Introduction

Full red lips are one of the hallmarks of youth and beauty in woman. Conversely narrowing and thinning of the lips is a feature of the aging face. The perceived sensuality associated with fuller lips has no doubt been propagated by the appearance of popular sex symbols such as Marilyn Monroe and Brigitte Bardot(Paris lips). Initially the procedures for lip enhancement consisted of tattooing for permanent color. Now simply improving the color of the lips and giving the impression of fullness is no longer satisfactory. More commonly, may now desire a more enhanced and physically fuller look to their lips.

Am I suitable?

This will assessed at your consultation. During this time Dr. Loeb will discuss your goals for surgery. Your lips will be examined and evaluated in relation to the rest of your face. After discussion, a treatment option will be based on your goals and concern as well as your anatomy and lifestyle.

You will also be asked about your medical history, drug allergies, and check for conditions that could cause problems, such as active or dormant skin infections or non-healed sores from injuries. Collagen injections are generally off limits for pregnant women, individuals who are allergic to beef or bovine products, patients who suffer from autoimmune diseases and those who are allergic to local anesthetics.

What are the options?

There are effectively three kinds of lip enhancement procedures:

• Injection(Restylane, Silicone)

• Surgical insertion of implants(Softform)

• Surgical advancement of your own tissue, V-Y advancement.

Injections(Restylane / Silicone)

These are probably the simplest to perform and can be done in a simple office visit.

Restylane is a non-animal stabilized hyaluronic acid (NASHA). It consists of complex sugar chains, which have been stabilized for longer lasting effect in the skin. The manufacturing process of Restylane is similar to the production of insulin or antibiotics. When combined with the body's hyaluronic acid, it creates volume for the treatment of lips, as well as other lines or wrinkles. It requires no pre-testing. The effect is temporary. It is particularly useful to see if you like a bigger lip before you do a permanent treatment.

Surgical insertion (Softform)

Softform: The Softform implant is a soft, hollow, tubular ePTFE(expanded polytetraflurethylene-a Gortex derivative) implant that offers a permanent, yet reversible, lip enhancement. It hollow configuration was designed to promote your own tissue in growth into the central lumen of the implant to provide stability. It is currently available in two outer dimension- 2.4mms and 3.2mms, with an approximate length of 7cms. Depending on the size chosen it is excellent for either defining or highlighting the upper edge of the lip vermilion (where the red color of the lip meets the normal pigmented skin) or to add more bulk overall to the lip.

How long has Softform been used, and is it safe? Softform was developed about years ago. The material however which it is made of i.e. PTFE has been used in vascular grafting for more than 20 years, and in more than 3.5 million people. It has also been used for hernia repair, abdominal wall reinforcement, and facial applications, showing high chemical stability and low infection and extrusion rates. So far there have never been any reported allergic reactions to ePTFE.

What are the advantages? As Softform is chemically stable and not metabolized by the body its effect is considered permanent. Additionally, should the Softform not be desired after any given length of time, then this could be removed. As Softform is a synthetic material it is commercially available and therefore eliminates the need to take donor fat or dermis from another part of your body, thereby eliminating the need for further scarring.

What are the disadvantages? Although there is a softening of the treated area over time, patients will likely be able to feel the implants or even a ridge after insertion. Occasionally a "bow stringing" appearance in the skin overlying the implant may be seen extremes of smiling. Due to the synthetic nature of the Softform implant, there have been rare reports of extrusion of the implant over time.

The procedure: Softform is usually inserted as a day-case/outpatient basis under local anesthesia. A small incision is made in each corner of the mouth and the Softform is threaded under the skin of the lips by means of its own closed delivery system. Following insertion a small suture is used to close the incision and some antibiotic ointment is applied over this until the incisions are healed. A short course of antibiotics is then prescribed.

Postoperatively: Treatment results are visible immediately, although there will be some associated swelling and bruising. Some patients may experience a sensation of tightness at the implantation site. The swelling and bruising will have subsided by day 7-10. Although you may always be able to feel the implant under your skin, softening of the implant is anticipated over time.

What are the risks?

As with any operation, risks such as bleeding and injection can occur. People who are prone to developing cold sores may develop an exacerbation following this type of surgery. If this were to happen then you would be given tablets and ointments to treat the cold sores which should not alter the overall results.

There may also be slight asymmetries of the lips, scarring, firmness of the graft, and changes in sensation (temporary).

Tissue Advancement (V-Y Advancement)

Tissue can be moved from inside the lip and advanced to the border adding bulk to the red lip. This requires incisions and sutures. The surgery is done with local anesthesia and takes about 45 minutes per lip. The advantages are permanence with your own tissue. The disadvantages are swelling for about a month, sometimes-permanent numbness and a 10% revision rate for small asymmetries.

Summary