- Lip enhancement
Lip enhancement is a type of cosmetic surgery that aims to improve the appearance of the
lipsby increasing their fullness through enlargement.
Full lips with an accentuated border have often been associated with
beautyand youth. It has been suggested that this is because the lips occupy both sides of the faceand, with the smile, constitute a major focal pointof overall facial beauty.Fact|date=June 2007 Tribal peoples worldwide have introduced various materialsinto and through the upper and lower lips of both gendersto enhance beauty. Unfortunately, one of the effects of human aging is atrophyof facial fatincluding the lips. In most cultures, this translatesas no longer attractive, youthful nor desirable. The procedureto enlarge lips can also reduce the fine lines and wrinklesabove the top lip, flaws often referred to as “smoker’s lines.”
surgeonstried injecting paraffininto the lips without success. [Heidingsfeld ML. Histopathology of paraffin prosthesis. J Cutan Dis 1906; 24:513-521] Liquid siliconewas 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. [Duffy D. Injectable liquid silicone: New perspectives. In: Klein ed. Tissue Augmentation in Clinical Practice: Procedures and Techniques. New York Marcel Dekker 1998; 235:267]
About 1980, injectable
bovine collagenwas introduced to the cosmetic surgery market and became the standard against which other injectablefillers were measured. [Klein AW. Implantation technique for injectable collagen. J Am Acad Dermatol 1983;9:224-28] However, that collagen does not last very long and requires an allergytest, causing the patientto wait at least three weeksbefore another appointment, after which more waiting is required to see cosmetic results.
Currently, fillers containing hyaluronic acid like
Restylaneand Juvedermhave captured the attention of consumersand physiciansin Europe, North America, South Americaand 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
biocompatiblematerials commonly used in other medical applications for years, became available to surgeonsfor 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
dermalmaterial made from the patient’s own skin. No risk of allergy exists but the results are very temporarybecause the body quickly absorbsthe material.
Collagenrequires an allergy test because the material is extracted from bovine hides. It lasts anywhere from four weeks to three monthsbecause 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
laboratoryprocess -- 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
cadaversand 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 rollsto 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 gelthat 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 painwhich disappeared two to five minuteslater. 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 interventiondue to nodulesin the lips. [Tzikas,T. L. Evaluation of the Radiance FN Soft Tissue Filler for Facial Soft Tissue Augmentation. Arch Facial Plast Surg. 2004; 6:234-239]
Gore-Teximplants. 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 stripsthat are 1/16 inch (2.4mm) and 3/16 (3.4 mm) diameter tubes. [Fezza JP.Advanta implants, Facial Plast Surgy, 2004 May;20(2):185-9]
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)
needlesthat are used to inject the very sensitive lips. Nonetheless, topicalanesthesias are often used for lip enhancement procedures.
Some of these new techniques and substances include.
Fat transfer. Surgeons harvestthrough liposuctionor excisionthe 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 acidfound 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. [ [www.plasticsurgery.org/media/Press_Kits/Procedural-Statistics-Press-Kit-Index.cfm 2006 Procedural Statistics Press Kit ] ] The substance usually lasts six months and, sometimes, longer. While Juvedermis 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 microspheresknown 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. [Blanchard, M. Filler material may cause nodules, lumps in lips. Cosmetic Surgery Times, 15 June, Issue, 2002]
Risks and side effects
Most patients are satisfied with their lip augmentation procedure and would undergo the
treatmentagain. 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. [Niechajev, Igor. Lip enhancement: surgical Alternatives and Histologic Aspects. Plastic & Reconstructive Surgery. 105(3):1173-1183, March 2000] When the lips are overfilled, the results can be comic, often supplying fodderto tabloidnewspapers and offbeatwebsites. Overaggressive injections can lead to lumpiness while too little can result in ridges.
reactionscan range from redness, swelling or itchingat the injection site(s.) Other possible complications include bleeding, uneven lips, movementof the implants or extrusion, when an implantbreaks through the outermost surfaceof the skin. The usual, expected swellingand bruisingcan last from several days to a week.
Some patients are allergic to the common local anesthetics like
lidocaineand 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 animalbyproducts. Other patients who should forego procedures to the lip include those who have active skin conditions like cold sores, blood clottingproblems, infections, scarring of the lips or certain diseases like diabetesor lupusthat cause slower healing. Patients with facial nervedisorders, severe hypertensionor recurrent herpes simplex lesionsshould also eschew lip augmentation. As in all surgeries, smokerscomplicate 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. [Coleman, SR. Long term survival for fat transplants: controlled demonstration. Aesthetic Plastic Surgery 2996; 19:421-425]
Gore-tex, despite its impressive rates of success in lip augmentation and other procedures, is nonetheless a foreign body which bears a slight
riskof becoming infected or rejected.
Cosmetic surgery providers often
advisetheir patients that many options now exist for improving the appearanceof the lips. Most practitioners also admit that successful lip augmentation is highly dependent on the skillof 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 technique. 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 volumeand achieves only a slight outward protrusion of the lips. [Giovanie Botti, Rene Villedieu. Augmentation cheilopolasty by using mucomuscular flaps. Aesthetic Plastic Surgery; Vol 19 (1) 1995, 69-74]
* Cosmetic surgery
* Maxillofacial surgery
* [http://www.cosmeticsurgery.com/articles/archive/an~232/ Before and after pictures of reasonable lip enhancements]
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