Lip augmentation is one of the most popular cosmetic surgery procedures offered.
As we age, we lose the fullness in our lips that makes them look young and
pouty. Aging causes the lips to become thin and also causes the small wrinkles
seen above the lip border.
Choosing the right injector for lip augmentation can be difficult, if you don’t
know what to look for. Most patients seeking lip augmentation today want to
achieve more fullness and poutiness, but also to appear natural. This is a much
more delicate issue than just pumping filler into the lips. Facial balance
consists of the lips, their maximal natural fullness, and the balance of the
tissues around them. The distance from the lip to the nose is very important.
The balance between the sides of the lips and also the central lip area is very
vermilion border and white roll of the lip should also be
Start by evaluating the physician’s work by reviewing pre/post procedure
photographs of their patients. If you want a natural look, you need to be very
clear in stating your intent that you prefer natural lip definition, not
augmentation to the injector! Make sure that both you and the injector are on
the same page with what you are trying to achieve.
If your natural lips are very thin and you are trying to achieve lips like
Angelina Jolie, then more than likely you will be disappointed. Going into lip
augmentation, you need to realize your own natural lip structure and what volume
level could be given without making your facial features out of balance. There
is actually a maximal amount of volume that can be safely attained given each
patient's own unique lip contours, anatomy and position within the face.
Before undergoing the procedure of
lip augmentation, it is imperative that you are in good general health. If you
suffer from oral herpes, scarring, or certain diseases such as diabetes, lupus,
connective tissues disorders, or blood clotting problems, you need to make sure
you go over this in detail with your physician.
Good candidates for lip
augmentation are those who have realistic expectations of the outcome.
Injections or implants can enhance and improve your natural look, but they're
not designed to create a radical change in your appearance. You want the
procedure to enhance your features, not overpower them. Certain health risks or
conditions such as blood clots, diabetes, or poor circulation can increase your
chance of complications.
Common Lip Problems that
respond well to Lip Augmentation:
Thin or flat lips
Poorly defined lips or Cupid's bow
In cases where the lips are too
large, or asymmetrical, a lip reduction might help.
Lip lifts are used in
patients that have a large top lift and have no tooth show when their lips are
parted. These options are usually permanent as the structure of the lips is
Looking at before and after photos will help you decide what type of look you
are searching for with lip augmentation.
Most physicians will give you a
pre operative information packet; that will tell you what medication you can
take and not take. It is very important that you do everything that your surgeon
is suggesting so that you can have the best outcome from your procedure. There
will be instructions about abstaining from aspirin containing products, alcohol
and some herbal supplements for up to two weeks before your procedure.
Aspirin and aspirin containing
products such as Advil; have a tendency to thin your blood which will inhibit
blood clotting. This can cause some difficulties during and after surgery. As
with every other cosmetic surgery procedure, abstaining from smoking would be
ideal and some surgeons would like to see no smoking for a minimum of two weeks
before the procedure. Smoking inhibits the oxygen needed to
get to the blood cells, which you need for optimal healing.
Your physician might suggest you
to pick up some Arnica Montana, Bromelain or Vitamin A to help with the swelling
and bruising that might occur.
If you are going to have an
invasive procedure such as a lip lift or
lip implants, then your surgeon might
order a complete blood count to be done before the surgery, as they want to be
sure you are good health.
The five areas of the
lips that should be discussed with your physician prior to any lip augmentation
The vermilion border is the most
common area that is enhanced with dermal fillers. The vermilion border is the
junction between the white and red part of the lips. By injecting dermal fillers
in this area, it is possible to define the lips, similar to wearing lip liner.
It gives the lip no more volume, but outlines the border to make it clearer. It
can also help with lines that cross through this area. For those who have
'lipstick bleeding', injecting a dermal filler in the vermilion border can also
help. The lip body can also be injected. This is usually done to enhance pout.
The oral commissures are located in the corners of the mouth, can also be
filled. This area usually increases in size with age due to the effect of
gravity on the cheek skin. Filling this area turns the corners of the lips
upwards creating a more positive and happy appearance.
The philtrum consists of the two lines in the centre of the upper lip that
connects to the nose. By enhancing this double-ridge, it is possible to give the
upper lip more shape and curve, enhancing the sensuality of the lips.
The cupid's bow, or the V shaped area in the centre of the upper lip can also be
enhanced with dermal fillers. This makes the V more pronounced. Done in
conjunction with the philtrum, it can achieve a pleasant overall shape to the
There are well over 25 different types of injectable fillers. These
injectable fillers work by stimulating collagen around the filler, which acts to
plump up the area that is injected. Injectable fillers range from temporary to
permanent. Temporary fillers are products that usually last anywhere from a few
weeks to 9 months; possibly longer depending on the individual, product and
injector. However, there are newer products that may last up to a few years
after injection. They come from animal sources, donated human sources (fat or
tissue), or are completely synthetic.
Some of the risks with lip fillers
are lumpiness, firmness, inflammation and even migration of the material may
occur. The most common permanent injectable fillers today are Artefill
Silikon 1000. The indications of Artefill is for treatment of medium-to-deep
wrinkles, folds and furrows, particularly
nasolabial folds; acne scars, lip
augmentation, etc. An allergy test is required with this product because of the
bovine collagen component of the injection. Artefill is FDA Approved since 2006.
Silikon 1000 is FDA Approved in the treatment for retina detachment however; it
is being used “off-label” for the treatment of lip augmentation, nasolabial
folds, and acne scars.
Depending on the extent of
treatment, injection procedures typically last between fifteen and sixty
minutes. Prior to the start of your procedure, the treatment areas will be
cleansed, usually using an alcohol based cleaner. Unlike collagen injections,
hyaluronic acid injections do not include an anesthetic agent, so if you elect
Perlane and Captique – a local or topical
anesthetic may be used to numb the treatment area during the procedure such as a
dental block or a regional block.
Using a syringe, the dermal filler is injected into the dermis at several points
along the edge of the treatment area. After approximately two to three
injections, the physician will massage the treatment area. The physician will
continue injecting the filler along the length of the wrinkle or fold until
maximum correction has been achieved. If a local anesthesia has not been used,
you may feel some minor stinging from the injections. After the injection, the
volume beneath the skin will increase, restoring a smoother, more youthful
Fat grafting of the lip ("lipo-sculpturing"
or "structural fat grafting") is one of the methods of maintaining a
permanent full and soft lip. Fat grafting is normally very well tolerated;
however there is a lot of down time with the recovery from this procedure. Fat
grafting generally doesn’t last that long in the lips due to the fact that the
lips simply get too much movement in order for the fat to adhere to the area.
Structural fat grafting of the lip
requires harvesting of fat from another site (usually the belly, thighs, or
"love-handles"). The harvest site and treatment sites are anesthetized using a
combination of local anesthetics and nerve blocks. Fat is removed from the donor
site using a specialized harvesting cannula attached to a suction syringe.
fat is processed by simple centrifugation prior to re-injection with fine cannulas. Approximately 1.0 cc of fat is use to rejuvenate the white roll above
the lip and 1.5 to 3 cc of fat is often used to fill the body of the upper lip.
Nearly twice that volume is often used on the body of the lower lip. Injection
techniques place the fat cells within the lip muscle to provide the augmentation
Lip implants create a permanent
yet reversible enhancement of the lips by defining their appearance more. These
implants do not shrink and are never absorbed into the body. They also remain in
place because scar tissue forms on the other end.
Advanta are all made from expanded polytetrafluoroethylene (ePTFE). This
material resembles “foam rubber” more or less and has been used for years in the
body for other type of surgical procedures. These are the only FDA approved
synthetic implants on the market at this time. Complications from having lip
implants include extrusion, infection, less mobility of the lips or the
treatment areas. Also the implants can have the tendency to get hard.
The procedure of lip implant surgery is more invasive than just receiving an
injectable dermal filler. You are first injected with a local anesthetic,
similar to those you might receive at a dentist’s office, for pain. After
numbness takes effect, a total of four incisions are made at each corner of the
mouth and the implant is inserted into the lip through the incisions. The
implant is trimmed, the incision sites are sutured, and the wounds are dressed.
Your physician may use absorbing or non-absorbing suture material and there is
usually minimal bleeding.
Please read here for more
information about Lip Implants:
As with all facial or lip injections
pain relief is a very common question. With the
hyaluronic acid fillers, because
they are delivered through a larger gauge needle, sometimes a sensitive patient
will have to have a nerve block or a dental block.
The dental blocks of course are more
invasive than a topical cream, but are much better for pain relief. The
block is performed by injecting 1 to 2 cc of local anesthetic right next to
where a major nerve group comes out of the bones of your face.
segment supplied by this nerve bundle then "falls asleep" for 1 to 4 hours. If
the block is performed through the mouth using some numbing cream or spray at
the injection site, it can be painless. There are relatively few nerve receptors
inside the mouth, and those are very susceptible to the topical creams.
EMLA Topical Cream is a local anesthetic which works
by blocking the nerves from transmitting painful impulses to the brain. It
numbs the skin to pain from injections (dermal or lip fillers).
EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is
an emulsion in which the mixture of lidocaine and prilocaine is a ratio of 1:1
by weight. It is packaged in 5 gram and 30 gram tubes.
Cream is available by prescription only.
Your physician will either supply you
with a tube or will write a prescription
to pick up at the pharmacy for use
before your dermal filler / lip augmentation
Photo courtesy of AstraZeneca - EMLA Cream
EMLA Cream Indications:
EMLA is indicated
as a topical anesthetic cosmetic procedures for dermal fillers.
normal intact skin for local analgesia and superficial minor surgery as
pre-treatment for infiltration anesthesia.
EMLA Cream should be used the following way:
Wash and dry the
area to be treated. Apply a thick layer of cream to the affected skin -
never rub EMLA into the skin.
EMLA Cream should
not be used on broken or damaged skin.
EMLA Cream in the eyes, nose, or mouth. If by accident it should get in the
eye area, rinse with plenty of water. If swallowed, call your local poison
Wash your hands
after using EMLA Cream.
Apply EMLA Cream
at least 20 minutes before the treatment.
effect will last approximately an hour after the procedure.