Types of Lip Augmentations

Lip augmentation procedures fall into two main categories:

• Lip augmentation with a dermal filler can either be a temporary or permanent filler
• The second category is lip implants and the main choices are the ones that use a dermal matrix called AlloDerm or the silastic soft plastic implants called PermaLip.

DERMAL FILLER ADVANTAGES

Most people who are first time patients look at their lips and wish they were a little fuller. However, there are some patients who have an upper lip with a lot of asymmetry where the right side is thin, the center is indented and the other side of the lip looks pretty good. Those patients are not candidates for any type of lip implant.

Lip implants go from one side of the lip across the center to the other side and augment the entire lip. There is no reliable method of using lip implants to try and plump one area up with part of an implant and then put a whole lip implant over it. People who have asymmetric lips really need to use a dermal filler that can be placed wherever they want. The advantage of dermal filler is that the results can really be tailored and customized to match the needs of younger patients who have never had a procedure performed on their lips before and who are looking for a lip augmentation.

If someone is not sure what their best option is, they should start out with dermal filler administered by an experienced injector. An experienced injector is aware of certain necessary beauty proportions for the lips. Violating the beauty proportions can make the lips look odd or lead to lips that have been commonly named “duck lips”.

If a patient is looking for a detailed difference on a specific small part, they should look into a dermal filler. If they want an overall fuller lip, they should also look into a dermal filler.  If they are seeking a semi-permanent or a permanent solution for fuller lips, they should consider a lip implant.

DIFFERENCES IN DERMAL FILLERS

There are a variety of fillers including Restylane, Juvederm, and Restylane Silk. In lay people's terms, these are thin fillers that are meant to be injected into areas of the body that have fine lines, shallow or deep folds.  . That means patients should only use dermal fillers like Restylane, Juvederm, Belotero, and Restylane Silk. They should not use any of the thicker dermal fillers that are meant to be injected into the fatty tissue layers of the face such as Voluma, Radiesse or Restylane Lift. The thicker fillers have no business being injected into the lips because they do not have a fatty tissue layer.  Injecting these thicker HA fillers, into the lips, can cause unwanted side effects like lumps and bumps.

Permanent fillers should not be injected anywhere in the face and certainly not in the lip. They are extremely difficult to deal with if they migrate, move or shift position. Some of them like Bio-Alcamid can create ongoing serious facial infections, leaving a biofilm that cannot be removed.

FAT INJECTIONS

Patients can have fat injections to create really big lips. Fat injections can move and dissolve unevenly creating many problems.   The thing about off shelf fillers is having a cc of Restylane or Juvederm is a stable amount of one cc. A patient can have it put in and get a really good idea of the amount of augmentation they are going to get.  The same can not be said of injecting fat anywhere in the face and the lips are no exception.  Fat was living, stable tissue in the body but removing it fractures the fat cells. Fat needs a blood supply in and out to live. Taking fat out of the body disrupts the blood supply making it dead tissue. So when people put it in their lips, they are putting a substance that they cannot control.

LIMITATIONS

The main limitation for dermal fillers is that they are temporary. Typically, using any of the dermal fillers means that the patient will get augmentation in the lips that is going to last somewhere between six and nine months.  To maintain the lip augmentation, the patient will have to get fillers again.

PROS OF DERMAL FILLERS AND LIP IMPLANTS

One of the main pros of dermal fillers is that they can be customized. They can be used in almost everyone's lip and are quick, safe, and highly effective. The downside is that the results are temporary and only last six to nine months.

For the lip implants, AlloDerm lasts seven years while PermaLip lasts forever. Those are the longer lasting implants that give a patient the maximum amount of volume.

Patients with lip implants can always add a dermal filler, at any time in the future, for added volume. That is the benefit of the lip implant. The downside is it is a surgical procedure which means it has a higher cost. There will be more bruising and swelling with a lip implant than with dermal filler.

COMPLICATIONS

The number one complication for lip augmentation is the lack of aesthetic judgement of the patient and/or the provider. Especially in lip augmentation, there are a lot of lips that look odd. They are swollen, puffy, too large and “ducky looking”.

The lips can be characterized as small, medium, or full and they can also be characterized by the proportion of the upper lip to the lower lip. The proper aesthetic proportion should be 75%. In other words, the upper lip should be no more than 75% the size of the lower lip which creates a central pout to the mouth. This proportion gives a soft, naturally attractive, pleasing look to the lips.

If the upper lip or the lower lip is too thin compared to the other, it looks umbalanced. If the upper lip is the same size as the lower lip, the mouth looks wrong. The minute that the upper lip is too big, it is a duck lip by definition. If the practitioner does not understand the balance, the chance of getting an incorrect proportion is very high.

It is important to go to a doctor who knows the right look for the patient as well as how to accomplish the look that the patient wants to achieve.

YOUNGER PATIENT PREFERENCE

In general, younger patients are drawn more to fillers and older patients are drawn more to lip implants. The younger people are getting dermal fillers to plump up their lips. It is quick, easy, very effective while costing less money.

It should come as no surprise however, that continual use of dermal fillers to the lips will cost way more, over the course of many years, than lip augmentation using a lip implant.

RECOVERY

A patient who gets dermal fillers should avoid aspirin, vitamin C, vitamin E, fish oil, and homeopathic medication for a week before the injections because it thins the blood making them more likely to bruise. If a patient does this, the downside should be nothing more than a slightly puffy lip for a day or two. If the doctor knows what they are doing and the patient does not have a tendency to bruise and bleed, the recovery time for dermal filler is not very long.

The recovery time for a lip implant is going to be around a week depending on what lip implant is used. PermaLip has a limited dissection (the silastic implant) so that is going to have a quicker recovery time with less bruising and swelling than AlloDerm. AlloDerm is placed a little bit differently which requires more dissection. Both lip implants can cause a slightly swollen upper lip for about a month but it is very soft and supple when it is done. Implants are not something a person can do today and then go out tomorrow and not have anybody know that the lips look big. It is going to be a week or two to adjust.

RESULTS

All of the results are immediate no matter which procedure is used.

With dermal filler, the patient will have nice full lips. With a lip implant, it takes 15 or 20 minutes to do a lip augmentation and the patient is going to have immediately fuller lips. There will be some swelling from the injections as well.

There could also be some swelling associated with implant placement so there will be more volume than just the implant alone. Over the next week or two, with ice applied to the mouth and lips, the swelling will go down.

FINAL THOUGHTS

It is important that patients see somebody who knows what they are doing in order to avoid things like a vascular occlusion. The arteries and veins, in the lips, come in from the corners of the mouth towards the midline or the center of the lip. The person injecting needs to be careful that they do not inject the filler too deeply at the corners of the mouth because they can put pressure on the vein and cause some issues with the tissue at the center of the lip. This happens rarely and the vast majority of lip augmentation with dermal fillers are incredibly safe, easy and highly effective. Be sure to visit a doctor who has been doing this for a long time and knows how to do lip augmentations well.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Francis Palmer, MD in Beverly Hills, CA