1. What are some of the fillers that can be used to plump up my lips?
There are a bewildering array of fillers on the market that have been used for lip augmentation. They basically fall into 8 categories.
Collagen-based products (Zyplast™, Zyderm™, Cosmoplast™, Isolagen™, etc.) last anywhere from 6 weeks to 3 months. They produce nice results, but they have been essentially supplanted by the Hyaluronic acid derivatives (HAD), which are sugars naturally found in the body. This is because HAD's last longer, between 3-6 months . They are more painful to inject than collagen, but a new product, Puragel® (coming to the US soon) will help tackle that problem since it is the first HAD to come premixed with a numbing agent. HAD's available in the US include Restylane™, Captique™and Hyalform®. Both collagen products and HAD's can produce beautiful enhancements to lip form and volume.
Radiesse™ is a calcium hydroxyapatite derived product (a substance naturally found in the human body). It lasts between 1-3 years and is great as generalized facial filler except in the lips (where it can result in uneven accumulations). Likewise, silicone-based products can result in unsightly problems in the lips that may appear years after the original injections were performed. Silicone does offer the advantage of being a permanent filler, however.
Polyacrylamide gels (PAG) such as Bio-Alcamid® and Aquamid® represent the latest in filler technology and, despite the fact that they are available in Europe and beyond, are not yet FDA approved for US usage. PAG's possess distinct advantages over other currently available fillers. They not only produce very natural results, but are permanent, safe and removable. I feel that the future of lip augmentation will align itself along these types of injectables. Polyvinyl alcohol based gels (Bioinblue®) provide another alternative for lip voluming. These are long-lasting and, again, produce natural results. However, they are not yet available in the US.
Autologous fat (taken from your own body) is currently my preferred substance to permanently add volume to the lips in the USA. It is soft, natural and absolutely safe. However, fat transfer involves a short procedure as opposed to a simple injection and there is associated swelling for a number of weeks postoperatively. This is the price of permanency. I tell my patients that they will look overdone for 2-3 weeks after the fat transfer. The 8th "filler" to be mentioned is Soft-Form®, an implantable tube of Gore-Tex™. This technique was briefly popular in the late 90's, early 00's. Results were mixed at best and most of the time the implant was palpable (and it felt hard).
2. Doesn't fat dissolve away? I have heard this from other surgeons and friends.
In the vast majority of cases, absolutely not! In order to get fat to "stay", it must be able to live and it lives by establishing a blood supply with the surrounding tissue it is transplanted in. The surgeon must carefully harvest the fat (usually from the abdomen, medial thighs or knees) with only a hand-held syringe under low suction and not with the high powered suction machines used for liposuction. The fat is then washed, dried and cleaned of any fibrous material that can lower its chance of survival. The fat is subsequently placed into small syringes which are used to transfer the purified tissue into the lips (or other areas) through specialized cannulae. (Cannulae are 1 -1.5 mm diameter tubes similar to a blunt-tipped needle). One must not forget that there is also an art to applying the fat in the correct layers in the lips to maximize effect and longevity. The surgeon must overcorrect the augmentation, anticipating that 40-60% of the transplanted fat will dissolve. Because of this fact, along with postoperative swelling, I advise my patients to plan their recovery schedule accordingly since their lips may look very exaggerated and "duck-like" during this time.
To summarize, fat transfer provides natural, soft and permanent tissue augmentation as long as the surgeon who performs it processes the fat properly and transfers it with delicate respect. Smoking and advancing age can lessen the percentage of fat that survives.
3. I have had my lips plumped up before. Can you put fat in my lips, even though I have something in them now?
Yes you can. Patients can also get additional fat transfers if they underwent a previous one. This is not to imply that the first ones didn't work, only that the patients were happy with the initial results and wanted to further highlight their previously successful lip enhancement.
4. My lips look old! Will fillers make my lip region young and beautiful again?
Not necessarily. As the lips age, they not only turn inwards and get thinner, but they also start to display other signs of aging that fillers alone can't correct. These other signs include a lengthening of the upper lip (the distance from the nose to the red portion of the lip itself), drooping of the lower lip and corners of the mouth. Wrinkles may also develop around the lips. The upper teeth get eclipsed by the drooping upper lip while the converse is true for the lower teeth-they become unveiled as the lower lip sags.
5. Why do you recommend an upper lip lift? What is a corner lip lift?
The upper lip very often increases in length with age. As it does so, the red portion of the lip tends to invert or turn inwards while the upper, forward-facing teeth become hidden by the descending lip. Meanwhile, the corners of the mouth may sag as well as the lower lip (which consequently exposes the lower forward-facing teeth). All of these changes tend to impart not only an aged, but also a sad and grim appearance to the mouth.
An upper lip lift shortens the upper lip, allows more red of the lip to show and exposes more of the upper teeth, all in one small operation. It is performed by removing a precise amount of skin below the nose through an incision in and around the deep grooves of the nose. A corner lip lift elevates the drooping corners of the mouth to a neutral position through basically an imperceptible scar hidden in the corner of the lip. The lower lip is elevated and rolled outwards (with a subtle pout) via a V-Y procedure, an internal tissue rearrangement performed on the inside (teeth-side) of the lower lip.
6. Is the V-Y procedure the same as a FATMA technique?
A V-Y plasty is an internal tissue rearrangement performed on the inside of the mouth corresponding to areas of the outside visible lip that have either turned inwards with aging or are thin and inverted because of one's genetics. The performance of a V-Y essentially rolls out the inverted lip to give it a more sensual, youthful appearance. The FATMA (FAt Transfer and Mucosal Advancement) is the simultaneous performance of strategic V-Y's along with fat transfer in one operative setting. I invented this technique (LINK HERE TO THE PDF DOWNLOAD) in order to provide the most effective solution to inverted and thin lips resulting from either hereditary or aging issues. It provides unparalleled results in terms of achieving a truly permanent, dramatic, natural and soft augmentation to the lips. I have been performing the FATMA technique for over 10 years as of the time of this writing.
7. What are the scars like?
Only upper lip and corner lip lifts involve any sort of potential scars on the face. However,the scars are hidden in natural crevices in and around the nose and the corner of the mouth, respectively. Furthermore, with advances in the aforementioned techniques, scars are rendered practically invisible. If, in the rare case, a small segment of scar is slightly noticeable, I have very effective ways to treat it in the clinic.
8. What can be done for my wrinkles? My lipstick "bleeds"!
The most effective way in dealing with upper lip wrinkles is the Ultrapulse™ CO2 laser. Unfortunately, the recovery period can be bothersome for up to 2 weeks after the procedure, but there is nothing that quite matches up to its safety (in the proper hands) and efficacy. Alternatives are the Fraxel™ laser (great for the rest of the face, less so for lip wrinkles), dermabrasion and Phenol peels. The latter two methods are associated with higher incidences of permanent facial hypopigmentaion (whitening of the skin).
9. What is the recovery period for what you propose?
Everyone heals at different rates, so it is impossible to predict with unerring accuracy how soon bruising and swelling will disappear. It is also important to note that every patient has a different threshold of comfort in returning back to social activities and being seen by others. Despite the fact it can take many months for all vestiges of remaining swelling and associated tightness to disappear after surgery, the average patient is very happy with the aesthetic outcome after only 2-3 weeks.
Fat transfer is generally associated with 10-14 days of "comical" swelling. Most feel comfortable returning to the public eye after 2-3 weeks. FATMA is generally associated with 21 days of "comical" swelling. Most feel comfortable returning to the public eye after 3-4 weeks. About a third feel comfortable in public after 2 weeks. Upper lip lifts alone are generally not associated with too much swelling of the red portion of the lip. However, they do result in a temporary tightness along the junction of the upper lip and nose which can persist for 3-4 months. The patients look good way before this time, but there is a decreased ability to display a "wide open" smile for about the same time period. Isolated V-Y plasties are associated with minimal bruising, but about 3 weeks of mild swelling. Corner lip lifts are very minor procedures indeed, with minimal swelling and bruising. Most patients are absolutely comfortable in public 4-5 days after the surgery (when the stitches are removed).
10. I have had previous lip work done and my lips are now asymmetrical. What can be done?
This can prove to be a rather difficult problem to correct. Often times, more than one surgical session is needed to correct all of the deformities and achieve a near-perfect result. Patients must understand this before embarking on the project. Generally, deformed lips consist of a varied array of bulges, lumps and adjacent depressions that need to be smoothed out. Through incisions made just inside the mouth, a combination of tissue removal and (fat) addition is performed. The surgeon who performs these procedures needs a keen, discerning eye with meticulous attention to detail. Patience on both the patient's and surgeon's part is also critical to success.