals.

Non-invasive:   Rejuvenation of your lips can be simple and temporary using cosmetics.  There are new chemical/mechanical formulas that irritate the skin of your lips to enhance the color or fullness.  Lip-liner can make your lips seem bigger and keep your lipstick from running, and many of the newer lipsticks will not run once they are applied.  Tattooing is also being performed to permanently color lips.  It is called permanent makeup, but often will fade some over time.  The "permanent makeup" is done by a specially trained technician using sterile technique, and is very technician dependent.  Like any procedures, there can be some downsides (misplaced color, running of the color, scarring of the lips, effect of the iron pigment in MRI's, etc.).

You must not forget the teeth under the lips.  They support the lips and contribute to your appearance.  Many times adjusting the teeth, modifying dentures or bridges or enhancing your teeth will enhance your lips and mouth.

Invasive techniques for enhancing lips range from "fillers" injected directly into the lips to laser surgery that will resurface your skin and eliminate wrinkles.  The skin of the lips can be removed or rearranged surgically to remodel the lip contour.  Fat, or dermis fat, can be grafted or transplanted to your lips to fill them out or reshape them.

Fillers are used to fill wrinkles, sharpen the edges and make the lips fuller.  There are temporary fillers and permanent fillers.  Temporary fillers range from the old workhorse of bovine collagen (collagen derived from cows, rarely used now) to the newest temporary fillers approved by the FDA made from hyaluronic acid.  In between but less commonly used now are human collagen derived products.  Human derived tissue fillers and hyaluronic acid based fillers do not need skin testing prior to use.

Hyaluronic acid, Restylane, Juvederm and related products are among the non-animal based dermal fillers.  Hyaluronic acid itself is already present in the human body and is compatible with our tissues.  There have been other hyaluronic acid fillers, but they were generally made of animal products.  One of the advantages of using the non-animal based fillers over the animal/human based fillers is the elimination of animal/human based disease transmission or possible allergic reactions.  Another advantage of temporary or biodegradable fillers is that they will eventually resorb.  I have been using Restylane for several years and find it lasts much longer than collagen.  Juvederm (also hyaluronic acid, but with more chemical cross links) is available and theoretically lasts a little longer, but it is more expensive for the same volume.  These can be painful at injection and usually need some type of anesthesia, either a topical anesthetic (or skin numbing cream) or an injection of a local anesthetic.

Permanent or semi-permanent fillers can also be used to enhance your lips.  They have a disadvantage in that they have small particles that could migrate from the site of injection.  They may cause a thick scar at the site of injection or you may experience a severe ongoing inflammatory reaction, these can be immediate or delayed by years.  These granulomas happen frequently.  I am reluctant to inject these more permanent substances into the very soft flexible tissue of the lip.  It is very difficult to surgically remove substance from your lip and have it still look good.  The longer the substance is designed to last, the more likely that sometime over your lifetime you could have a reaction to it that might stiffen your lip.  I feel that these fillers may be more appropriate for harder tissue agumentation.  Anytime you elect to inject permanent fillers in your lips make sure you understand the long term risks involved.  Sculptra is a new long term tissue filler but is not recommended for use in the lips and I will not inject it into the lips.

Autologous fillers:  My perferred lip filler is fat.  In fat grafting we remove fat from somewhere on your body using a liposuction syringe (typically we have fat deposits somewhere, often very easily accessible) and reinject it into the lips.  The biggest advantage to fat injection is that it is your own tissue and there is no danger of rejection or disease transmission.  The other advantage is that if the fat graft survives, it will survive your lifetime.  It will retain a memory of its original identity.  As you age your lips become thinner and your native lip fat will fade.  The transplanted fat, if it comes from an area such as your stomach or thighs, will remain in place.  Fat transplantation has come a long way and is generally more successful than it was in the past.  There are newer techniques of fat graft preparation and injection that seem to improve fat graft survival.  However, just like any graft (a skin graft for instance) the fat does not always survive the transplantation.  Immediately after the grafting you will have marked swelling as the tissue is growing new blood vessels.  It will be surprising the amount of swelling you could have after fat grafting.  You need to be prepared for the recovery time.  It will be about two to three weeks before the swelling recedes significantly and several months before we know how much fat actually survived.

Another autologous option for augmentation is a dermal-fat graft. It can be placed directly in your lips.  Skin and a small amount of fat is removed from elsewhere on your body and is prepared and threaded through your lip to make it fuller.  You would have a donor site scar where the skin and fat came from.  The surgery is more involved for placing the dermis/fat graft than a fat graft alone.  It also will not be "rejected", but it also causes significant swelling.  The recovery may be longer.  With the new onset of better fat-graft only preparation techniques, this has fallen somewhat out of favor, though it is still a good technique.

Direct surgical excisions and rearrangements of tissue:  There are also other surgical techniques to improve your lips.  You can remove skin to shorten your lips and make them fuller and younger.  As you age you lose volume and projection of your lips.  Your upper lip becomes longer and flatter.  To restore the youthful appearance of the upper lip we remove a small amount of skin leaving a discrete scar under your nose.  A small amount of your upper teeth showing will give a subtle youthful appearance.  Tissue can also be rearranged inside of your lip to make your lip look fuller.

Many people feel that they have a sad or grumpy expression because the corners of their mouth are slightly down-turned.  This is due to heredity and has little to do with your mood.  Unfortunately this can influence how others see you.  Skin can be removed and rearranged at the sides of your mouth to upturn the corners of your lips.  It does leave a scar at the sides of your lips, but you are trading a "grumpy" expression that people can see from across the room for a scar that someone might see from eight inches.  Wearing lipstick will help camouflage this.

Laser skin resurfacing, dermabrasion or deep chemical peels can be used to eliminate or reduce wrinkles around the mouth.  It is very successful in diminishing vertical lines around your mouth as well as reducing the creases at your cheek and lip fold.  The CO2 laser carefully removes the outer layer of skin and shrinks the next layer effetively tightening the skin.  Dermabrasion sands off the outer layer of skin, and often will soften or eliminate fine lines.  Both the CO2 laser and dermabrasion involves at least a week long recovery period.  The postoperative redness associated with skin resurfacing can be easily camouflaged with makeup in about ten days.  There are other lasers and treatments that can be used for resurfacing the lips that heal faster, but they do not penetrate as deep and they get less resolution of the wrinkles.  Chemical peels help with the wrinkles, but they do not penetrate as deep and they get less resolution of the wrinkles.  Chemical peels help with the wrinkles, but the ones that eliminate the wrinkles the best also will make the skin lighter in color and take much longer to heal.

Surgical techniques, resurfacing and fillers can be performed alone or simultaneously.  They may complement each other, enhancing different parts of the lips.  They may also be performed at the same time other procedures are being performed such as facelifts and eyelid lifts.  If you want to rejuvenate your lips, do your research, choose your surgeon carefully, and enjoy you new lips.