Article by Dr. Kimberley Goh, Lip Enhancement

Lip Enhancement

Plastic surgeons have been enhancing lips for decades, but today 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 makes your lips seem bigger and keeps your lipstick from running, and many of the newer lipsticks will not run once they are applied. Tattooing, also performed to permanently color lips, is called permanent makeup, but it often fades over time. "Permanent makeup" is done by a specially trained technician using sterile technique, and is very technician-dependent. Like any procedures, there may be downsides (misplaced color, running of color, scarring of the lips, effect of the iron pigment in MRIs, etc.)

Don't 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 enhances your lips and mouth.

Invasive techniques for enhancing lips range from "fillers" injected directly into the lips to laser surgery that resurfaces your skin and eliminates 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, and can be temporary or permanent. 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. Skin testing is not necessary prior to use of human derived tissue fillers and hyaluronic acid based fillers.

Hyaluronic acid, Restylane®, JUVÉDERM® 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 advantage of using non-animal based fillers over 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 eventually resorb. I have been using Restylane® for several years and find it lasts much longer than collagen. JUVÉDERM® (also hyaluronic acid, but with more chemical cross links) is available and theoretically lasts a little longer, but is more expensive for the same volume. These can be painful at injection and usually need some type of anesthesia, either a topical anesthetic (skin numbing cream) or an injection of a local anesthetic.

Permanent or semi-permanent fillers can also enhance your lips. The disadvantage is 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. The reactions 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 extremely 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 it is that at some point 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 augmentation. Anytime you elect to inject permanent fillers in your lips, be 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 preferred 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. Another advantage is that if the fat graft survives, it survives your lifetime. It retains a memory of its original identity. As you age your lips become thinner and your native lip fat fades. The transplanted fat (if it comes from an area such as your stomach or thighs) remains 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 may be surprising how much swelling you might have after fat grafting. You must be prepared for the recovery time. It takes 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, prepared and threaded through your lip to make it fuller. You will 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 will not be "rejected" but it 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 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 discreet scar under your nose. A small amount of your upper teeth showing gives you 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 helps camouflage this.

Laser skin resurfacing, dermabrasion or deep chemical peels can 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, effectively tightening the skin. Dermabrasion sands off the outer layer of skin, and often softens or eliminates fine lines. Both the CO₂ laser and dermabrasion involve at least a week-long recovery period. The postoperative redness associated with skin resurfacing can easily be camouflaged with makeup in about ten days. There are other lasers and treatments that heal faster that can be used for resurfacing the lips, but they do not penetrate as deeply and there is less resolution of wrinkles. Some chemical peels help with the wrinkles, but they also do not penetrate as deeply and wrinkles are less resolved. Chemical peels that eliminate the wrinkles the best also make the skin lighter in color and take much longer to heal.

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